Musculoskeletal Pain Disorders Research Articles

Translation, cross-cultural adaptation, and measurement properties of the Arabic version of the fear avoidance components scale

Purpose This study aimed to translate, validate, and cross-culturally adapt the original FACS into the Arabic language. Methods The English version of the FACS was translated and culturally adapted into Arabic following international guidelines. The psychometric properties of the final version of the FACS-Arabic (FACS-A) were tested among 119 patients with different musculoskeletal (MSK) pain disorders. Results The Cronbach’s α for the FACS-A was 0.86. The test-retest reliability, measured with intraclass correlation coefficient, was 0.80. The FACS-A showed positive significant correlations with other psychological patient-reported measures, including the pain catastrophizing scale (PCS) (r = 0.545); p ≤ 0.01), Brief Pain Inventory (BPI)-pain score (r = 0.546; p ≤ 0.01), BPI-pain interference score (r = 0.511; p ≤ 0.01), and Hospital Anxiety and Depression Scale (HADS) (r = 0.451, 0.336, respectively; p ≤ 0.01). Confirmatory factor analysis of the FACS-A confirmed the two-factor structure found in the original English version. Conclusion This study determined the FACS-A to be a reliable and valid tool for the assessment of the fear-avoidance beliefs in Arabic-speaking individuals with MSK pain disorders.

Decision Support for Managing Common Musculoskeletal Pain Disorders: Development of a Case-Based Reasoning Application.

Common interventions for musculoskeletal pain disorders either lack evidence to support their use or have small to modest or short-term effects. Given the heterogeneity of patients with musculoskeletal pain disorders, treatment guidelines and systematic reviews have limited transferability to clinical practice. A problem-solving method in artificial intelligence, case-based reasoning (CBR), where new problems are solved based on experiences from past similar problems, might offer guidance in such situations. This study aims to use CBR to build a decision support system for patients with musculoskeletal pain disorders seeking physiotherapy care. This study describes the development of the CBR system SupportPrim PT and demonstrates its ability to identify similar patients. Data from physiotherapy patients in primary care in Norway were collected to build a case base for SupportPrim PT. We used the local-global principle in CBR to identify similar patients. The global similarity measures are attributes used to identify similar patients and consisted of prognostic attributes. They were weighted in terms of prognostic importance and choice of treatment, where the weighting represents the relevance of the different attributes. For the local similarity measures, the degree of similarity within each attribute was based on minimal clinically important differences and expert knowledge. The SupportPrim PT's ability to identify similar patients was assessed by comparing the similarity scores of all patients in the case base with the scores on an established screening tool (the short form Örebro Musculoskeletal Pain Screening Questionnaire [ÖMSPQ]) and an outcome measure (the Musculoskeletal Health Questionnaire [MSK-HQ]) used in musculoskeletal pain. We also assessed the same in a more extensive case base. The original case base contained 105 patients with musculoskeletal pain (mean age 46, SD 15 years; 77/105, 73.3% women). The SupportPrim PT consisted of 29 weighted attributes with local similarities. When comparing the similarity scores for all patients in the case base, one at a time, with the ÖMSPQ and MSK-HQ, the most similar patients had a mean absolute difference from the query patient of 9.3 (95% CI 8.0-10.6) points on the ÖMSPQ and a mean absolute difference of 5.6 (95% CI 4.6-6.6) points on the MSK-HQ. For both ÖMSPQ and MSK-HQ, the absolute score difference increased as the rank of most similar patients decreased. Patients retrieved from a more extensive case base (N=486) had a higher mean similarity score and were slightly more similar to the query patients in ÖMSPQ and MSK-HQ compared with the original smaller case base. This study describes the development of a CBR system, SupportPrim PT, for musculoskeletal pain in primary care. The SupportPrim PT identified similar patients according to an established screening tool and an outcome measure for patients with musculoskeletal pain.

Efficacy of Osteopathy Mobilization Techniques in Patients with Non - Specific Neck Pain in Musculoskeletal Disorders

Efficacy of Osteopathy Mobilization Techniques in Patients with Non - Specific Neck Pain in Musculoskeletal Disorders

Functional Status in Relation to Common Geriatric Syndromes and Sociodemographic Variables - A Step Forward Towards Healthy Aging.

Geriatric syndromes (GS) are prevalent in the older population, with an impact on morbidity and disability. This study aimed to investigate the prevalence of functional dependence and ten GS in community older adults and to examine the different associations between these syndromes and sociodemographic variables and their impact on functional dependence. A cross-sectional study of 342 outpatients seen at the geriatric clinic in the period 2015-2023. The mean age was 75±7.4. One-third had functional dependence and 96.2% had at least one GS. The mean number of GS was 3.11±1.74, ranging from 2.56±1.67 in the 60s to 3.55±1.70 in octogenarians. The most common GS found were polypharmacy (79.5%), musculoskeletal pain (49.7%), and Major Neurocognitive Disorder (MND) (32.7%). Polypharmacy was significantly associated with female sex and chronic pain, whereas sensory impairment was associated with male sex. MND, dizziness, and urinary incontinence were the only GS that significantly predicted functional dependence and were typically associated with increasing age. Functional dependence increases as individuals age, paralleled by increases in MND, urinary incontinence, dizziness, sensory impairment, and constipation. Notably, only MND, incontinence, depression, and dizziness were significant predictors of functional dependence. Consequently, it is imperative to screen older adults presenting with these syndromes for early signs of functional decline to optimize their function and avert subsequent dependence, morbidity, and mortality.

The efficacy of heart rate variability biofeedback training on sleep disorders and impact of fibromyalgia: Results of a phase II randomized controlled trial

ObjectiveFibromyalgia syndrome (FMs) is a chronic, musculoskeletal pain disorder characterized by sleep disturbances, fatigue, and cognitive dysfunction. Heart rate variability biofeedback (HRV-BF) aiming to improve self-regulation and strengthen the parasympathetic nervous system has been shown to be effective in several pain syndromes, but its efficacy in FMs has not been adequately investigated. This Phase II trial aimed to assess the feasibility and preliminary measurement of the improvement induced by HRV-BF in FMs. MethodsSixty-four patients with FMs were recruited. Patients were randomly assigned to either the experimental group (EG) or the control group (CG). The EG received 10 HRV-BF training sessions in addition to pharmacological standard therapy. The CG received standard therapies for 10 weeks. The FMs impact on daily life, sleep regularity, sense of coherence, depression symptoms and pain has been assessed as primary outcomes, quality of life as secondary. Result23 (71.9%) of EG patients completed the intervention and 20 (62.5%) of the CG were re-evaluated at time T1. No side effects were reported. It was not found any statistical differences between groups over time in primary and secondary outcomes. ConclusionsThe HRV-BF intervention did not demonstrate efficacy in both primary and secondary outcomes. However, it is quite feasible in terms of drop-out rate and side effects. Further studies with larger sample sizes are needed to determine its actual efficacy.ClinicalTrials.gov with code: NCT04121832

Engineered extracellular vesicle-based gene therapy for the treatment of discogenic back pain

Painful musculoskeletal disorders such as intervertebral disc (IVD) degeneration associated with chronic low back pain (termed “Discogenic back pain”, DBP), are a significant socio-economic burden worldwide and contribute to the growing opioid crisis. Yet there are very few if any successful interventions that can restore the tissue's structure and function while also addressing the symptomatic pain. Here we have developed a novel non-viral gene therapy, using engineered extracellular vesicles (eEVs) to deliver the developmental transcription factor FOXF1 to the degenerated IVD in an in vivo model. Injured IVDs treated with eEVs loaded with FOXF1 demonstrated robust sex-specific reductions in pain behaviors compared to control groups. Furthermore, significant restoration of IVD structure and function in animals treated with FOXF1 eEVs were observed, with significant increases in disc height, tissue hydration, proteoglycan content, and mechanical properties. This is the first study to successfully restore tissue function while modulating pain behaviors in an animal model of DBP using eEV-based non-viral delivery of transcription factor genes. Such a strategy can be readily translated to other painful musculoskeletal disorders.

Toxicity Assessment of a No-Pain Pharmacopuncture Extract Using a Standard Battery of In Vitro Chromosome Aberration Tests.

Genotoxicity is evaluated through a chromosomal aberration test using cultured mammalian cells to determine the toxicity of no-pain pharmacopuncture (NPP), which has recently been used to treat musculoskeletal pain disorders in Korean medical clinical practice. An initial test was performed to determine the dosage range of the NPP, followed by the main test. In this study, NPP doses of 10.0, 5.0, and 2.5%, and negative and positive controls were tested. An in vitro chromosome aberration test was performed using Chinese hamster lung cells under short-term treatment with or without metabolic activation and under continuous treatment without metabolic activation. Compared with the saline negative control group, NPP did not significantly increase the frequency of chromosomal abnormalities in Chinese hamster lung cells, regardless of the presence or absence of metabolic activation. Additionally, the number of cells with structural chromosomal abnormalities was significantly higher in the positive control group than that in the negative control group that received saline. Based on the above results, the chromosomal abnormality-producing effect of NPP was determined to be negative under these test conditions.

Daoyin therapy in chronic neck pain: study protocol for a randomized controlled trial

BackgroundDaoyin therapy (DT), an ancient therapeutic approach with a history spanning thousands of years, has traditionally been employed to address musculoskeletal pain and psychosomatic disorders. However, the application of DT for chronic neck pain (CNP) has received limited attention in the existing literature, and systematic randomized clinical trials (RCTs) in this context remain scarce. This manuscript outlines an RCT protocol designed to investigate whether DT is more effective at alleviating CNP in adult individuals compared to other interventions.MethodsA 12-week RCT was conducted, with participants undergoing randomization into one of three groups: DT, Meditation + Fitness Exercise (M+FE), or a control group. Participants in the DT and M + FE groups attended their respective training classes three times per week for 12 weeks. Participants in the control group were required to attend health education workshops every 2 weeks. Following the 12-week intervention period, all participants underwent follow-up assessments at the 16th week. Outcome measures encompassed the Simplified Chinese Neck Pain and Disability Scale (SC-NPAD) and Visual Analog Scale (VAS) for pain assessment, Static Neck Posture Assessment (SNPA) to evaluate neck and shoulder posture and function, Short Form-36 (SF-36) to assess quality of life, and blood tests measuring 5-Hydroxytryptamine (5-HT), Norepinephrine/Noradrenaline (NE/NA), γ-aminobutyric acid (GABA), Adreno-Cortico-Tropic-Hormone (ACTH), β-Endorphin (β-EP), and Calcitonin-Gene-Related Peptide (CGRP) levels via high-performance liquid chromatography (HPLC), chemiluminescence immunoassay (CLIA), enzyme-linked immunosorbent assay (ELISA), and radioimmunoassay (RIA). Brain activity changes were monitored through MRI scans. Repeated measures analyses of variance (ANOVAs) will be used to evaluate the outcomes at baseline, at the 12th week, and at the 16th week. Generalized Estimating Equation (GEE) models will be applied to analyze changes in outcomes over time and differences between groups.DiscussionThis trial aims to evaluate the efficacy of DT in comparison to other interventions and explore the neuroendocrine mechanisms underlying its effects in adults with CNP. If the intervention and procedures demonstrate feasibility and acceptability, there are plans to conduct a more extensive controlled trial. This could potentially pave the way for the broader application of DT, not only in the context of CNP but also for other chronic diseases.Trial registrationThis trial has been registered with the Chinese Clinical Trial Registry (Registration ID: [ChiCTR2400079571]).

Identification of prevalence of musculoskeletal disorders and various risk factors in dentists

PurposeThe awkward and repetitive movements lead to tissue straining, potentially leading to painful musculoskeletal disorders (MSDs). MSDs in dentists result in work inefficiency and a reduction in work hours. A survey was conducted to assess the prevalence of MSDs amongst the dental population of interest. MethodsCustomized individual detail questionnaires, Standard Nordic Musculoskeletal questionnaires, and Level of Pain estimation using the Likert Scale were used to deduce the various responsible risk factors for the occurrence of MSDs in dentists. Inferential statistical analysis was done to identify the prevalence and severity of the MSDs. The Chi-Square test (95 % confidence interval) was used to identify and compare the association of risk factors involved in MSDs with the occurrence of the Effect of MSDs, the presence of MSDs, and the severity of the MSDs. ResultsThe results of the study deduced that the dentists followed the sedentary work practices. The dentists experienced maximum discomfort in the neck region, which was accompanied by the discomfort experienced in the lower back, hands and wrists, making the upper extremity being more susceptible to the MSDs. Gender risk factors the, the prevalence of MSDs in the dentist's upper back, and the severity of pain in the upper back region showed a significant association level. ConclusionThe wrist posture, the prevalence of MSDs and the severity of pain in the dentists' neck, shoulder and upper back showed a significant association level.

Acceptance and use of a clinical decision support system in musculoskeletal pain disorders – the SupportPrim project

BackgroundWe have developed a clinical decision support system (CDSS) based on methods from artificial intelligence to support physiotherapists and patients in the decision-making process of managing musculoskeletal (MSK) pain disorders in primary care. The CDSS finds the most similar successful patients from the past to give treatment recommendations for a new patient. Using previous similar patients with successful outcomes to advise treatment moves management of MSK pain patients from one-size fits all recommendations to more individually tailored treatment. This study aimed to summarise the development and explore the acceptance and use of the CDSS for MSK pain patients.MethodsThis qualitative study was carried out in the Norwegian physiotherapy primary healthcare sector between October and November 2020, ahead of a randomised controlled trial. We included four physiotherapists and three of their patients, in total 12 patients, with musculoskeletal pain in the neck, shoulder, back, hip, knee or complex pain. We conducted semi-structured telephone interviews with all participants. The interviews were analysed using the Framework Method.ResultsOverall, both the physiotherapists and patients found the system acceptable and usable. Important findings from the analysis of the interviews were that the CDSS was valued as a preparatory and exploratory tool, facilitating the therapeutic relationship. However, the physiotherapists used the system mainly to support their previous and current practice rather than involving patients to a greater extent in decisions and learning from previous successful patients.ConclusionsThe CDSS was acceptable and usable to both the patients and physiotherapists. However, the system appeared not to considerably influence the physiotherapists' clinical reasoning and choice of treatment based on information from most similar successful patients. This could be due to a smaller than optimal number of previous patients in the CDSS or insufficient clinical implementation. Extensive training of physiotherapists should not be underestimated to build understanding and trust in CDSSs.

The Comparison of Fatigue and Trunk and Neck Postures during Working in Tailors with and Without Nonspecific Chronic Neck Pain

Objectives: Work-induced musculoskeletal pain disorders are among the most common problems among workers. This study aimed to compare fatigue and trunk and neck postures during work in tailors with and without nonspecific chronic neck pain.
 Methods: In this cross-sectional study, 30 sewing machine operators participated voluntarily and were divided in two groups of people with (15 persons) and without (15 persons) chronic nonspecific neck pain. The craniovertebral, cranial, and shoulder angles were calculated three intervals (at the start of work, after 2 hours of continuous work, after 4 hours of continuous work) using the photogrammetric method. Borg scale was used to examine work-induced fatigue. A one-way repeated measure analysis of variance at the significance level of 0.05 was used for data analysis.
 Results: There were significant differences in craniovertebral, cranial, and shoulder angle changes (P < 0.001) between the two groups while working. Postural trunk and neck changes were more evident in the nonspecific chronic neck pain group. However, there were no significant differences in terms of fatigue levels between the two groups (P = 0.639).
 Conclusion: The upper trunk related posture among workers with nonspecific chronic neck pain may be more negatively affected during work. So it is suggested that maintaining proper posture should be more emphasized among these workers.

Work-related musculoskeletal disorders among dental staff in south Malaysia

The dental industry poses ergonomic health concerns, leading to work-related musculoskeletal disorders (MSD) among staff. This study aims to assess MSD incidence and related sociodemographic and occupational hazard factors among dental practitioners in Johor, Malaysia. A cross-sectional investigation in December 2022 included 382 dental officers from government and commercial sectors. Participants comprised 79.2% females, 72.3% Malays, 97.4% non-smokers, and 92.4% working in dental clinics. MSD was most prevalent in the neck, shoulder, and lower back regions. Logistic regression revealed higher neck pain probability among smokers and a positive association between back pain and standing while working. Poisson regression indicated an inverse relationship between exercise frequency and MSD pain occurrence. Regular physical activity correlated with lower body mass index (BMI) and reduced MSD pain. The study underscores the importance of ergonomic interventions and promoting exercise to prevent MSD and enhance the well-being of dental staff in Johor, Malaysia. Understanding the factors contributing to MSD among dental practitioners is crucial for implementing effective preventive measures and improving overall occupational health in the dental industry.

A data mining approach for determining biomechanical adaptations in runners who experienced and recovered from patellofemoral pain syndrome

ABSTRACT Patellofemoral pain (PFP) is a common musculoskeletal pain disorder experienced by runners. While biomechanics of those with PFP have been extensively studied, methodological considerations may omit important adaptations exhibited by those experiencing and recovered from pain. Instead of a priori selection of discrete biomechanical variables, a data mining approach was leveraged to account for the high dimensionality of running gait data. Biomechanical data of runners symptomatic for, recovered from, and who had never experienced PFP were collected at the 1st (M1) and 21st (M21) minutes of a treadmill run. Principal component analysis and a logistic regression model were used to classify healthy and symptomatic runners, and a feature ranking process determined the important features. The M1 model achieved an accuracy of 82.76% with features related to knee flexion angle, hip abduction moment and gluteus maximus activation, while the M21 model required an additional nine features to achieve an accuracy of 79.31%. Data for recovered runners were projected onto the models, resulting in five and seven out of twelve symptomatic classifications at M1 and M21, respectively. Following the onset of pain, a greater number of features were required to classify runners with PFP, suggesting they may experience individual pain adaptation strategies.

59 A Preliminary Investigation of Digital Clock Drawing in Fibromyalgia Patients Versus Non-Fibromyalgia Peers

Objective:Widespread musculoskeletal pain disorders like fibromyalgia are often accompanied by varying levels of cognitive dysfunction. Fibromyalgia research suggests that around the time of diagnosis, typically 30-50 years of age, many patients are already showing cognitive difficulties on various neuropsychological assessments. It is unknown, however, how older adults with fibromyalgia perform on rapid cognitive screeners in clinical settings. The present study compared older adults with and without fibromyalgia on a digitized version of a classic neuropsychological screener, the clock drawing test.Participants and Methods:Participants aged 65+ were recruited as part of a larger IRB-approved and federally funded investigation within the preoperative surgical center at the University of Florida (UF) and UF Health. Participant data were obtained with Health Insurance Portability and Accountability Act (HIPAA) waiver and honest broker medical extraction from January 2018 to December 2019 (N=14,807). Based on medical record diagnostic code, participants were categorized into fibromyalgia or non-fibromyalgia groups, then propensity score matched based on age, ethnicity, race, sex, and years of education. The final sample contained 718 older adults (mean age= 71.3±4.89, education years= 13.7±2.62, female= 98.1%, white= 87.9%) (n=359 in each group). All participants completed the command and copy condition of the digital Clock Drawing Test (dCDT). Variables of interest for both conditions included: total completion time (TCT), pre-first hand latency (PFHL), clock face area (CFA), and digit misplacement. These variables were chosen to represent two latency and two graphomotor variables. A natural log transformation was applied to all dCDT variables to achieve normality of the distribution.Results:We confirmed that there was no significant group difference in age, ethnicity, race, sex, and years of education following the propensity match. Fibromyalgia patients had higher comorbidity scores on American Society of Anesthesiologists Classification (ASA) (p= 0.003). Analysis of variance (ANOVA) showed a significant group difference in TCT for both command [F(1,637)= 5.13, p= 0.024, d=0.178] and copy conditions [F(1,466)= 4.03, p= 0.045, d=0.179j. Controlling for ASA, a repeated measures analysis of covariance (ANCOVA) showed that groups still differed in TCT in the command condition [F(1,630)= 4.21, p= 0.041, n2= 0.007; Fibromyalgia > Non-Fibromyalgia], but not in the copy condition.Conclusions:In our sample, older adults with fibromyalgia showed slower TCT to command by approximately three seconds compared to non-fibromyalgia peers. Since TCT to command taps into multiple domains of cognitive functioning, our results are consistent with previous work demonstrating poorer performance across many cognitive domains in fibromyalgia. Future research should continue investigating digital cognitive assessments to identify older adults with fibromyalgia who may be at higher risk for cognitive change. Data acquired through NIH R01 AG055337.

Topical Delivery Systems Effectively Transport Analgesics to Areas of Localized Pain via Direct Diffusion.

Topical delivery systems (TDSs) enable the direct transport of analgesics into areas of localized pain and thus minimize the side effects of administration routes that rely on systemic drug distribution. For musculoskeletal pain, clinicians frequently prescribe topical products containing lidocaine or diclofenac. This study assessed whether drug delivery from a TDS into muscle tissue occurs mainly via direct diffusion or systemic transport. An investigational TDS containing 108 mg lidocaine (SP-103, 5.4% lidocaine), a commercially available TDS containing 36 mg lidocaine (ZTlido®, 1.8% lidocaine), and a topical pain relief gel (Pennsaid®, 2% diclofenac) were tested. Using open flow microperfusion (OFM), interstitial fluid from the dermis, subcutaneous adipose tissue (SAT), and muscle was continuously sampled to assess drug penetration in all tissue layers. Ex vivo and in vivo experiments showed a higher diffusive transport of lidocaine compared to diclofenac. The data showed a clear contribution of diffusive transport to lidocaine concentration, with SP-103 5.4% resulting in a significantly higher lidocaine concentration in muscle tissue than commercially available ZTlido® (p = 0.008). These results indicate that SP-103 5.4% is highly effective in delivering lidocaine into muscle tissue in areas of localized pain for the treatment of musculoskeletal pain disorders (e.g., lower back pain).

PLATELET RICH FIBRIN- A Natural Regenerative Biomaterial

PRF is a blood-derived autologous product, rich in platelets, leukocytes, growth factors, and fibrin matrix, obtained through a simplified centrifugation process. Its unique composition endows PRF with remarkable regenerative potential, making it a versatile tool in various medical fields. Clinical applications of PRF span across dentistry, orthopedics, dermatology, and beyond. In dentistry, it aids in bone grafting, tissue regeneration, and wound healing, enhancing postoperative outcomes. In orthopedics, PRF injections accelerate tissue repair and reduce pain in musculoskeletal disorders. Dermatologists employ PRF for facial rejuvenation, wound healing, and hair restoration, capitalizing on its natural growth factors. The future of PRF holds promising avenues in tissue engineering, chronic wound management, and sports medicine. Its safety and efficacy, coupled with minimal risk of adverse reactions, make it an attractive therapeutic option. PRF represents a breakthrough in regenerative medicine, offering personalized, minimally invasive solutions for a spectrum of clinical challenges. Ongoing research and innovation in PRF applications hold significant potential to transform patient care across diverse medical disciplines.

Using fine-tuned large language models to parse clinical notes in musculoskeletal pain disorders

Using fine-tuned large language models to parse clinical notes in musculoskeletal pain disorders

Fibromyalgia in the Emergency Department: Perspective

Fibromyalgia is a complex musculoskeletal pain disorder, which requires a delicate approach in the emergency setting. Above all else, it is imperative on every clinician to ensure these patients are not suffering from a life-threatening condition. Fibromyalgia is often characterized by diffuse musculoskeletal pains secondary to pain dysregulation and central sensitization and often accompanied by fatigue, sleep and mood disturbances, and/or cognitive dysfunction

Metabolic Fingerprinting for the Diagnosis of Clinically Similar Long COVID and Fibromyalgia Using a Portable FT-MIR Spectroscopic Combined with Chemometrics.

Post Acute Sequelae of SARS-CoV-2 infection (PASC or Long COVID) is characterized by lingering symptomatology post-initial COVID-19 illness that is often debilitating. It is seen in up to 30-40% of individuals post-infection. Patients with Long COVID (LC) suffer from dysautonomia, malaise, fatigue, and pain, amongst a multitude of other symptoms. Fibromyalgia (FM) is a chronic musculoskeletal pain disorder that often leads to functional disability and severe impairment of quality of life. LC and FM share several clinical features, including pain that often makes them indistinguishable. The aim of this study is to develop a metabolic fingerprinting approach using portable Fourier-transform mid-infrared (FT-MIR) spectroscopic techniques to diagnose clinically similar LC and FM. Blood samples were obtained from LC (n = 50) and FM (n = 50) patients and stored on conventional bloodspot protein saver cards. A semi-permeable membrane filtration approach was used to extract the blood samples, and spectral data were collected using a portable FT-MIR spectrometer. Through the deconvolution analysis of the spectral data, a distinct spectral marker at 1565 cm-1 was identified based on a statistically significant analysis, only present in FM patients. This IR band has been linked to the presence of side chains of glutamate. An OPLS-DA algorithm created using the spectral region 1500 to 1700 cm-1 enabled the classification of the spectra into their corresponding classes (Rcv > 0.96) with 100% accuracy and specificity. This high-throughput approach allows unique metabolic signatures associated with LC and FM to be identified, allowing these conditions to be distinguished and implemented for in-clinic diagnostics, which is crucial to guide future therapeutic approaches.

Assessment of ophthalmic vascular changes in fibromyalgia patients using optical coherence tomography angiography: is there a real pathology?

BackgroundFibromyalgia (FM) is a widespread musculoskeletal pain disorder. Although the pathogenesis of fibromyalgia is unknown, central neurotransmitter systems and autonomic nervous system abnormalities may play a critical role. Today, the diagnosis is made by clinical findings, and there is no objective, confirmatory tests. Studies examining ophthalmic structures in patients with fibromyalgia using optic coherence tomography (OCT) and optic coherence tomography angiography (OCTA) sought objective evidence of both the neurodegenerative and vascular processes of the disease. In the results of these few studies, some findings of retinal and vascular density changes were found. Materials and methodsIn this cross-sectional study, retinal superficial and deep vascular plexus density (SVP and DVP), choroid thickness, and choriocapillaris density were investigated in 42 patients with fibromyalgia and 42 healthy controls using OCTA. Results42 fibromyalgia patients, including 42 age- and gender-matched healthy controls, were enrolled in this study. Central macular thickness (CMT) was found to be significantly thinner in fibromyalgia patients than in healthy groups. Retinal SVP and DVP were evaluated. No significant differences were observed between FM patients and control subjects as regards DVP density in the macular area. However, SVP density significantly decreased in the superior and inferior quadrants of fibromyalgia patients compared to the healthy controls. There was no significant difference in choriocapillaris density and choroid thickness between the patients with fibromyalgia and the healthy group in all quadrants. ConclusionWe evaluated detailed ophthalmic vascular structures of patients with fibromyalgia using OCTA in our study. We found changes only superior and inferior quadrants of retinal superficial structures. There was no significant difference in other superficial vascular quadrants of the retina, deep vascular structures, and choriocapillaris density. On the other hand, the central macular thickness was thinner in FM patients. Therefore, these data show that the role of vascular processes in the pathogenesis of fibromyalgia is small, but thinner central macular thickness in FM may be significant as an objective finding of the disease