Tender Point Count Research Articles

Application of the grading system for "nociplastic pain" in chronic primary and chronic secondary pain conditions: a field study.

The concept "nociplastic pain" has been developed for patients with features of nociceptive system sensitization that are not explained as nociceptive or neuropathic. Here, we tested how well the recently published grading system differentiates between chronic primary and secondary pain conditions. We recruited patients with fibromyalgia (FMS, n = 41), complex regional pain syndrome (CRPS, n = 11), osteoarthritis (OA, n = 21), or peripheral nerve injury (PNI, n = 8). We used clinical history, pain drawings, quantitative sensory testing (QST), and questionnaires to classify their pains as possibly or probably "nociplastic." All patients with chronic primary pain exhibited widespread/regional pain not explainable by either nociceptive or neuropathic mechanisms. Widespread pain occurred in 12 patients with OA but was identified as nociceptive in 11 of 12. Regional pain occurred in 4 patients with PNI but was identified as neuropathic in 3 of 4. At this step, the grading system had 100% sensitivity and 93% specificity. Clinical evidence for pain hypersensitivity by QST, and history of hypersensitivity and mental comorbidities did not differentiate between chronic primary pain (QST: 36/52 = 69%, history: 43/52 = 83%) and secondary pain conditions (QST: 20/29 = 69%, history: 24/29 83%). Based on these data, specificity remained excellent (93%), but sensitivity dropped substantially (60%) due to lacking evidence for pain hypersensitivity in many patients with FMS. This low sensitivity suggests that the published grading system is not suitable for screening purposes. We suggest structural and content modifications to improve sensitivity, including placement of patient history before clinical examination and addition of a high tender point count as evidence for widespread pain hypersensitivity.

Interictal widespread pressure hyperalgesia and aura: associations with vestibular migraine in a cross-sectional study.

Patients with vestibular migraine (VM) exhibit higher levels of central sensitization and share similar disorder characteristics with migraine with vestibular symptoms (MwVS), except in terms of disability. These patients experience fluctuating mechanical pain thresholds and persistent vestibular symptoms even without a migraine attack. This study aimed to investigate whether interictal allodynia or hyperalgesia can differentiate between VM, MwVS, and migraine only. We conducted a cross-sectional study of patients with episodic migraine aged between 18 and 65 years, categorized into three groups. A questionnaire was used to collect and compare demographic and clinical variables. Interictal widespread pressure hyperalgesia (IWPH) was evaluated using the Manual Tender Point Survey. Patients with tender point counts ≥7 were classified as having IWPH. The study included 163 patients: 31 with VM, 54 with MwVS, and 78 with migraine without vestibular symptoms (migraine only). We found that aura (p = 0.042, odds ratio 3.50, 95% confidence interval 1.26-10.4), tender point count (p < 0.001, d = 0.889, median difference = 2), and IWPH (p = 0.002, odds ratio 5.3, 95% confidence interval 1.80-17.2) were significantly associated with VM compared to MwVS. Aura and IWPH were significantly associated with VM. However, there were no significant associations observed for interictal allodynia or hyperalgesia between the other two groups. IWPH and aura are associated with VM, indicating their potential roles in its pathogenesis. These findings may contribute to the differential diagnosis and management of migraine, potentially leading to targeted treatment strategies.

Thiol-Disulfide Balance in Fibromyalgia: A Case-Control Study

Aim. We aimed to examine the thiol-disulfide (SS) balance, a recognized marker of oxidative stress, in fibromyalgia syndrome (FMS).&#x0D; Methods. The study comprised 98 female participants (61 newly diagnosed patients and 37 patients under treatment) with FMS, along with 82 apparently healthy female volunteers. In both groups, assessments were conducted using the Fibromyalgia Impact Questionnaire (FIQ), Visual Analogue Scale (VAS), Pittsburgh Sleep Quality Index (PSQI), Fatigue Severity Scale (FSS), Short Form-36 (SF-36), Tender Point Count, Beck Depression Inventory (BDI), and Beck Anxiety Inventory (BAI). Native thiol (NT) and total thiol (TT) levels were measured, SS levels and SS/NT ratio were calculated.&#x0D; Results. FMS patients demonstrated significantly lower NT levels, higher SS levels, and an elevated SS/NT ratio compared to the control group (p&lt; 0.05 for all groups). In FMS patients, a statistically significant correlation was found between SS level and the SS/NT ratio, as well as the number of tender points (r=-0.24, p=0.02; r=-0.21, p=0.04), SF-36 pain subscales (r=0.22, p=0.032; r=0.21, p=0.04), and BAI scores (r=-0.22, p=0.01; r=-0.23 p=0.03). In the subgroup analysis, all health assessment scales were observed to exhibit statistically significant differences between the under-treatment group and newly-diagnosed group when compared to the control group (p&lt; 0.05 for all groups). The FIQ, VAS, FSS, and BAI scores were found to be significantly lower in the under-treatment group as compared to the newly-diagnosed group (p&lt; 0.05 for all groups). In the newly-diagnosed group, NT was significantly lower and the SS/NT ratio was significantly higher than those in the control group (p&lt; 0.05). In the under-treatment group, SS levels and SS/NT ratio were significantly higher as compared to the control group (p&lt; 0.05). In the multivariate regression analysis, which incorporated age, health assessment scales, patient subgroups, tender points, and duration of symptoms to predict the SS/NT ratio, variabes such as being in the under-treatment group, tender points, and BAI score were identified as significant predictors (p&lt; 0.05).&#x0D; Conclusions. The thiol-SS balance was observed to shift in the oxidative direction, and oxidative stress was higher in the FMS group. The absence of a significant difference between the under-treatment group and the newly-diagnosed group in terms of thiol-SS balance parameters suggests a shift to oxidative stress in patients, independent of the treatment status.

Phenotypic characteristics of patients with chronic widespread pain and fibromyalgia: a cross-sectional cluster analysis

Objective This study aimed to explore whether phenotypic characteristics of patients with chronic widespread pain (CWP) and fibromyalgia (FM) can be aggregated into definable clusters that may help to tailor treatments. Method Baseline variables (sex, age, education, marital/employment status, pain duration, prior CWP/FM diagnosis, concomitant rheumatic disease, analgesics, tender point count, and disease variables derived from standardized questionnaires) collected from 1099 patients (93.4% females, mean age 44.6 years) with a confirmed CWP or FM diagnosis were evaluated by hierarchical cluster analysis. The number of clusters was based on coefficients in the agglomeration schedule, supported by dendrograms and silhouette plots. Simple and multiple regression analyses using all variables as independent predictors were used to assess the likelihood of cluster assignment, reported as odds ratios (ORs) with 95% confidence intervals (CIs). Results Only one cluster emerged (Cluster 1: 455 patients). Participants in this cluster were characterized as working (OR 66.67, 95% CI 7.14 to 500.00), with a medium-term/higher education (OR 16.80, 95% CI 1.94 to 145.41), married/cohabiting (OR 14.29, 95% CI 1.26 to 166.67), and using mild analgesics (OR 25.64, 95% CI 0.58 to > 999.99). The odds of being an individual in Cluster 1 were lower when having a worse score on the PDQ (score ≥ 18) (OR < 0.001, 95% CI < 0.001 to 0.02). Conclusion We identified one cluster, where participants were characterized by a potentially favourable clinical profile. More studies are needed to evaluate whether these characteristics could be used to guide the management of patients with CWP and FM.

Prevalence and characteristics of fibromyalgia according to three fibromyalgia diagnostic criteria: A secondary analysis study.

The purpose of this study was to explore the prevalence of fibromyalgia (FM) according to different diagnostic criteria in a clinical sample and to explore the clinical characteristics in cases and non-cases by the diagnostic criteria used. A sample of 182 participants, both positive (n = 120) and negative (n = 62) FM individuals according to a clinical, pragmatic classification was used. Their characteristics were explored according to three different FM diagnostic criteria, i.e., the American College of Rheumatology (ACR) 1990, ACR 2016, and APS Pain Taxonomy (AAPT), respectively. Thus, impact of FM (FIQ), symptoms of anxiety and depression (HADS), tender point (TP) counts, and mechanical pressure sensitivity (in kPa) were compared in cases versus non-cases depending on diagnostic criteria of FM used. Descriptive analyses used chi-square statistic for categorical variables and non-parametric Mann-Whitney U tests for continuous variables. From the clinical positive FM sample (n = 120), n = 99, 108, and 110 persons were diagnosed positive according to the ACR 1990, ACR 2016, and AAPT FM diagnostic criteria, respectively. All these three diagnostic tools discriminated FM positively from diagnostic FM non-cases when measuring TP-counts, mechanical pressures, and most FIQ-items, but they varied for anxiety and depression. The prevalence of FM differed somewhat with the use of ACR 1990, ACR 2016, and the AAPT as diagnostic tools. The anxiety and depression symptoms differed significantly between cases and non-cases using some but not all the diagnostic criteria. Regarding other FM symptoms, e.g., TPs and most FIQ items, all diagnostic criteria contrasted case from non-case.

The correlation between occupation type and fibromyalgia severity.

Fibromyalgia (FM) is a chronic pain disorder associated with financial burden, decreased work productivity and absenteeism. Occupational stressors and specific employment factors may contribute to the severity of FM. To determine if occupation type or employment status correlates with FM diagnostic and severity parameters, as assessed via validated instruments including tender points (TP), Widespread Pain Index (WPI), Symptom Severity (SS) and pain regions. We performed a cross-sectional study of 200 adult patients diagnosed with FM at a single-centre FM clinic. Demographic and clinical data were extracted from the electronic medical records. Occupations were manually grouped in an iterative modified-Delphi approach and participants were grouped by employment status (Working, Not Working/Disabled or Retired) for analysis. In our cohort, 61% were employed and 24% were not working/disabled, while the remainder were students, homemakers or retired. SS score was significantly higher (P < 0.001) in not working/disabled patients compared to those employed. Business owners had the lowest TP count (median = 14) and the lowest median SS score (median = 7). WPI was highest for Others (Arts/Entertainment, Driver/Delivery and Housekeeper/Custodian workers; median=16) and the lowest for Retail/Sales/Wait Staff (median = 11). Work-related factors, occupation type and employment status correlate with diagnostic and severity parameters of FM. Employed participants had significantly lower SS scores suggesting that work loss correlates with SS. Participants employed in entry-level jobs or jobs with higher physical or financial stressors may experience greater FM symptoms. Further studies are required to explore work-related factors and their impact on the diagnostic and severity parameters of FM.

Effectiveness of Hyperbaric Oxygen for Fibromyalgia: A Meta-Analysis of Randomized Controlled Trials.

Hyperbaric oxygen therapy (HBOT) has been reported as an emerging treatment regimen for fibromyalgia syndrome (FMS), with a paucity of solid evidence. Accordingly, a systematic review and meta-analysis were performed to address the effectiveness of HBOT on FMS. We searched the Cochrane Database, EMBASE, Medline, PubMed, Clinicaltrials.gov, and PsycINFO, and the reference sections of original studies and systematic reviews from inception to May 2022. Randomized controlled trials (RCTs) on the treatment of FMS with HBOT were included. Outcome measures included pain, Fibromyalgia Impact Questionnaire (FIQ), Tender Points Count (TPC), and side effects. Four RCTs, with 163 participants, were included for analysis. Pooled results showed that HBOT could benefit FMS with significant improvement at the end of treatment, including FIQ (SMD = -1.57, 95% CI -2.34 to -0.80) and TPC (SMD = -2.50, 95% CI -3.96 to -1.05). However, there was no significant effect on pain (SMD = -1.68, 95% CI, -4.47 to 1.11). Meanwhile, HBOT significantly increased the incidence of side effects (RR = 24.97, 95% CI 3.75 to 166.47). Collectively, emerging evidence from RCTs indicates that HBOT can benefit FMS patients in FIQ and TPC throughout the observation time phrases. Although HBOT has some side effects, it does not cause serious adverse consequences.

The impact of fibromyalgia syndrome on obstructive sleep apnea syndrome in terms of pain threshold, daytime symptoms, anxiety, depression, disease severity, and sleep quality: a polysomnographic study.

Current studies have focused on the association of fibromyalgia syndrome (FMS) and obsctructive sleep apnea syndrome (OSAS). Results of these studies on the effect of this association have been inconsistent. The current study aimed to investigate the effect of FMS on OSAS regarding sleep quality, pressure pain threshold, fatigue, daytime symptoms, anxiety, and depression, and also to determine the relationship between OSAS severity and FMS. In a cross-sectional design, patients diagnosed with OSAS were evaluated in two groups comparing those with and those without FMS. Data on demographics, headache, morning fatigue, and chronic pain duration were collected. Questionnaires including the Fatigue Severity Scale (FSS), Fibromyalgia Impact Questionnaire (FIQ), Beck Depression Inventory (BDI), and Beck Anxiety Inventory (BAI) were completed. Pressure pain threshold, tender points, and polysomnographic data were recorded. Of 69 patients, 27 were diagnosed with FMS + OSAS and 42 were diagnosed as OSAS only. Statistically significant differences were found between the two groups in VAS, pain duration, morning fatigue, headache, BAI, tender point count, FIQ and FSS scores, and algometer measurements. All polysomnografic data were compared, and no statistically significant differences were found between the two groups. There were no statistically significant differences in the algometer, BDI, BAI, FIQ, and FSS scores when analyzed according to the severity of OSAS. The findings suggest that FMS has no effect on polysomnographic parameters of OSAS. Headache, daytime fatigue, anxiety, depression, pain duration, and pain intensity are higher while the pressure pain threshold is lower when FMS is present. No correlation was found between OSAS severity and FMS, fatigue, pressure pain threshold, depression, and anxiety. NCT05367167/date: April 8, 2022.

The relationship between serum leptin, insulin-like growth factor-1, and insulin-like growth factor binding protein-3 levels and clinical parameters in primary fibromyalgia patients.

The aim of this study was to investigate the levels of leptin, growth hormone, insulin-like growth factor-1, and insulin-like growth factor binding protein-3 and their relations with clinical parameters in patients with primary fibromyalgia and healthy controls. Our study was performed on 30 female patients with primary fibromyalgia and 30 healthy controls. The levels of insulin-like growth factor-1 and insulin-like growth factor binding protein-3 were measured by a two-site immunoradiometric assay. The serum level of leptin was measured by the ELISA kit. The serum level of leptin was significantly higher, but the serum levels of insulin-like growth factor-1 were significantly lower in patients with fibromyalgia syndrome than healthy controls (p<0.001). The leptin level was positively correlated with the Visual Analog Scale, Fibromyalgia Impact Questionnaire score, Beck Depression Inventory score, tender point count, age, and duration of disease (p<0.001), but it was negatively correlated with insulin-like growth factor-1 (p<0.001). The insulin-like growth factor-1 level was negatively correlated with age, Visual Analog Scale, Fibromyalgia Impact Questionnaire and Beck Depression Inventory scores, duration of disease, and tender point count (p<0.001). Our results indicate that high levels of serum leptin and low levels of serum insulin-like growth factor-1 may play a role in the physiopathogenesis of fibromyalgia and may be related to some symptoms.

Predicting acupuncture efficacy in fibromyalgia: results of a pragmatic open-label study.

To identify the predictive factors of treatment response to acupuncture in patients with fibromyalgia (FM). Patients with FM refractory to standard drug therapy underwent eight weekly acupuncture sessions. Significant improvement, defined as a reduction of at least 30% of the revised Fibromyalgia Impact Questionnaire (FIQR), was assessed at the end of the eight weeks (T1) of treatment and three months after the end of treatment (T2). Univariate analysis was conducted to identify predictors of significant improvement at T1 and T2. Variables that resulted to be significantly associated with clinical improvement at univariate analysis were included in multivariate models. Analyses were conducted on 77 patients (9 males, 11.7%). At T1, significant improvement in FIQR was recorded in 44.2% of patients. At T2, persistent significant improvement was recorded in 20.8% of patients. In the multivariate analysis, predictive variables of treatment failure were tender point count (TPC) (odds ratio [OR] =0.49, 95% confidence interval [95% CI]: 0.28-0.86, p=0.01) and pain magnification (OR=0.68, 95% CI: 0.47-0.99, p=0.04) assessed with the Pain Catastrophising Scale, at T1. At T2, the only predictive variable of treatment failure was concomitant duloxetine use (OR=0.21, 95% CI: 0.05-0.95, p=0.04). High TPC and a tendency for pain magnification predict immediate treatment failure, while duloxetine therapy predicts it three months after completion of the acupuncture course. The identification of clinical characteristics of unfavourable response to acupuncture could help to implement a cost-effective prevention of treatment failure in FM.

Statin Therapy and Symptom Burden in Patients With Fibromyalgia: A Prospective Questionnaire Study

ObjectiveTo evaluate the association between statin use and symptom severity, tender point count, fatigue, cognition, mood, and sleep issues in patients with fibromyalgia (FM).MethodsBetween May 2012 and November 2013, 668 patients with FM were surveyed. Patients were stratified into statin users and statin nonusers. Primary outcome was FM symptom severity (FIQ-R questionnaire) and tender point count. Secondary outcomes included fatigue (MFI-20), cognitive dysfunction (MASQ), anxiety (GAD-7), depression (PHQ-9), and sleep issues (SPI-II). Regression analysis assessed for differences in these clinical outcomes between statin users and statin nonusers and adjusted for age, sex, body mass index, ethnicity, tobacco use, opioid use, and neuropathic medication use.ResultsOf the FM patients, 79 (11.8%) were statin users, whereas 589 (88.2%) reported no current statin use. Compared with the control cohort, statin users were older (55.0±11.3 years vs 46.2±12.9 years; P<.001) and had a higher body mass index (33.0±7.0 kg/m2 vs 29.8±7.7 kg/m2; P=.001). Adjusted linear regression revealed no association between statin use and symptom severity (total FIQ-R scores, 57.7±18.3 vs 59.0±18.1; adjusted β coefficient, −0.4; 95% CI, −4.8 to 4.1; P=.871). There was also no association between statin use and tender point count (14.8±4.1 vs 14.5±4.2; adjusted β coefficient, 0.2; 95% CI, −0.8 to 1.2; P=.732). Secondary outcome analysis revealed no difference between statin users and statin nonusers in metrics measuring fatigue, cognition, anxiety, depression, and sleep problems.ConclusionAdministration of statin therapy for at least 1 month is not a risk factor for worse symptom burden in patients with FM. Statin therapy should be offered to dyslipidemic FM patients with an appropriate medical indication to optimize their cardiovascular health.

Fibromyalgia syndrome in chronic hepatitis C virus (HCV) infection patients: A potential association and pathogenic role

BackgroundHigher prevalence of fibromyalgia (FM) among chronic hepatitis-C virus (HCV) suspects virally-mediated pathway. Aim of the workTo determine the frequency and clinical characteristics of FM in Egyptian patients with chronic HCV and to evaluate its relationship to viral load. Patients and methods150 Egyptian patients with chronic HCV and 150 controls were included. Liver function tests, thyroid stimulating hormone (TSH), HCV antibodies, HCV-ribonucleic acid (RNA) and abdominal ultrasonography were done. FM was diagnosed according to 2010 American College of Rheumatology (ACR) classification criteria. ResultsThe mean age of the patients was 54.1 ± 8.4 years and they were 94 females: 56 males; and the mean duration of HCV was 6.9 ± 3.2 years. Fatigue, arthralgia, arthritis, morning stiffness, weakness, sicca-like symptoms, depression, cognitive, sleep disturbances and irritable bowel syndrome (IBS) were significantly more frequent in HCV patients. Twenty six patients with HCV (17.3%) and 4 (2.7%) of the controls had FM. HCV patients with FM had significantly higher widespread pain index, symptom severity score, visual analogue scale (VAS), tender points count and stiffness than controls with FM. HCV patients with FM had significant higher VAS score, fatigue and depression than without FM. Rates of hematological features, autoantibodies, liver enzymes, abdominal US findings, patients with viral load > 800,000 IU/L were comparable. ConclusionThere is increased rate of fibromyalgia in chronic HCV patients and is associated with higher pain intensity, tender point count, symptom severity and fatigue. FM in patients with HCV infection is not related to viral load of HCV.

Analysis of the Muscular Activity, Peak Torque in the Lower Limbs, and Static Balance after Virtual Rehabilitation in Women with Fibromyalgia: A Randomized Controlled Study.

Objective: To analyze the effect of the exergaming on muscular activity at rest and on maximum voluntary isometric contraction by electromyography (EMG) at peak torque, widespread pressure hyperalgesia identified using a tender point count, and static balance in fibromyalgia. Materials and Methods: Thirty-five women were divided into two groups: Wii™ (virtual rehabilitation, n = 16) and control (stretching exercises, n = 19), through simple randomization. The volunteers were evaluated by means of EMG, dynamometry by load cell, baropodometry, and algometry before interventions and reevaluated after the 10th and 20th sessions. The subjects participated fully in three 1-hour treatment sessions per week of 20 sessions. Results: The Wii group showed significant benefits for the peak torque of dorsiflexion movement after 20 sessions and for movement plantarflexion after 10 sessions. The control group showed bilateral improvement in muscular activity in the tibialis anterior muscle after 20 sessions. Both groups showed a significant decrease in tender point count, suggesting improved hyperalgesia after 10 sessions and 20 sessions. No significant improvement was found in static baropodometry in the two evaluated groups. Conclusion: Exergaming have the potential to increase the peak torque for dorsiflexion and plantarflexion movement in women with fibromyalgia. It also produces a decrease in tender point count equal to that with flexibility exercises and does not produce changes in the static balance.

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

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

Balneotherapy for Fibromyalgia Syndrome: A Systematic Review and Meta-Analysis.

(1) Background: The efficiency of balneotherapy (BT) for fibromyalgia syndrome (FMS) remains elusive. (2) Methods: Cochrane Library, EMBASE, MEDLINE, PubMed, Clinicaltrials.gov, and PsycINFO were searched from inception to 31 May 2020. Randomized controlled trials (RCTs) with at least one indicator were included, i.e., pain, Fibromyalgia Impact Questionnaire (FIQ), Tender Points Count (TPC), and Beck’s Depression Index (BDI). The outcome was reported as a standardized mean difference (SMD), 95% confidence intervals (CIs), and I2 for heterogeneity at three observational time points. GRADE was used to evaluate the strength of evidence. (3) Results: Amongst 884 citations, 11 RCTs were included (n = 672). Various BT regimens were reported (water types, duration, temperature, and ingredients). BT can benefit FMS with statistically significant improvement at different time points (pain of two weeks, three and six months: SMD = −0.92, −0.45, −0.70; 95% CI (−1.31 to −0.53, −0.73 to −0.16, −1.34 to −0.05); I2 = 54%, 51%, 87%; GRADE: very low, moderate, low; FIQ: SMD = −1.04, −0.64, −0.94; 95% CI (−1.51 to −0.57, −0.95 to −0.33, −1.55 to −0.34); I2 = 76%, 62%, 85%; GRADE: low, low, very low; TPC at two weeks and three months: SMD = −0.94, −0.47; 95% CI (−1.69 to −0.18, −0.71 to −0.22); I2 = 81%, 0; GRADE: very low, moderate; BDI at six months: SMD = −0.45; 95% CI (−0.73 to −0.17); I2 = 0; GRADE: moderate). There was no statistically significant effect for the TPC and BDI at the remaining time points (TPC at six months: SMD = −0.89; 95% CI (−1.85 to 0.07); I2 = 91%; GRADE: very low; BDI at two weeks and three months: SMD = −0.35, −0.23; 95% CI (−0.73 to 0.04, −0.64 to 0.17); I2 = 24%, 60%; GRADE: moderate, low). (4) Conclusions: Very low to moderate evidence indicates that BT can benefit FMS in pain and quality-of-life improvement, whereas tenderness and depression improvement varies at time phases. Established BT regimens with a large sample size and longer observation are needed.

Sex-Related Differences in Symptoms and Psychosocial Outcomes in Patients With Fibromyalgia: A Prospective Questionnaire Study.

ObjectiveTo investigate sex-related differences in patients with fibromyalgia (FM) in terms of demographic characteristics and clinical features, including tender point count (TPC), mood disorders, sleep problems, FM symptom severity, fatigue, cognitive dysfunction, and quality of life (QOL).Patients and MethodsWe studied 668 consecutive patients with FM (606 women) from May 1, 2012, to November 30, 2013. Validated questionnaires assessed outcomes of depression (Patient Health Questionnaire-9), anxiety (Generalized Anxiety Disorder-7), sleep problems (Medical Outcomes Study Sleep Scale), FM symptom severity (Revised Fibromyalgia Impact Questionnaire), fatigue (Multidimensional Fatigue Inventory), cognitive dysfunction (Multiple Ability Self-report Questionnaire), and QOL (36-Item Short Form Health Survey). Nonparametric Mann-Whitney U and Pearson χ2 tests were used to compare continuous and categorical outcome measures, respectively, between men and women. Linear regression models were performed for all continuous dependent variables, adjusting for age, body mass index, ethnicity, marital status, and highest education level completed. P<.05 was considered statistically significant. The Benjamini-Hochberg procedure was used to adjust for multiple comparisons.ResultsMultiple linear regression analysis revealed a significant association of female sex and greater TPC (P<.001), lower overall FM symptom severity (lower overall Revised Fibromyalgia Impact Questionnaire score; P=.03), and higher QOL subscale score for vitality (36-Item Short Form Health Survey vitality subscale score; P=.02). After adjustment for multiple comparisons, only the association between female sex and greater TPC remained significant. There were no sex-related differences in demographic characteristics, depression, anxiety, sleep problems, FM symptom severity, cognitive dysfunction, and QOL.ConclusionA higher TPC may be associated with female sex in patients with FM. The assumption of other sex-based differences in the clinical presentation of FM was not supported in our study.

The Low Glutamate Diet Effectively Improves Pain and Other Symptoms of Gulf War Illness.

Gulf War Illness (GWI) is a multisymptom disorder including widespread chronic pain, fatigue and gastrointestinal problems. The objective of this study was to examine the low glutamate diet as a treatment for GWI. Forty veterans with GWI were recruited from across the US. Outcomes included symptom score, myalgic score, tender point count, dolorimetry and the Chalder Fatigue Scale. Subjects were randomized to the low glutamate diet or a wait-listed control group, with symptom score being compared after one month. Subjects then went onto a double-blind, placebo-controlled crossover challenge with monosodium glutamate (MSG)/placebo to test for return of symptoms. Symptom score was compared between diet intervention and wait-listed controls with an independent t-test and effect size was calculated with Cohen’s d. Change scores were analyzed with Wilcoxon Signed Rank tests. Crossover challenge results were analyzed with General Linear Models and cluster analysis. The diet intervention group reported significantly less symptoms (p = 0.0009) than wait-listed controls, with a very large effect size, d = 1.16. Significant improvements in average dolorimetry (p = 0.0006), symptom score, tender point number, myalgic score and the Chalder Fatigue Scale (all p < 0.0001) were observed after the 1-month diet. Challenge with MSG/placebo resulted in significant variability in individual response. These results suggest that the low glutamate diet can effectively reduce overall symptoms, pain and fatigue in GWI, but differential results upon challenge suggest that other aspects of the diet, or underlying differences within the population, may be driving these changes. Future research is needed to identify potential nutrient effects, biomarkers, and underlying metabolic differences between responders and non-responders.

The Low Glutamate Diet Significantly Improves Pain and Other Symptoms in Veterans with Gulf War Illness

Abstract Objectives The objective was to examine if a low glutamate diet can reduce symptoms in Gulf War Illness (GWI), a multi-symptom chronic pain condition. Methods Forty GW veterans were recruited from across the US. Baseline measures included assessment of symptoms, myalgic score, tender point count, and dolorimetry. Subjects were randomized to the low glutamate diet, or to a wait-listed control group, starting the diet one month later. Measures were evaluated post-diet, and then subjects were randomized to a double-blind placebo-controlled crossover challenge with monosodium glutamate (MSG)/placebo to assess whether symptoms return/worsen in each condition. Challenge data have not yet been un-blinded, and thus are not included in this abstract. Symptom scores were compared between those randomized to immediate dietary intervention versus wait-listed controls (independent t-tests). After everyone completed the 1-month diet, change scores were analyzed for the whole group (Wilcoxon Signed Rank tests). Improvement was defined as ‘much’ or ‘very much’ improved on the patient global impression of change (PGIC) score, and the effect size was calculated (Cohen's d). Results After 1-month, overall symptom number (mean (SD)) significantly differed between the diet group (11(6)) and the wait-listed controls (18(6)), P = 0.0007. The diet had a very large effect size, d = 1.17, with no adverse effects reported. When comparing pre-post scores after all subjects followed the 1-month diet, the number of symptoms went from a mean(SD) of 21(5) at baseline to 12(6) post-diet, P &amp;lt; 0.0001. The severity of remaining symptoms was also significantly reduced (all P &amp;lt; 0.0001). Seventy-two % of subjects met the PGIC criteria for improvement. Highly significant improvements in pain measures were also observed for myalgic score (P &amp;lt; 0.0001), number of tender points (P &amp;lt; 0.0001), and average dolorimetry (P &amp;lt; 0.001). Conclusions These striking results suggest that the low glutamate diet may be an effective treatment for chronic pain and symptoms associated with Gulf War Illness. Funding Sources Department of Defense (DoD), US Army Medical Research Acquisition Activity, Office of the Assistant Secretary of Defense for Health Affairs through the GWI Research Program. Opinions, interpretations, conclusions and recommendations are those of the author and are not necessarily endorsed by the DoD.

Type D Personality is Associated With Disease Severity and Poor Quality of Life in Turkish Patients With Fibromyalgia Syndrome: A Cross-Sectional Study.

This study aims to investigate the rate of type D personality in Turkish patients with fibromyalgia (FM) and evaluate its associations with clinical parameters of FM as well as its effects on health-related quality of life (HRQoL). The study included 100 patients with FM (14 males, 86 females; mean age 34.6±7.4 years; range, 22 to 49 years) fulfilling 1990 American College of Rheumatology diagnostic criteria and 50 healthy controls (9 males, 41 females; mean age 32.6±6.5 years; range, 21 to 50 years). Type D personality was assessed using the type D scale-14 (DS-14). FM disease severity was determined by Fibromyalgia Impact Questionnaire (FIQ), functional status by Stanford Health Assessment Questionnaire (HAQ), and HRQoL by Nottingham Health Profile (NHP). Severity of pain and fatigue were measured by visual analog scale (VAS). The frequency of type D personality was 33% in FM patients and 12% in controls (odds ratio=3.612, 95% confidence interval 1.398-9.333) (p=0.006). Type D FM patients scored higher in tender point count (TPC), FIQ, HAQ, VAS-pain and all NHP subgroups except energy (p<0.01). Type D personality was found to be correlated with FIQ, TPC, HAQ, VAS-pain and NHP subgroups except energy (p<0.01). Based on our findings, assessment of personality characteristics of patients with FM may hold the key for the treatment of the disease. Besides, a better understanding of personality-related pain in FM patients may provide a more targeted approach to pain treatment.

The Relationship Between Clinical and Quantitative Measures of Pain Sensitization in Knee Osteoarthritis.

Pain sensitization in knee osteoarthritis (OA) is associated with greater symptom severity and poorer clinical outcomes. Measures that identify pain sensitization and are accessible to use in clinical practice have been suggested to enable more targeted treatments. This merits further investigation. This study examines the relationship between quantitative sensory testing (QST) and clinical measures of pain sensitization in people with knee OA. A secondary analysis of data from 134 participants with knee OA was performed. Clinical measures included: manual tender point count (MTPC), the Central Sensitization Inventory (CSI) to capture centrally mediated comorbidities, number of painful sites on a body chart, and neuropathic pain-like symptoms assessed using the modified PainDetect Questionnaire. Relationships between clinical measures and QST measures of pressure pain thresholds (PPTs), temporal summation, and conditioned pain modulation were investigated using correlation and multivariable regression analyses. Fair to moderate correlations, ranging from -0.331 to -0.577 (P<0.05), were identified between MTPC, the CSI, number of painful sites, and PPTs. Fair correlations, ranging from 0.28 to 0.30 (P<0.01), were identified between MTPC, the CSI, number of painful sites, and conditioned pain modulation. Correlations between the clinical and self-reported measures and temporal summation were weak and inconsistent (0.09 to 0.25). In adjusted regression models, MTPC was the only clinical measure consistently associated with QST and accounted for 11% to 12% of the variance in PPTs. MTPC demonstrated the strongest associations with QST measures and may be the most promising proxy measure to detect pain sensitization clinically.