Widespread Musculoskeletal Pain Research Articles

Reduced sympathetic activity is associated with the development of pain and muscle atrophy in a female rat model of fibromyalgia

Fibromyalgia (FM) is characterized by chronic widespread musculoskeletal pain accompanied by fatigue and muscle atrophy. Although its etiology is not known, studies have shown that FM patients exhibit altered function of the sympathetic nervous system (SNS), which regulates nociception and muscle plasticity. Nevertheless, the precise SNS-mediated mechanisms governing hyperalgesia and skeletal muscle atrophy in FM remain unclear. Thus, we employed two distinct FM-like pain models, involving intramuscular injections of acidic saline (pH 4.0) or carrageenan in prepubertal female rats, and evaluated the catecholamine content, adrenergic signaling and overall muscle proteolysis. Subsequently, we assessed the contribution of the SNS to the development of hyperalgesia and muscle atrophy in acidic saline-injected rats treated with clenbuterol (a selective β2-adrenergic receptor agonist) and in animals maintained under baseline conditions and subjected to epinephrine depletion through adrenodemedullation (ADM). Seven days after inducing an FM-like model with acidic saline or carrageenan, we observed widespread mechanical hyperalgesia along with loss of strength and/or muscle mass. These changes were associated with reduced catecholamine content, suggesting a common underlying mechanism. Notably, treatment with a β2-agonist alleviated hyperalgesia and prevented muscle atrophy in acidic saline-induced FM-like pain, while epinephrine depletion induced mechanical hyperalgesia and increased muscle proteolysis in animals under baseline conditions. Together, the results suggest that reduced sympathetic activity is involved in the development of pain and muscle atrophy in the murine model of FM analyzed.

Fecal Microbiota Transplantation Improves Clinical Symptoms of Fibromyalgia: An open-label, Randomized, Nonplacebo-Controlled Study

Fibromyalgia (FM) is a complex and poorly understood disorder characterized by chronic and widespread musculoskeletal pain, of which the etiology remains unknown. Now, the disorder of the gut microbiome is considered as one of the main causes of FM. This study was aimed to investigate the potential benefits of fecal microbiota transplantation (FMT) in patients with FM. A total of 45 patients completed this open-label randomized, nonplacebo-controlled clinical study. The Numerical Rating Scale (NRS) scores in the FMT group were slightly lower than the control group at 1 month (P> 0.05), and they decreased significantly at 2, 3, 6, and 12 months after treatment (P < 0.001). Besides, compared with the control group, the Widespread Pain Index (WPI), Symptom Severity (SS), Hospital Anxiety and Depression Scale (HADS) and Pittsburgh Sleep Quality Index (PSQI) scores were significantly lower in the FMT group at different time points (P < 0.001). After 6 months of treatment, there was a significant increase in serotonin (5-HT) and gamma-aminobutyric acid (GABA) levels (P < 0.001), while glutamate levels significantly decreased in the FMT group (P < 0.001). The total effective rate was higher in the FMT group (90.9%) compared to the control group (56.5%) after 6 months of treatment (P < 0.05). FMT can effectively improve the clinical symptoms of FM. With the close relations between the changes of neurotransmitters and FM, certain neurotransmitters may serve as a diagnostic marker or potential target for FM patients. PerspectiveFecal microbiota transplantation (FMT) is a novel therapy that aims to restore the gut microbial balance and modulate the gut-brain axis. It is valuable to further explore the therapeutic effect of FMT on FM. Furthermore, certain neurotransmitters may become a diagnostic marker or a new therapeutic target for FM patients.

Nutritional Status, Dietary Intake, Quality of Life, and Dysphagia in Women With Fibromyalgia.

Fibromyalgia syndrome (FMS) is an idiopathic chronic disease characterized by widespread musculoskeletal pain, hyperalgesia, and allodynia that has been recently associated with risk of dysphagia. We aimed to analyze the association between nutritional status, micro- and macronutrient intake, and quality of life (QoL) in a cohort of women with FMS and risk of dysphagia compared to women with FMS without risk of dysphagia. A cross-sectional study was conducted in 46 women with FMS. Risk of dysphagia was assessed by the Eating Assessment Tool (EAT-10) and the Volume-Viscosity Swallow Test (V-VST). The Food Frequency Questionnaire and the Swallowing Quality of Life Questionnaire were used to assess dietary intake and QoL, respectively. Thirty women with FMS were at risk for dysphagia (65.21%), assessed by the EAT-10. Based on the V-VST, the frequency of risk of dysphagia was 63.04%. Significant differences in body mass index (BMI) were found between women at risk for dysphagia and those without risk. Women at risk for dysphagia had significantly lower overall QoL scores than those women without risk. No significant differences were found for dietary intake and dysphagia risk. Women with FMS at risk for dysphagia have significantly lower BMI values and worse QoL than women without dysphagia risk, supporting the importance of assessing dysphagia in clinical practice in persons with FMS.

Unraveling the Complex Web of Fibromyalgia: A Narrative Review.

Fibromyalgia is a complex and often misunderstood chronic pain disorder. It is characterized by widespread musculoskeletal pain, fatigue, and heightened sensitivity, and has evolved in diagnostic criteria and understanding over the years. Initially met with skepticism, fibromyalgia is now recognized as a global health concern affecting millions of people, with a prevalence transcending demographic boundaries. The clinical features and diagnosis of fibromyalgia encompass a range of symptoms beyond pain, including sleep disturbances and cognitive difficulties. This study emphasizes the importance of a comprehensive evaluation for accurate diagnosis, considering the shift from tender point reliance to a more holistic approach. Etiology and pathophysiology involve genetic predisposition, neurotransmitter dysregulation, central sensitization, and immune system involvement. Risk factors such as gender, age, family history, and comorbid conditions contribute to susceptibility. The impact on quality of life is profound, affecting physical and social aspects, often accompanied by mood disorders. Management approaches include pharmacological interventions, non-pharmacological therapies, lifestyle modifications, and alternative treatments. This study also delves into emerging research, exploring advances in neurobiological understanding, brain imaging, genetic markers, glutamate modulation, cannabinoids, gut microbiome, and digital health tools for fibromyalgia management. Overall, this study provides a nuanced and up-to-date overview of the complexities surrounding fibromyalgia, aiming to enhance understanding and support for individuals grappling with this challenging condition.

Assessment of knowledge and prevalence of fibromyalgia among medical students and physicians in Riyadh region.

Fibromyalgia is a chronic condition that is characterized by widespread musculoskeletal pain and tenderness of soft tissue. The prevalence of FM in Saudi Arabia is not known. The diagnosis of FM is mainly clinical. The knowledge about fibromyalgia is poor, even among healthcare providers. To assess the knowledge and prevalence of fibromyalgia among medical students and physicians in the Riyadh region. A cross-sectional study was conducted at all medical colleges in Riyadh and Riyadh hospitals. The study was conducted on both medical students and physicians using a questionnaire. The SPSS program was used to analyze the data. A total of 556 participants were involved; 56.5% heard about fibromyalgia, and only 5.6% attended Continuing Medical Education (CME) activity. There were 31.5% had high knowledge, whereas 68.5% had low knowledge. The level of knowledge was associated with the year (P = 0.002), specialty (P = 0.013), hearing about fibromyalgia (P = 0.0001), attending lectures (P = 0.009), and being aware of diagnostic criteria (P = 0.0001). The prevalence of FM was high, and there was poor knowledge among medical students and physicians regarding fibromyalgia.

The existence of a bidirectional link between ischemic heart disease and fibromyalgia.

Fibromyalgia (FM) is one of the most common causes of chronic widespread musculoskeletal pain, but also sleep disturbances, cognitive and psychological disorders. It has been suggested that FM may have a correlation with cardiovascular events. In this study, we aimed to assess the association between FM and ischemic heart disease (IHD). A population-based cross-sectional study was conducted utilizing data retrieved from the largest medical records database in Israel, Clalit Health Services. Patients were defined as having FM or IHD when there were at least two such documented diagnoses in their medical records. The occurrence of IHD was compared between FM and age- and sex-frequency-matched healthy controls. A logistic regression model was used to estimate this association following an adjustment for conventional cardiovascular risk factors and depression. An overall population of 18 598 FM patients and 36 985 age- and gender-matched controls were included in the study. The proportion of IHD amongst FM patients was increased in comparison to controls (9.2% and 6.2%, respectively; P < 0.001). Furthermore, FM demonstrated an independent association with IHD on multivariate analysis (odds ratio [OR], 1.43; 95% confidence intervals [CI], 1.33-1.54; P < 0.0001). Finally, IHD was also found to be independently associated with the diagnosis of FM (OR, 1.40; CI, 1.31-1.51; P < 0.0001). Our data suggest a bidirectional link between FM and IHD even after the adjustment for conventional cardiovascular risk factors. These findings should be considered when treating patients with either FM or IHD, and their routine interactional screening may be of clinical importance.

Vasodilatory Peripheral Response and Pain Levels following Radiofrequency Stressor Application in Women with Fibromyalgia.

Fibromyalgia (FM) is a syndrome of unknown pathogenesis that presents, among other symptoms, chronic widespread musculoskeletal pain. This study aims to analyze the effects of radiofrequency on core body temperature and the peripheral temperature of the dorsal surfaces and palms of the hands and its association with pain levels in patients with FM. A case-control observational study was conducted with a total of twenty-nine women diagnosed with FM and seventeen healthy women. Capacitive monopolar radiofrequency was applied to the palms of the hands using the Biotronic Advance Develops device. Peripheral hand temperature was analyzed using a thermographic camera, and core body temperature was analyzed with an infrared scanner. Pressure pain thresholds (PPTs) and electrical pain were recorded with an algometer and a Pain Matcher device, respectively. A significant decrease was observed in women with FM in pain electrical threshold (95% CI [0.01-3.56], p = 0.049), electrical pain (95% CI [2.87-10.43], p = 0.002), dominant supraspinatus PPT (95% CI [0.04-0.52], p = 0.023), non-dominant supraspinatus PPT (95% CI [0.03-0.60], p = 0.029), and non-dominant tibial PPT (95% CI [0.05-0.89], p = 0.031). Women with FM have increased hypersensitivity to pain as well as increased peripheral temperature after exposure to a thermal stimulus, such as radiofrequency, which could indicate disorders of their neurovascular response.

Causal association between gut microbiota and fibromyalgia: a Mendelian randomization study.

Fibromyalgia (FM) is a syndrome characterized by chronic and widespread musculoskeletal pain. A number of studies have implied a potential association between gut microbiota and FM. However, the casual association between gut microbiota and FM remains unknown. Mendelian randomization (MR) study was conducted using the summary statistics of genetic variants from the genome-wide association study (GWAS). Inverse variance weighted (IVW), combined with MR-Egger and weighted median were used to investigate the causal association between 119 gut microbiota genera and FM. Sensitivity analyses were performed on the MR results, including heterogeneity test, leave-one-out test and pleiotropy test. A total of 1,295 single nucleotide polymorphism (SNPs) were selected as instrumental variables (IVs), with no significant heterogeneity and pleiotropy according to the sensitivity analyses. Five gut microbiota genera were found to have significant casual association with FM. Coprococcus2 (OR = 2.317, p-value = 0.005, 95% CI: 1.289-4.167), Eggerthella (OR = 1.897, p-value = 0.001, 95% CI: 1.313-2.741) and Lactobacillus (OR = 1.576, p-value =0.020, 95% CI: 1.073-2.315) can increase the risk of FM. FamillyXIIIUCG001 (OR = 0.528, p-value = 0.038, 95% CI: 0.289-0.964) and Olsenella (OR = 0.747, p-value = 0.050, 95% CI: 0.557-1.000) can decrease the risk of FM. This MR study found that gut microbiota is casually associated with FM. New insights into the mechanisms of FM mediated by gut microbiota are provided.

Headache, Migraines, Obesity and Medication Burden on Fibromyalgia Impact and Quality of Life

Fibromyalgia (FM) is a common, complex, and chronic pain disorder characterized by widespread musculoskeletal pain, fatigue, and tenderness in localized areas. A multitude of other central sensitization related symptoms contribute to a profound medication burden and diminished quality of life for affected individuals. We evaluated the impacts of gender, chronicity of headache, migraine, obesity and medication burden on overall FM impact. We used the following validated questionnaires: Fibromyalgia Impact Questionnaire (FIQR), Beck Depression Inventory (BDI), Central Sensitization Inventory (CSI) and measured weight and body mass index (BMI) on a large university cohort of FM subjects. We found that female subjects with FM showed a significant increase in FIQR compared to males with FM. Additionally, we noted positive correlations between weight (Wt) and FIQR, BDI and CSI; BMI and FIQR, and BMI and CSI. Fibromyalgia subjects with a history of migraines (FM-migraine) showed statistically significant increases in FIQR, BDI and CSI compared to FM subjects with no reported history of migraines (FM-non-migraine). There was a steady increase in FIQR, BDI and CSI values with an increase in the frequency of headaches in both the FM -migraine and FM -non-migraine groups. When evaluating BMI, when comparing survey responses of overweight and obese patients to normal weight patients, all FIQR, BDI and CSI values were significantly increased in the various classes of overweight except CSI for the overweight category which appeared to approach significance (p=0.057). There were no statistically significant differences in questionnaire responses for individuals with FM on medications relative to those on no medications. Taken together, a history of migraines and headaches, frequency of headaches and obesity may impact survey responses significantly, negatively impact quality of life and correlate with higher levels of depression but medication burden did not.

Fibromyalgia Animal Models Using Intermittent Cold and Psychological Stress.

Fibromyalgia (FM) is a chronic pain condition characterized by widespread musculoskeletal pain and other frequent symptoms such as fatigue, sleep disturbance, cognitive impairment, and mood disorder. Based on the view that intermittent stress would be the most probable etiology for FM, intermittent cold- and intermittent psychological stress-induced generalized pain (ICGP and IPGP) models in mice have been developed and validated as FM-like pain models in terms of the patho-physiological and pharmacotherapeutic features that are shared with clinical versions. Both models show long-lasting and generalized pain and female-predominant sex differences after gonadectomy. Like many other neuropathic pain models, ICGP and IPGP were abolished in lysophosphatidic acid receptor 1 (LPAR1) knock-out mice or by LPAR1 antagonist treatments, although deciding the clinical importance of this mechanism depends on waiting for the development of a clinically available LPAR1 antagonist. On the other hand, the nonsteroidal anti-inflammatory drug diclofenac with morphine did not suppress hyperalgesia in these models, and this is consistent with the clinical findings. Pharmacological studies suggest that the lack of morphine analgesia is associated with opioid tolerance upon the stress-induced release of endorphins and subsequent counterbalance through anti-opioid NMDA receptor mechanisms. Regarding pharmacotherapy, hyperalgesia in both models was suppressed by pregabalin and duloxetine, which have been approved for FM treatment in clinic. Notably, repeated treatments with mirtazapine, an α2 adrenergic receptor antagonist-type antidepressant, and donepezil, a drug for treating Alzheimer's disease, showed potent therapeutic actions in these models. However, the pharmacotherapeutic treatment should be carried out 3 months after stress, which is stated in the FM guideline, and many preclinical studies, such as those analyzing molecular and cellular mechanisms, as well as additional evidence using different animal models, are required. Thus, the ICGP and IPGP models have the potential to help discover and characterize new therapeutic medicines that might be used for the radical treatment of FM, although there are several limitations to be overcome.

Self-reported musculoskeletal pain, headache, jaw pain and swallowing dysfunction in a sample of young Saudi adults who stutter.

To report the prevalence of musculoskeletal pain, headache, jaw pain and difficulty in swallowing among people who stutter (PWS). The cross-sectioal study was conducted from October 3, 2021, to March 21, 2022, after approval from the ethics review committee of King Khalid University, Abha, Saudi Arabia, and comprised adult people who stutter belonging to different regions of Saudi Arabia. They were divided into five groups based on stuttering severity as estimated by Stuttering Severity Instrument-4. Data was collected on musculoskeletal pain in different body areas using a questionnaire.. Data ws analysed using SPSS 22. Of the 101 Arabic-speaking subjects, 63(62.4%) were males and 38(37.6%) were females. The overall mean age was 27±7 years (range: 18-39 years). The largest group was of subjects with moderate severity of stuttering 31(30.6%); 21(68%) males and 10(32%) females. The increase in number of musculoskeletal pain locations was related to the severity of stuttering (p<0.05). The most common musculoskeletal pain sites were the lower back 31(31%), neck 26(26%) and shoulder 26(26%). Frequent headaches and difficulty chewing hard food due to jaw pain were reported by 49(49%) and 22(22%) participants, respectively (p<0.05). Swallowing difficulty was reported by 9(9%) participants (p>0.05). Widespread chronic musculoskeletal pain of low intensity was found to be common among people who stuttered, and the number of pain locations was positively related to stuttering severity.

Investigation of Early Growth Response Protein (EGR) Levels in Patients with Fibromyalgia Syndrome: A Cross-Sectional Study.

Fibromyalgia is a soft tissue rheumatism characterized by chronic and widespread musculoskeletal pain at specific points in the body. In this study, we aimed to investigate the relationship between Early Growth Response (EGR1, EGR2, and EGR3) protein levels in patients with Fibromyalgia Syndrome (FMS) and healthy controls. In our studies, 76 FMS patient group and 78 healthy control group who were newly diagnosed with primary FMS according to the 2010 American College of Rheumatology criteria for fibromyalgia in Sivas Cumhuriyet University Hospital, Physical Therapy, and Rehabilitation were used. Venous blood samples were taken from both groups for the measurement of EGR1, EGR2, and EGR3 protein plasma levels, and protein levels were determined using ELISA methods. Statistical parametric test assumptions were compared using the Independent Student's t-test. In addition, specificity, sensitivity, and AUC values were calculated with the ROC curve. The relationship between plasma EGR1 protein levels of FMS patients and control groups was statistically significant (p=0.001). EGR1 protein levels were found to be lower in the patient group diagnosed with FMS compared to the control group. It has been suggested that EGR1 protein levels can be important in the diagnosis of FMS disease.

Adult-onset hypophosphatemic osteomalacia as a cause of widespread musculoskeletal pain: A retrospective case series of single center experience

BACKGROUND Osteomalacia (OM) is frequently confused with various musculoskeletal or other rheumatic diseases, especially in patients with adult-onset widespread musculoskeletal pain because of its low prevalence and non-specific manifestations. AIM To facilitate the early diagnosis and etiology-specific treatment of adult-onset hypophosphatemic OM. METHODS A retrospective review of medical records was performed to screen adult patients who visited a physiatry locomotive medicine clinic (spine and musculoskeletal pain clinic) primarily presenting with widespread musculoskeletal pain at a single tertiary hospital between January 2011 and December 2019. We enrolled patients with hypophosphatemia, high serum bone-specific alkaline phosphatase levels, and at least one imaging finding suggestive of OM. RESULTS Eight patients with adult-onset hypophosphatemic OM were included. The back was the most common site of pain. Proximal dominant symmetric muscle weakness was observed in more than half of the patients. Bone scintigraphy was the most useful imaging modality for diagnosing OM because radiotracer uptake in OM showed characteristic patterns. Six patients were diagnosed with adefovir (ADV)-induced Fanconi syndrome, and the other two patients were diagnosed with tumor-induced OM and light-chain nephropathy, respectively. After phosphorus and vitamin D supplementation and treatment for the underlying etiologies, improvements in pain, muscle strength, and gait were observed in all patients. CONCLUSION Mechanical pain characteristics, hypophosphatemia, and distinctive bone scintigraphy patterns are the initial diagnostic indicators of adult-onset hypophosphatemic OM. ADV-induced Fanconi syndrome is the most common etiology of hypophosphatemic OM in hepatitis B virus-endemic countries.

Assessment of the therapeutic potential of lutein and beta-carotene nanodispersions in a rat model of fibromyalgia

Fibromyalgia (FM) is a chronic disorder characterized by widespread musculoskeletal pain, fatigue, and cognitive impairment. Despite the availability of various treatment options, FM remains a challenging condition to manage. In the present study, we investigated the efficacy of formulated nanodispersions of lutein and beta-carotene in treating FM-related symptoms induced by reserpine in female Wistar rats. Several techniques have been implemented to assess this efficacy at various levels, including biochemical, bioelectrical, and behavioral. Namely, oxidative stress markers, monoamine levels, electrocorticography, pain threshold test, and open field test were conducted on control, FM-induced, and FM-treated groups of animals. Our results provided compelling evidence for the efficacy of carotenoid nanodispersions in treating FM-related symptoms. Specifically, we found that the dual action of the nanodispersion, as both antioxidant and antidepressant, accounted for their beneficial effects in treating FM. With further investigation, nano-carotenoids and particularly nano-lutein could potentially become an effective alternative treatment for patients with FM who do not respond to current treatment options.

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 &gt; 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.

Significant use of non-evidence-based therapeutics in a cohort of Australian fibromyalgia patients.

Fibromyalgia is a common condition characterised by chronic widespread musculoskeletal pain and central sensitivity features. Appropriate management requires a multidisciplinary approach prioritising non-pharmacological strategies. Evidence-based fibromyalgia medications are not always easily available, effective or tolerated. To characterise actual medication usage in Australian fibromyalgia patients. Demographic and clinical data, including medication use information, were gathered by chart review from patients attending the Monash Fibromyalgia Clinic between January 2019 and June 2022. Eligible patients were invited to complete an anonymous questionnaire between June and August 2022 to assess current therapeutic use. The questionnaire assessed fibromyalgia clinical features by using the Revised Fibromyalgia Impact Questionnaire and the 2016 modified American College of Rheumatology Fibromyalgia criteria. The chart review included 474 patients, and 108 participants completed the questionnaire. Most chart review (78.7%) and questionnaire participants (85.2%) reported using at least one medication for their fibromyalgia. 48.5% of chart review patients and 58.3% of questionnaire participants reported using at least one evidence-based medication, usually amitriptyline, duloxetine or pregabalin. However, the most common individual medications for questionnaire participants were non-steroidal anti-inflammatory drugs (48.2%), paracetamol (59.3%) and opioids (34.3%), with most opioids being typical opioids. Among questionnaire participants, 14.8% reported using cannabinoids, and 70.4% reported using at least one supplement, vitamin or herbal/naturopathic preparation. Not all medication or substance use was recorded during clinic appointments. Fibromyalgia patients engage in various pharmacotherapeutic strategies that are not always evidence-based or disclosed to their treating clinicians.

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

Can open label placebos improve pain and gluten tolerance via open label placebos in fibromyalgia patients? A study protocol for a randomised clinical trial in an outpatient centre

IntroductionFibromyalgia syndrome (FMS) is defined as a medical condition with chronic widespread musculoskeletal pain accompanied by mood disorders, fatigue and sleep disturbances. Treatment of this condition can often be challenging....

Prevalence and Risk Factors of De Novo Widespread Post-COVID Pain in Nonhospitalized COVID-19 Survivors: A Nationwide Exploratory Population-Based Survey

This survey investigated the prevalence of de novo widespread musculoskeletal post-COVID pain and risk factors for its development in nonhospitalized COVID-19 survivors. A nationwide exploratory cross-sectional study was conducted, including a cohort of 593,741 Danish residents who had suffered from a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection from March 2020 to December 2021. A questionnaire was distributed to the Danish population via the digital mail system (e-Boks). Self-reported demographic data, previous medical comorbidities (diagnosed), socioeconomic data, time of infection, prior chronic pain conditions (diagnosed), development of de novo widespread pain after infection, pain medication, and pain intensity information were collected. Responders consisted of 130,443 nonhospitalized participants (58.2% women; mean age: 50.2 years). At a mean of 14.4 (standard deviation 6.0) months after infection, 6,875 (5.3%) patients reported the presence of de novo widespread musculoskeletal post-COVID pain. Almost 75% of the patients reported a moderate to severe intensity of the pain. In conclusion, de novo widespread post-COVID pain was present in 5.3% of nonhospitalized COVID-19 survivors 1 year after infection (14.4 ± 6.0 months). Older age, female sex, higher BMI, and history of migraine, whiplash, stress, type-2 diabetes, neurological disorders, and lower socioeconomic status were risk factors associated with the development of de novo widespread post-COVID pain in nonhospitalized patients. As de novo widespread pain is considered a sign of sensitization, this group will require specialized pain management attention. PerspectiveThis article presents de novo widespread post-COVID pain prevalence in a cohort of 130,443 citizens infected with COVID-19. The study identifies potential risk factors associated with the development of these new pain symptoms. The results may increase focus on this patient group and potentially help identify predictors for postinfection pain development.

Neuropsychiatric Factors Involved in the Development of Fibromyalgia: A Literature Review

Fibromyalgia is a complex neuropsychiatric disorder characterized by widespread musculoskeletal pain, tenderness, and fatigue. Its exact cause remains unknown, but genetic predisposition, physical or emotional trauma, and disturbances in pain processing are believed to play significant roles. The condition redominantly affects women and can occur at any age. Diagnosis is challenging due to the absence of specific tests, but criteria set by the American College of Rheumatology aid in identification. Management involves a combination of pharmacological and non-pharmacological approaches, with analgesics, antidepressants, and anticonvulsants used for pain relief. Non-pharmacological treatments include physical therapy, cognitive-behavioral therapy, and stress-reduction techniques. Neuropsychiatric factors, such as stress, trauma, depression, anxiety, and altered pain processing, play crucial roles in fibromyalgia’s development and maintenance.