The significance of the sleeping-waking brain for the understanding of widespread musculoskeletal pain and fatigue in fibromyalgia syndrome and allied syndromes

Faculty of Medicine, University of Toronto, Sleep Disorders Clinic of the Centre for Sleep and Chronobiology, 340 College Street, Suite 580, Toronto, ON MST 3A9, Canada.
Joint, bone, spine: revue du rhumatisme (Impact Factor: 3.22). 08/2008; 75(4):397-402. DOI: 10.1016/j.jbspin.2008.01.021
Source: PubMed

ABSTRACT The clinical focus of rheumatologists on the widespread pain and numerous tender points in specific anatomic regions in their patients who show no evidence for disease pathology has lead to the characterization of such peripheral symptoms as a specific disorder of the musculoskeletal system, now commonly known as fibromyalgia. This rheumatologic diagnostic entity has resulted in relative inattention to an understanding of their patients' common complaints of unrefreshing sleep, chronic fatigue and psychological distress. Experimental evidence from humans and animal studies indicate that there is an inter-relationship of disturbances in the physiology of the sleeping-waking brain with the widespread musculoskeletal pain, chronic fatigue, and psychological distress in patients with hitherto unexplained pain/fatigue illnesses, e.g., fibromyalgia and chronic fatigue syndromes. The emerging knowledge of the dysfunction of the nervous system in such patients has lead to the study of novel medications that affect neurotransmitter functions, e.g., pregabalin, serotonin/noradrenaline compounds and sodium oxybate that are shown to improve many of the symptoms of such patients.

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    ABSTRACT: The authors tested the hypothesis that obstructive sleep apnea (OSA) signs/symptoms are associated with the occurrence of temporomandibular disorder (TMD), using the OPPERA prospective cohort study of adults aged 18 to 44 years at enrollment (n = 2,604) and the OPPERA case-control study of chronic TMD (n = 1,716). In both the OPPERA cohort and case-control studies, TMD was examiner determined according to established research diagnostic criteria. People were considered to have high likelihood of OSA if they reported a history of sleep apnea or ≥ 2 hallmarks of OSA: loud snoring, daytime sleepiness, witnessed apnea, and hypertension. Cox proportional hazards regression estimated hazard ratios (HRs) and 95% confidence limits (CL) for first-onset TMD. Logistic regression estimated odds ratios (OR) and 95% CL for chronic TMD. In the cohort, 248 individuals developed first-onset TMD during the median 2.8-year follow-up. High likelihood of OSA was associated with greater incidence of first-onset TMD (adjusted HR = 1.73; 95% CL, 1.14, 2.62). In the case-control study, high likelihood of OSA was associated with higher odds of chronic TMD (adjusted OR = 3.63; 95% CL, 2.03, 6.52). Both studies supported a significant association of OSA symptoms and TMD, with prospective cohort evidence finding that OSA symptoms preceded first-onset TMD.
    Journal of dental research 05/2013; 92(S7). DOI:10.1177/0022034513488140 · 4.14 Impact Factor
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    New Insights into Fibromyalgia, 01/2012; , ISBN: 978-953-307-407-8
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    ABSTRACT: This study aimed to evaluate the efficacy of cognitive-behavioral therapy for insomnia (CBT-I) on polysomnographic parameters in patients with fibromyalgia (FM). Twenty-six women with FM participated in the study and were randomly assigned to a CBT-I (n = 13) group or sleep hygiene (SH) condition (n = 13). The evaluation consisted in two interview sessions and domiciliary polysomnography study before and after treatment. The results show that time-in-bed and wake percentage diminish after CBT-I. Improvements were also observed in sleep efficiency, which was close to normal levels. The percentage of NREM stage 1 sleep decreased and NREM stages 3 sleep and 4 increased. Similarly, light sleep (stages 1 and 2) diminished and deep sleep increased (stages 3 and 4) after CBT-I. No improvements were observed in any of these parameters in the individuals undergoing SH therapy. This randomized controlled trial provides new evidence that the use of CBT-I in FM patients can significantly improve objective sleep parameters. KEYWORDS. Fibromyalgia. Insomnia. Cognitive-behavioral therapy. Domiciliary polisomnography. Randomized controlled trial.
    International Journal of Clinical and Health Psychology 01/2012; 12(1):39-53. · 2.79 Impact Factor


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