Fibromyalgia syndrome: review of clinical presentation, pathogenesis, outcome measures, and treatment.
ABSTRACT Fibromyalgia syndrome (FM) is a common chronic pain condition that affects at least 2% of the adult population in the USA and other regions in the world where FM is studied. Prevalence rates in some regions have not been ascertained and may be influenced by differences in cultural norms regarding the definition and attribution of chronic pain states. Chronic, widespread pain is the defining feature of FM, but patients may also exhibit a range of other symptoms, including sleep disturbance, fatigue, irritable bowel syndrome, headache, and mood disorders. Although the etiology of FM is not completely understood, the syndrome is thought to arise from influencing factors such as stress, medical illness, and a variety of pain conditions in some, but not all patients, in conjunction with a variety of neurotransmitter and neuroendocrine disturbances. These include reduced levels of biogenic amines, increased concentrations of excitatory neurotransmitters, including substance P, and dysregulation of the hypothalamic-pituitary-adrenal axis. A unifying hypothesis is that FM results from sensitization of the central nervous system. Establishing diagnosis and evaluating effects of therapy in patients with FM may be difficult because of the multifaceted nature of the syndrome and overlap with other chronically painful conditions. Diagnostic criteria, originally developed for research purposes, have aided our understanding of this patient population in both research and clinical settings, but need further refinement as our knowledge about chronic widespread pain evolves. Outcome measures, borrowed from clinical research in pain, rheumatology, neurology, and psychiatry, are able to distinguish treatment response in specific symptom domains. Further work is necessary to validate these measures in FM. In addition, work is under way to develop composite response criteria, intended to address the multidimensional nature of this syndrome. A range of medical treatments, including antidepressants, opioids, nonsteroidal antiinflammatory drugs, sedatives, muscle relaxants, and antiepileptics, have been used to treat FM. Nonpharmaceutical treatment modalities, including exercise, physical therapy, massage, acupuncture, and cognitive behavioral therapy, can be helpful. Few of these approaches have been demonstrated to have clear-cut benefits in randomized controlled trials. However, there is now increased interest as more effective treatments are developed and our ability to accurately measure effect of treatment has improved. The multifaceted nature of FM suggests that multimodal individualized treatment programs may be necessary to achieve optimal outcomes in patients with this syndrome.
SourceAvailable from: Susana Cristina Lerosa Telles[Show abstract] [Hide abstract]
ABSTRACT: The Brazilian physiotherapists are working in Sleep field in Brazil, both in clinical practice and research. There are only a few professionals in light of the huge demand of sleep disorders patients. This text aims to gather evidence and propose protocols to produce guidelines of clinical practice in the performance of physiotherapists in Brazil. It addresses Obstructive Sleep Apnea Syndrome, Neuromuscular Disorders, Restless Legs Syndrome, Periodic Leg Movements, Fibromyalgia and Sleep Bruxism.
[Show abstract] [Hide abstract]
ABSTRACT: The literature shows that more than 30% of the patients with fibromyalgia feel that their symptoms are not managed well. In addition, care for patients with rheumatoid arthritis is not consistent with guidelines for early, aggressive treatment and access to care is not optimal. My thesis describes our research with regard to several activities for care improvement and includes 6 peer reviewed publications. Part I of the thesis focuses on fibromyalgia. (Cost) effectiveness of a multidisciplinary intervention with aftercare (MD) for recently diagnosed patients was assessed in a randomised controlled trial comparing the results of the intervention with aerobic exercise (AE) and with usual care (UC). Our results showed that most outcomes improved over time and in health care costs reduced in the three groups. However, between group differences were small and we could not conclude about the effectiveness of the MD intervention. Program costs are not offset by subsequent savings in health care costs. Being employed and full participation in an intervention are independently associated with the patient’s global impression of improved health, whereas a longer duration of symptoms and higher perceived limitations in physical functioning contribute to a worse experience of health. Part II focuses on the role of the nurse in the care for patients with inflammatory arthritis. Based on evidence from a systematic review of the literature and expert opinions 10 European League Against Rheumatism (EULAR) recommendations for the role of the nurse in the management of inflammatory arthritis were formulated; seven recommendations cover the role of the nurse in care and management, whereas three recommendations focus on professional support for nurses. Subsequently, the recommendations were disseminated and evaluated. A web-based survey among nurses, rheumatologists and patients from 22 European countries and the USA showed a high level of agreement but a substantially lower level of application in daily practice. Agreement and application were lowest in Eastern- and Central Europe. Many reasons for disagreement with the recommendations and barriers to the application of the recommendations were reported that can be used to develop tailored strategies supporting further implementation of the recommendations for rheumatology nursing care.03/2014, Degree: PhD, Supervisor: Prof.dr.R. Landewé, Prof.dr. A. Boonen
[Show abstract] [Hide abstract]
ABSTRACT: Background The prevalence of fibromyalgia increases worldwide and is characterized by widespread and chronic pain. Treatment is difficult and includes both drug and non-drug approaches. Milnacipran, an antidepressant, is used for fibromyalgia, with a possible beneficial effect on central pain modulation. Our hypothesis is that the efficacy of milnacipran in fibromyalgia depends on the performance of pain inhibitory controls. Methods/design A randomized, double blind, clinical trial (NCT01747044) with two parallel groups, in 48 women with fibromyalgia, is planned in the Clinical Pharmacology Center, University Hospital, Clermont-Ferrand, France. Conditioned pain modulation (estimated with thermal stimuli using a numeric pain rating scale), the primary endpoint measure, is evaluated before and one month after treatment with milnacipran or placebo. Secondary outcome measures include the predictability of pain descending pathways performance for milnacipran efficacy, tolerance and cognitive function. Data analysis is performed using mixed models; the tests are two-sided, with a type I error set at alpha = 0.05. Not only will this trial allow estimation of the beneficial effect of milnacipran on pain and on descending pain pathways but it will also evaluate whether the performance of this modulatory system could be predictive of its efficacy in alleviating pain. Discussion This method would allow clinicians to take a pro-active attitude by performing a rapid psychophysical test before starting milnacipran treatment and would avoid unnecessary prescription while preventing therapeutic failure in patients who often face this recurrent problem. Trial registration ClinicalTrials.gov NCT01747044.Trials 04/2015; 16(1). DOI:10.1186/s13063-015-0659-4 · 2.12 Impact Factor