No full-text available
To read the full-text of this research,
you can request a copy directly from the authors.
Documento de consenso sobre el diagnóstico y tratamiento de la fibromialgia en Cataluña
Abstract
La fibromialgia (FM) es una enfermedad cronica y compleja que provoca dolores extensos que pueden llegar a ser invalidantes, y afecta a la esfera biologica, psicologica y social del paciente. La FM es un problema de salud dada su elevada prevalencia y morbilidad, su alto indice de frecuentacion y el elevado consumo de recursos sanitarios que provoca 1 . El Pla de Salut de Catalunya 1996-1998 ya recoge este problema, fruto del cual se elaboraron unos Criterios Comunes Minimos para la Atencion de Enfermos con Fibromialgia. Debido a la evolucion de los conocimientos que ha acontecido en los ultimos anos y a la confirmacion de su alta prevalencia y morbilidad, se ha constituido un grupo de trabajo multidisciplinario con la voluntad de redactar un documento orientativo, a modo de guia de practica clinica, que estructure y homogeneice los conceptos y actitudes que se pueden aplicar a estos pacientes.
... Si bien el beneficio para la salud que resulta del consumo habitual de frutas y vegetales frescos está claramente probado, existe una creciente proporción de brotes de enfermedades transmitidas por alimentos que han sido relacionadas con frutas y vegetales frescos, lo que ha puesto en entredicho la seguridad de las frutas y vegetales no sometidas a procesamientos para 2,4 reducir o eliminar microorganismos patógenos. ...
... Además, en este tipo de vegetales se ha encontrado contaminación con huevos de parásitos como Ascaris lumbricoides, Trichuris trichiura, quistes de Entamoeba histolytica, Giardia lamblia y virus como hepatitis A, Norwalk y rotavirus. Lo anterior podría atribuirse a que estos vegetales crecen muy cerca de los suelos de cultivo y por lo tanto tienen mayor probabilidad de ser contaminados con 3,4 microorganismos presentes en la tierra. ...
... A continuación, con el sedimento se procedió a la observación microscópica de vermes y protozoarios. Posteriormente se realizó el método 4 de flotación Willis. ...
La fibromialgia (FM) es una afección de curso crónico y fluctuante de etiología desconocida, caracterizada por la presencia de dolor crónico musculo-esquelético generalizado, con bajo umbral de dolor, hiperalgesia y alodinia (dolor producido por estímulos habitualmente no dolorosos). El tratamiento de la FM se orienta al control de los síntomas que predominan en cada paciente. Esta conducta se basa suficientemente en que se
trata de una patología sin una etiología clara y demostrada hasta hoy. En este artículo de revisión se presentan los cuatro pilares del tratamiento actual de la FM, considerados todos igualmente importantes.
... La Fibromialgia (FM) es una enfermedad de causa desconocida que responde a un incremento de la percepción del dolor a nivel del Sistema Nervioso Central. (1) Es reconocida por todas las organizaciones médicas internacionales y por la OMS desde 1992. Su alta prevalencia la ha convertido en un problema asistencial de primera magnitud. ...
... Este síndrome está acompañado de sueño no reparador y fatigabilidad que afecta de forma severa a la salud. (1) Puede presentarse como única alteración o asociada a otras enfermedades. No tiene causa conocida y antes de llegar al diagnóstico definitivo, la persona con fibromialgia puede haber consultado a diferentes especialistas (digestivo, corazón, traumatología, psiquiatría, reumatología, rehabilitación...). ...
... El paciente tiene que presentar dolores generalizados en los 4 cuadrantes del cuerpo más la espalda, por un período de al menos 3 meses, y debe tener dolor en 11 de los 18 puntos sensibles, establecidos para su diagnóstico. (1) Ante la dificultad del diagnóstico y la poca efectividad del tratamiento, muchas personas con FM desconfían del modelo médico hegemónico y recurren cada vez más a las terapias alternativas para dar respuesta a sus problemas de salud. (6) Para ello, y basándonos en la experiencia de estudios anteriores (10)(11) vamos a realizar una serie de Talleres de relajación, actividad física, autoestima, higiene postural e intervención psicológica. ...
Through our daily activities in the health center we have detected a growing demand from patients that go to family medical clinics for treatment, information, nursing and social work, that have been weakened by fibromyalgia (FM). FM patients are confronted with society's and health professional's ignorance of this syndrome. Faced with this problem, we the nurses at the Health Center, have decided to design an educational activity for healthcare professionals to update their knowledge about this syndrome of chronic pain and to promote among these patients further knowledge, skills and attitudes to understand and accept the disease, improve communication, as well as teaching healthy living and promoting associations. We must act on them individually with a personalized assessment and collectively, with relaxation workshops, physical activity, self-esteem, healthy posture and psychological intervention. The methodology we use is both theoretical expositions as well as interrogative method and group dynamics. We hope to present the different interventions for the management of FM, especially those with strong evidence of effectiveness. And from now on, to work with these patients, we will have a standardized care plan for patients with FM.
... Se trata de un síndrome clínico, de etiología desconocida, que provoca dolor musculoesquelético crónico, difuso e incapacitante. Se suele acompañar de trastornos como fatiga, alteraciones del sueño, jaquecas o colon irritable, entre otros [1][2][3][4][5]. El tipo de pacientes con esta sintomatología representa hasta el 20% de personas atendidas por primera vez en consultas de reumatología [2]. ...
... Varios autores la caracterizan, además, por disminuir considerablemente la calidad de vida de quienes la padecen [7,8]. Por estas razones, así como por el consumo de recursos sanitarios, constituye un problema de salud pública de primer orden [1,3] que suscita un creciente interés en la comunidad científi ca. Prueba de ello es el incremento de investigaciones y artículos publicados sobre el tema, que en el período de 1996 a 2005 se triplicaron respecto a la década anterior [8]. ...
Introduction:
Fibromyalgia is rheumathological disease a combination of physical, psychological and social limitations. The aim of the present study is to determinate the benefits of Ai Chi program on quality of life, depression and pain.
Patients and methods:
An experimental study was performed with 20 fibromyalgia patients two different cities. Outcome measures were functional capacity (Fibromyalgia Impact Questionnaire), pain (Visual Analogue Scale) and quality of life (Short Form-36). Measures were performed at baseline and after ten weeks post-intervention.
Results:
After ten weeks of treatment, the results showed significant reduction (p < 0,05) in virtually all outcome measures.
Conclusion:
An Ai Chi aquatic therapy programme contributes to reduce pain and improve quality of life as well as physical and mental health in patients with fibromyalgia.
... Se trata de un síndrome clínico, de etiología desconocida, que provoca dolor musculoesquelético crónico, difuso e incapacitante. Se suele acompañar de trastornos como fatiga, alteraciones del sueño, jaquecas o colon irritable, entre otros [1][2][3][4][5]. El tipo de pacientes con esta sintomatología representa hasta el 20% de personas atendidas por primera vez en consultas de reumatología [2]. ...
... Varios autores la caracterizan, además, por disminuir considerablemente la calidad de vida de quienes la padecen [7,8]. Por estas razones, así como por el consumo de recursos sanitarios, constituye un problema de salud pública de primer orden [1,3] que suscita un creciente interés en la comunidad científi ca. Prueba de ello es el incremento de investigaciones y artículos publicados sobre el tema, que en el período de 1996 a 2005 se triplicaron respecto a la década anterior [8]. ...
... Según Collado et al. (2002), la fibromialgia constituye un síndrome crónico de etiología desconocida caracterizado por la presencia de dolor generalizado en el paciente, que puede llegar incluso a ser incapacitante para el mismo. Afecta a las esferas biológica, psicológica y social de los enfermos, representando un elevado costo para la sanidad pública. ...
... Patients affected by fibromyalgia usually suffer pain and depressive symptoms, which causes a significant reduction in their quality of life. Fibromyalgia is a psychosomatic disease characterized by generalized pain, in some parts or throughout the whole body (Collado et al., 2002). In order to relieve this symptomatology, a group of fourteen women with fibromyalgia took part in a training program in Mindfulness-Based Stress Reduction (MBSR). ...
Patients affected by fibromyalgia usually suffer pain and depressive symptoms, which cause a significant reduction in their quality of life. In order to relieve this symptomatology, a training program in Mindfulness-Based Stress Reduction (MBSR) was applied to a group of 14 women with fibromyalgia during an eight-week period. The patients showed a significant improvement in the post-treatment assessment in terms of their quality of life, the presence and intensity of pain and depressive symptoms. Similarly, they developed more adaptive strategies to cope with pain, based on self-affirmation variables and information searching. However these results were not maintained in the one-month follow-up, with patients thus experiencing a relapse in the majority of the variables studied. Women who continued with post-treatment mindfulness meditation broadly maintained the acquired improvements.
... Según Collado et al. (2002), la fibromialgia constituye un síndrome crónico de etiología desconocida caracterizado por la presencia de dolor generalizado en el paciente, que puede llegar incluso a ser incapacitante para el mismo. Afecta a las esferas biológica, psicológica y social de los enfermos, representando un elevado costo para la sanidad pública. ...
... Patients affected by fibromyalgia usually suffer pain and depressive symptoms, which causes a significant reduction in their quality of life. Fibromyalgia is a psychosomatic disease characterized by generalized pain, in some parts or throughout the whole body (Collado et al., 2002). In order to relieve this symptomatology, a group of fourteen women with fibromyalgia took part in a training program in Mindfulness-Based Stress Reduction (MBSR). ...
Patients affected by fibromyalgia usually suffer pain and depressive symptoms, which cause a significant reduction in their quality of life. In order to relieve this symptomatology, a training program in Mindfulness-Based Stress Reduction (MBSR) was applied to a group of 14 women with fibromyalgia during an eight-week period. The patients showed a significant improvement in the post-treatment assessment in terms of their quality of life, the presence and intensity of pain and depressive symptoms. Similarly, they developed more adaptive strategies to cope with pain, based on self-affirmation variables and information searching. However, these results were not maintained in the one-month follow-up, with patients thus experiencing a relapse in the majority of the variables studied. Women who continued with post-treatment mindfulness meditation broadly maintained the acquired improvements.
... La medida de las concentraciones de tirotropina (TSH) en el suero se ha recomendado como prueba comple mentaria de primera línea en el diagnóstico de la fibro mialgia (FM) 1 , enfermedad emergente 2 de compleja identificación y con una prevalencia en la población ge neral española del 2,7% (4,2% en mujeres) 1 . Sin embar go, en la actualidad no hay datos acerca de la prevalen cia de disfunción tiroidea (DT) en pacientes con FM ni estudios de coste-eficiencia favorables a su escrutinio sistemático en sospechosos de presentarla. ...
... La medida de las concentraciones de tirotropina (TSH) en el suero se ha recomendado como prueba comple mentaria de primera línea en el diagnóstico de la fibro mialgia (FM) 1 , enfermedad emergente 2 de compleja identificación y con una prevalencia en la población ge neral española del 2,7% (4,2% en mujeres) 1 . Sin embar go, en la actualidad no hay datos acerca de la prevalen cia de disfunción tiroidea (DT) en pacientes con FM ni estudios de coste-eficiencia favorables a su escrutinio sistemático en sospechosos de presentarla. ...
Background and objective
Due to its prevalence, morbidity, and frequency rate, fibromyalgia (FM) represents a health problem and produces high healthcare resource utilization. Serum thyrotropin (TSH) measurement is recommended as a first-line laboratory test to exclude hypothyroidism as a cause of FM syndrome. The aim of this study was to analyze the prevalence of thyroid dysfunction (TD), the frequency of TSH measurement, the effect of levothyroxine treatment, and whether screening for TD is justified in women with suspected FM.
Patients and methods
A cross-sectional descriptive study was performed in 400 consecutive female outpatients with suspected FM and in 384 controls from January 2001 to October 2004. TSH measurement was used as the first line test to detect TD.
Results
The prevalence of TD in patients with suspected FM (40/400; 10%; 95% CI: 7-13%) and controls was similar (46/384; 12%; 95% CI: 9-15%). No differences were found in the types and grades of TD.
The prevalence of TD was higher in patients with suspected FM and connective tissue diseases (12%) than in those without these diseases (5%). The most frequent TD was subclinical hypothyroidism (5.5% in suspected FM and 6.7% in controls), and in 93% of these cases TSH concentrations were <10 mIU/L. FM persisted in all women with hypothyroidism even after euthyroidism was achieved with levothyroxine. A total of 870 TSH determinations were performed in 360 euthyroid patients with suspected FM.
Conclusions
The prevalence of TD in women with suspected FM does not differ from that in the general population. Screening for TD does not appear to be justified in women without diseases that increase their risk. In many cases the request for thyroid function tests is excessive. Treatment for hypothyroidism does not affect FM.
... It is a subjective reporting system that functioned as a physical and emotional self-assessment tool for the women before and after therapy. It consists of six variables (pain, fatigue, self-esteem, readiness, concentration and relaxation) which were selected from the Interdisciplinary Consensus Documents on the characterisation and treatment of FM (Carruthers & Van de Sande, 2006;Collado et al., 2002;Rivera et al., 2006). These variables have been deemed useful to evaluate the effectiveness of the music therapy programme in this specific population. ...
Fibromyalgia is a frequent disease, especially in women, and is recognised as a syndrome. Its effects can be very limiting, worsening your quality of life. In this paper, an adaptation of Priestley’s Analytical Music Therapy was applied through the symbolic use of improvised music in women with fibromyalgia with the aim of evaluating the subjective perception of relief or improvement of their symptoms. The study is based on 580 self-reports provided by 76 participants and obtained in 72 music therapy sessions carried out over six years and has a quasi-experimental research design with pretest-posttest measures and no control group. The perceived change experienced by the participants has been analysed in each of the dimensions of the Physical and Emotional Awareness Self-Assessment Wheel (CACFE) evaluation tool. The results showed that statistically significant changes occur when comparing the pre-post session reports: increase in concentration (68%), relaxation (65.5%), self-esteem (40.4%) and readiness (14.6%); and decrease in fatigue (51.9%) and pain perception (17.7%). In addition, an underlying structure of self-perceived change was found: through multidimensional scaling (MDS), two dimensions were found – intensity of change in relation to receptive techniques to access the unconscious, and driver of change through active techniques to explore the conscious mind and strengthen the self.
... La atención integral de la FM requiere de un enfoque terapéutico integral, focalizado en el desarrollo de los aspectos positivos, que influya en los diferentes sistemas implicados, haciendo al paciente capaz de experimentar elevados niveles de felicidad y de interés por las cosas (Aspinwall, 2001;Carver, 1998;Fredickson, 2001). Esta línea de investigación puede contribuir al desarrollo y difusión de programas de intervención que obtengan más beneficios en el tratamiento de los pacientes con FM, a la vez que reduzcan el consumo de recursos sanitarios, que se considera muy elevado (Clawn, 2001;Collado et al., 2002;Consensus Document of Fibromyalgia, 1993;Wolfe et al., 1997). Para atender a las personas con FM es necesario prestar atención a sus aspectos psicosociales partiendo de un enfoque biopsicosocial y no estrictamente biomédico (Gordon, 2003;Okifuji y Turk, 2002;Winfield, 2000). ...
La fbromialgia, que ocurre generalmente en mujeres, se caracteriza por dolor músculo-esquelético generalizado, asociado a trastornos del sueño, altos niveles de ansiedad o depresión, con repercusiones en la capacidad de trabajo, y en la vida familiar y social, todo lo cual afecta su capacidad funcional y calidad de vida. Sus repercusiones psicosociales requieren un manejo integral, aunque no es frecuente encontrar reportes de intervenciones hechas en talleres grupales con técnicas derivadasde la psicología positiva, centradas no tanto en disminuir los efectos negativos como en propiciar emociones positivas que fomenten satisfacción y felicidad. El presente artículo da cuenta de la efcacia de una intervención conformada por trece sesiones cuyo objetivo fue aumentar la felicidad y la satisfacción vital y disminuir el dolor y los estados emocionales negativos. Para ello, se utilizó un diseño experimental, con grupos control y experimental, cada uno con 79 pacientes, en quienes se midieron distintas variables antes y después de la intervención mediante instrumentos válidos y confables usados en estudios previos. La intervención generó cambios favorables en la calidad de vida y disminuyó la intensidad del dolor y los niveles de profundidad de la depresión, no así losniveles de ansiedad. Las pacientes expresaron una considerable satisfacción con la intervención.
... As for gender, it is women who suffer most from the disease with a ratio of 9: 1 with respect to men (20); age of onset is between 35 and 55 years (23). It is a disease that affects the biological, psychological and social spheres of the patient and it is considered to be a major health problem because of its prevalence, high morbidity and high rate of utilization and consumption of health resources (24). ...
Introduction: Fibromyalgia is a condition that affects up to 5% of the population and causes significant deterioration of the quality of life for the sufferer, so it is a therapeutic challenge. The objective of the present study was to describe the experience of the AtlasPROfilax® method in patients with fibromyalgia diagnosed according to the criteria of the American College of Reumatology (ACR) 2010.
Methodology: A cross - sectional study with 63 patients with fibromyalgia was done. Patients were monitored two and six months after applying the AtlasPROfilax® method, in order to evaluate the pain level by visual analogue scale VAS and reevaluate ACR criteria in the follow-up appointment.
Results: The average age of patients was 48.5 SD 12.6 years, 95.24% were female. 100% of patients improved pain (initial VAS of 8 vs 4 and 3 after two and six months respectively) and these were significant results. A reduction of widespread pain index as well as a reduction in the presence of symptoms such as fatigue, non-restorative sleep and cognitive disorders that are typical of fibromyalgia were also found in 46% of cases
Conclusion: This study has provided evidence of the effectiveness of the neuromuscular stimulation method of the suboccipital musculature called AtlasPROfilax® in the treatment of fibromyalgia. Randomized and controlled studies are required to demonstrate the medium and long term effectiveness of this therapeutic alternative.
... La fibromialgia o síndrome de fibromialgia (FM) es una patología reumática crónica que presenta como característica principal dolor generalizado en el sistema osteomuscular, afectando de forma principal a músculos y tejidos blandos (estructuras ligamentosas y tendinosas) e incapacitando a la persona que la padece (Andreu y Sanz, 2005;Wolfe et al., 1990). Junto a la sintomatología dolorosa característica, en la FM aparecen otros tipos de síntomas entre los que destacan (Collado, Aljiotos, Benito et al., 2002;Cuevas, 2010;Gelman, Lera, Caballero y López, 2002;Prados y Miró, 2012): fatiga crónica (desde leve cansancio hasta agotamiento extremo), trastornos del sueño, Novedad y relevancia ¿Qué se sabe sobre el tema? ...
The aim of this study was to contribute to the knowledge of the variables that may be associated with memory performance in a group of patients with fibromyalgia (FM). The study examines the relationship among memory performance and socio-demographic, psychological and somatic variables; it also attempts to estimate the explanatory power of the studied variables in memory performance. A total of 20 participants diagnosed with FM completed various measures of memory performance (immediate recall, delayed recall, recognition and working memory), and different psychological (attentional span, anxious-depressive symptoms and personality) and somatic measures (somatic symptoms and pain intensity). Significant correlations were found among memory performance capacities and the different types of variables evaluated. The subsequent regression analysis showed that only the variables years of study, pain intensity and attentional span were independently associated with immediate recall, recognition memory and working memory. These findings suggest that in this sample the examined psychosocial and somatic variables are associated differentially with different memory capacities. This study contributes to learning more about variables associated with memory performance on FM.
... 3. VALORACIÓN FUNCIONAL DEL SFC SEGÚN ESCALA CLÍNICA. Se aplicó una escala clínica de graduación progresiva de menor (Grado I) a mayor afectación (Grado IV), ya empleada habitualmente en valoración funcional de patología reumatológica (17) y que valora el grado de afectación de los pacientes con SFC (Tabla 2). 4. VALORACIÓN DE COMORBILIDADES: Dada la importancia de la presencia de comorbilidades asociadas al SFC, se valoró específicamente la presencia de: 1) Fibromialgia, con aplicación de los criterios del American College of Rheumatology (1990), consensuados en Catalunya en el documento de un comité de expertos (18), 2) Síndrome seco ocular o bucal, corroborado con test de Schrimer patológico, 3) Obesidad definida según índice de masa corporal > 30, 4) Distimia evaluada con entrevista psicopatológica estructurada según los criterios del DSM-IV, 5) Disfunción tiroidal, evaluada en presencia de anticuerpos antitiroidales a título significativo y validación de actividad funcional hormonal con medida de tiroxina y TSH plasmática. 6) Colon irritable, definido según los criterios de Roma para esta enfermedad., 7) Endometriosis, definida por presencia de dismenorrea prolongada y (10).Este cuestionario está validado y es aplicable a cualquier tipo de población o enfermedad para valoración de CVRS. ...
Background: Chronic Fatigue Syndrome is a disabling disease that modifies the quality of life and supposes a marked functional impairment of patients. Aim of Study: In patients with CFS, to evaluate: 1) Health -related quality of life (HRQL) and Functional impairment (FI) parameters, 2) Gradation of FI with a clinical scale. 3) Presence and influence of comorbidity related to CFS, and 4) Relationship between HRQL and FI parameters in CFS with standard population values, and with values form a group of patients of similar age affected of Rheumatoid Arthritis (RA). Patients and Methods: Cross-sectional study with consecutive inclusion of 100 patients affected of CFS. Evaluation of: 1) Epidemiological data and work situation at diagnosis. 2) Function impairment evaluation with a clinical scale of progressive involvement (degrees I to IV). 3) Evaluation of comorbilities: Fibromyalgia, Sicca Syndrome, Obesity, Dysthymia, Thyroid dysfunction, Irritable Bowel Syndrome and Endometriosis 4) Evaluation of HRQL with the validated Medical Outcomes Study Short-Form (SF-36) questionnaire and evaluation of FI with the specific Standford Health Assessment Questionnaire (HAQ). 5) Comparison of results in CFS with those of general population and also with patients affected of RA. Results: In CFS, the functional impairment was moderate (II) In half of patients, and slight (I) or severe (III-IV) in a quarter, respectively. All dimensions of HAQ questionnaire were affected. HRQL parameters measured with SF-36 questionnaire were more affected in patients with CFS as compared to standard population values as well as in comparison to patients affected of RA. The dimensions mainly related to FI were physical function, physical role, vitality, social function and emotional role. There was a direct relationship between the clinical functional scale and most of the SF-36 dimensions. The function disability index measured by HAQ highly related with values of physical role and body pain from SF-36 questionnaire. Patients with CFS presented a mean ot 2.4 different types of comorbidity, with an inverse relationship with HRQL dimensions. Conclusions: In patients with CFS there is a clear decrease of HRQL and FI parameters, with significantly lower values as compared to standard population and also to patients with RA. The presence ot co morbidity supposes a major degree in functional disability. A clinical scale evaluating progressive degree of involvements was useful in the functional evaluation of patients with CFS. To potentially improve the HRQL and FI in patients with CFS we should address to modify those dimensions clearly affected, mainly physical function, body pain as well as treatment of comorbidities.
... El síndrome de fibromialgia (SFM) se caracteriza principalmente por la presencia de dolor crónico, difuso y generalizado, que puede llegar a ser invalidante y afectar a la esfera biológica, psicológica y social del paciente 1 . Dado que no existe ninguna prueba de laboratorio ni hallazgo radiológico específico para el diagnóstico del SFM, la valoración del dolor y de las consecuencias de la enfermedad en la calidad de vida de los afectados se considera fundamental para la evaluación de los sujetos con SFM. ...
... La fibromialgia es una patología de naturaleza crónica que afecta a nivel biológico (falta de energía, dolor, etc.), psicológico (ansiedad, depresión, etc.), y social, y que afecta a la calidad de vida tanto a nivel personal, social como laboral (Collado et al., 2002). ...
RESUMEN: En este estudio se analizan los efectos que un programa de medi-tación para el desarrollo de la conciencia plena (mindfulness), puede tener so-bre la salud percibida en un grupo de pacientes diagnosticados con fibromialgia. Participaron 33 pacientes diagnosticados de fibromialgia. Se realizó un diseño cuasiexperimental con medición pretest-postest-seguimiento, con un grupo ex-perimental y un grupo control. Como instrumento de evaluación se utilizó el Cuestionario SF-36. Los análisis estadísticos realizados muestran una mejora en las dimensiones funcionamiento físico, dolor corporal, salud general, fun-cionamiento social, rol emocional, salud mental, y componente mental una vez finalizada la intervención. Estas mejoras se mantienen en la evaluación de segui-miento realizada tres meses después de finalizada la intervención. Estos resultados son acordes con otras investigaciones donde se ha comprobado la eficacia de las técnicas de mindfulness en la mejora de pacientes con fibromial-gia. No obstante, el estudio presenta varias limitaciones que habría que subsanar en sucesivas investigaciones para dotar de mayor validez a los resultados obte-nidos. Palabras clave: meditación, conciencia plena, fibromialgia, salud percibida, in-tervención. Perceived health improvement through a mindfulness meditation development program in fibromyalgia patients ABSTRACT: This study analyzes the effects of a mindfulness development meditation program on perceived health in a group of patients diagnosed with fibromyalgia. Thirty-three patients diagnosed with fibromyalgia participated. A quasi-experimental pretest/posttest/follow-up design was carried out, with one experimental group and one control group. The SF-36 Questionnaire was used as the evaluation instrument. The statistical analyses done show an improvement in the dimensions physical functioning, bodily pain, general health, social functioning, role emotional, men-tal health, and mental component at the end of the intervention. These improve-ments are maintained in the follow-up test given three months after intervention. These results are in agreement with other studies which have found mindfulness techniques to be effective in improving patients with fibromyalgia. Nevertheless, the study shows various limitations that would have to be corrected in successive studies to bring more validity to the results.
... personas frente a poblaciones sanas (Birtane et al., 2007). Por otro lado, numerosos estudios han reflejado menores niveles de los pacientes con FM en estas escalas en comparación con otras patologías (Birtane et al., 2007), reflejando que la CDV del paciente está claramente afectada, especialmente en áreas de la función física y rol emocional, lo que influye de manera determinante sobre la capacidad para trabajar, así como para la vida social (Collado et al., 2002). Parece obvia la influencia de la depresión sobre la CDV de los pacientes con FM (Tander et al., 2008). ...
The aim of the current study was to determine the relationship between levels of depression and perceived quality of life based on the level of physical activity in patients with fibromyalgia in Seville (Spain). A total of 67 women diagnosed with fibromyalgia voluntarily participated in the study. The level of physical activity was assessed using the International Questionnaire of Physical Activity, the incidence of depression was assessed using the Beck Depression Inventory and their perceived quality of life using the SF-36. Significant differences between physical function and general health based on the depression categories in those with a moderate level of physical activity were found. In addition, high correlations were found between levels of depression and physical functioning (r = -.409, p < .05), general health (r = -.453, p < .05) and mental health (r = -.539, p < .05) among the participants. In conclusion, given the close relationship between depression and the perceived quality of life and the ability of physical activity to modulate these relationships in fibromyalgia patients, professionals should establish prevention strategies based on the promotion of physical activity to help improve health in this population.
... A. Tratamiento farmacológico Para algunos autores, es falso que el SFM se trate de una enfermedad incurable que inexorablemente conduce a la incapacidad laboral absoluta, o que no haya nada que hacer hasta que no aparezca un medicamento del todo eficaz 36 . Si recogemos las diferentes revisiones sistemáticas de la literatura médica actual reflejadas en los diferentes documentos realizados por expertos, podemos observar que se utilizan diversos fármacos para el tratamiento del SFM, que se apoyan en algunos ensayos clínicos de calidad que nos permiten medir su grado de eficacia [37][38][39] . En la Tabla 1 se mencionara el tipo de evidencia que posee cada uno de los medicamentos utilizados en SFM. ...
The Fibromyalgia Syndrome is a clinical syndrome of chronic widespread pain and reduced pain thresholds to palpation. The pathophysiology remains unknown, but there is increasing evidence that peripheral and central sensitization cause an amplification of sensory impulses that may alter pain perception in Fibromyalgia Syndrome patients. The multidisciplinary approach for its treatment is very important, against the traditional biomedical approach, because of the high complexity of the patients. Treatment should be directed by the physician, who makes the diagnosis and coordinates the interdisciplinary team, in which the psychologist conducting the initial assessment and cognitive behavioral therapy and the therapist makes the initial assessment and performs comprehensive rehabilitation treatment. In this review, we find the three most important areas of treatment of fibromyalgia syndrome, furthering the pharmacological treatment and physiotherapy, as literature review the most current scientific evidence.
... Fibromyalgia syndrome (FMS) is a chronic musculoskeletal disorder characterized by widespread and diffuse pain, often accompanied by fatigue, sleep disturbances, and depressed mood [1]. It significantly impairs the quality of life of the patients and can be highly disabling [2]. Since neither diagnostic laboratory tests nor specific radiological findings are available for its diagnosis, the assessment of pain severity and accompanying symptoms is considered essential on this regard, as well as its impact on the functional capacity and the quality of life of FMS patients. ...
The Revised version of the Fibromyalgia Impact Questionnaire (FIQR) was published in 2009. The aim of this study was to prepare a Spanish version, and to assess its psychometric properties in a sample of patients with fibromyalgia.
The FIQR was translated into Spanish and administered, along with the FIQ, the Hospital Anxiety Depression Scale (HADS), the 36-Item Short-Form Health Survey (SF-36), and the Brief Pain Inventory (BPI), to 113 Spanish fibromyalgia patients. The administration of the Spanish FIQR was repeated a week later.
The Spanish FIQR had high internal consistency (Cronbach's alpha was 0.91 and 0.95 at visits 1 and 2 respectively). The test-retest reliability was good for the FIQR total score and its function and symptoms domains (intraclass correlation coefficient [ICC] > 0.70), but modest for the overall impact domain (ICC = 0.51). Statistically significant correlations (p < 0.05) were also found between the FIQR and the FIQ scores, as well as between the FIQR scores and the remaining scales' scores.
The Spanish version of the FIQR has a good internal consistency and our findings support its validity for assessing fibromyalgia patients. It might be a valid instrument to apply in clinical and investigational grounds.
... Se están empleando diversas modalidades de tratamientos no farmacológicos, como los basados en intervenciones psicológicas bajo la denominación común de mente-cuerpo, para mejorar la actitud de los pacientes frente a la enfermedad 4 . Otros tratamientos no farmacológicos, tales como los rehabilitadores por medio de ejercicio físico y otras modalidades de medicina física, también se están usando cada vez más en el tratamiento de estos pacientes [5][6][7] . Por último, también se han probado múltiples modalidades de medicina alternativa y complementaria en el tratamiento de la FM 8,9 . ...
Fibromyalgia is a known disease, with a prevalence of around 2.5 % of the Spanish population over 20 years old. A significant aspect of the disease is that a certain amount of fibromyalgics declare that their illness appeared soon after suffering a mild or severe trauma. Patients with post-traumatic fibromyalgia show the same signs and symptoms as those with primary fibromyalgia and their prognosis is similar or somewhat worse than the latter. Among other factors determining the agreement with the diagnosis of post-traumatic fibromyalgia, is the specialty of the doctor: rheumatologists seem the most prone to accept it while the majority of orthopedists tend to reject it. According to different publications, the claim for compensation does not modify signs and symptoms or the outcome of these patients. In conclusion, forensic doctors should keep in mind the possibility that the injured patient that does not heal following the usual course of time may suffer from post-traumatic fibromyalgia.
Fibromyalgia is a chronic and complex pathology that provokes muscular pain which may become invalidant, associated to a badly night rest and fatigue that affects the biological, psychological and social environment of the patients. Its high prevalence makes fibromyalgia a first magnitude sanitary problem. The fact that its diagnostic criteria is only clinical, and that its aetiopathogenesis has not yet been clarified. This makes very difficult the study and therapeutical approach of the disease. The multidisciplinary approach for its treatment is very important, against the traditional biomedical approach, because of the high complexity of the patients. In this review, we try to bring together the current knowledgements in the literature, though it has to be highlighted that many studies and medical and paramedical references approach the topic with complete scientific rigour.
The purpose of the study was to design two cognitive behavioral treatments
(CBT) for people with fibromyalgia (FM): therapy with electromyographic
biofeedback (T1) and therapy without biofeedback (T2); and to assess their
effects on psychopathological symptoms. The study was carried out with 88
people diagnosed with FM, aged between 26 and 65 years; 33 received T1, 33
received T2, and 22 were assigned to a control group without treatment. An
evaluation was performed before and after a treatment of 10 sessions with the
“Symptom Checklist-90-Revised,” the “State-Trait Anxiety Inventory,” the “Beck
Depression Inventory” and “State-Trait Anger Expression Inventory”. The results
showed that participants who had received a treatment decreased symptoms of
hostility, state-anxiety, trait-anxiety, depression, trait-anger, and anger expression
(p< .05). The effects of the two treatments were similar, and no significant group
differences were found for any variable. The control group decreased less the
symptoms, increasing anxiety and anger. This work provides an efficacious tool to
reduce psychopathological symptoms and negative feelings in people with FM.
Background:
Fibromyalgia syndrome (FMS) is a rheumatic disorder that presents with physical, psychological and social symptoms.
Objective:
The aim of this study was to assess the effects of a program of water-based Ai Chi on the health-related quality of life of subjects with FMS.
Methods:
An experimental pilot study was performed with a sample of 20 female subjects diagnosed with FM and recruited from two different settings. Assessments were performed using the a visual analog scale and the Short Form-36 physical and mental health summary scores. Measurements took place at baseline and upon completion of 10 treatment sessions.
Results:
After 10 treatment sessions, significant improvements (P < 0.05) were found in practically all the variables under study, with significant differences in values such as pain perception, vitality, mental health, as well as perceived overall improvement in quality of life.
Conclusions:
A water-based Ai Chi program may contribute to the improvement of mental and physical health and the quality of life in women with FMS.
The goal was to find differences among fibromyalgic patients (FM), rheumatoid illness patients, and a healthy control group (n = 15 ea). The variables tested among each group were pain, depressive symptoms, anxiety, coping strategies, and childhood maltreatment. A discriminant analysis was made, obtaining two functions of high levels of fit. Patients with,FM and rheumatoid illness showed equal levels of pain; however, patients with FM experienced more childhood maltreatment, currently experiencing more depression, less anxiety symptoms, and coping strategies. These functions correctly classified 53.3% of patients with FM and 60.0% of the other two groups; versus 33.3% expected at random. It is expected that by including sexual abuse in childhood and helplessness in clinical reports, improves the ability to detect patients with FM.
Evaluar y comparar la eficacia de protocolos de craneopuntura con electroestimulación, lidocaína intravenosa (i.v.), ketamina i.v. y ozono en autohemoterapia como terapias complementarias al tratamiento habitual en la reducción del dolor y la mejora de la calidad de vida de pacientes con fibromialgia (FM).
El síndrome fibromiálgico es un síndrome clínico caracterizado por dolor crónico generalizado y reducción de los umbrales del dolor a la palpación. La fisiopatología sigue siendo desconocida, pero cada vez hay más evidencia de que la sensibilización periférica y central provocan una amplificación de los impulsos sensoriales que puede alterar la percepción del dolor en los pacientes.
El dolor es una experiencia subjetiva difícilmente evaluable por su variada expresión. Actualmente, la resonancia magnética funcional (RMf) permite objetivar la respuesta cerebral al estímulo doloroso.ObjetivoEvaluar la respuesta cerebral al dolor en pacientes con dolor crónico esencial generalizado diagnosticados de fibromialgia (FM).Sujetos y métodosSe administró un estímulo doloroso por presión mecánica a 15 pacientes con FM y 11 controles durante la adquisición de RMf. Se realizaron diversos ensayos de activación variando la presión ejercida sobre una superficie de 1 cm2 del dedo pulgar.ResultadosDurante la adquisición de RMf, la aplicación de una presión mecánica de 4 kg no ocasionó molestias relevantes en ningún sujeto control. Contrariamente, todos los pacientes, excepto uno, refirieron dolor moderado-grave con este estímulo. La RMf puso de manifiesto que, con poca presión (4 y 5 kg), es excepcional la activación de regiones distintas al área sensitivomotora primaria contralateral al dedo estimulado en los sujetos control. Sin embargo, 5 pacientes (p = 0,027), a 4 kg de presión, y 7 (p = 0,030), a 5 kg, activaron las regiones cerebrales conocidas como mediadoras de la respuesta al dolor (área sensitivomotora primaria, corteza parietal, ínsula y región del cíngulo anterior).ConclusionesLos resultados sugieren que una proporción significativa de pacientes diagnosticados de FM y con bajo umbral doloroso presentan una consistente respuesta cerebral al dolor con estímulos mecánicos de baja intensidad, mientras que en otra parte de los casos el cerebro responde de forma similar a los sujetos control.
Purpose: To determine groups in women with fibromyalgia syndrome (FM) based on symptomatology and determine cardiovascular parameters during treadmill exercise to prescribe them physical activity. Methods: Women (N =32, age =53.3 ± 6.6yr) were assigned into two different groups according to their functional capacity and symptomatology. During incremental treadmill exercise test, exercise intensity was increased until participants achieved volitional exhaustion (VO2max). Expired respiratory gases, ventilator parameters and heart rate (HR) were measured continuously during exercise and RPE was assessed each minute during the test. Results: Peak VO2 values for the group 1 were significantly different than for group 2 (24,9 ± 3,2 ml•kg-1•min-1 (Group 1) and 21,5 ± 2,1 ml•kg-1•min-1(Group 2)) similar ones to the found in other studies with women with FM, altough lower than anther populations without this pathology. On the other hand, if we take into account the VO2VT, we found no significant differences between groups in both trials. We found also differences in all the evaluated parameters. Conclusion: Depending on the level of affectation and the symptomatology of the FM patients, their aerobic capacities were differents; therefore, we are not be able to prescribe physical activity with the same intensity for both groups. According to those results, professionals could prescribe physical activity with a high security and control.
Objetivos: Describir la comorbilidad de pacientes con fibromialgia (FM) y analizar su posible relación con el estado funcional. Diseño: Transversal. Análisis descriptivo y de línea base de un ensayo clínico aleatorizado, multicéntrico (estudio FIBROQOL). Emplazamiento: Ámbito urbano. Marco de Atención Primaria (AP). Participantes: Criterios de inclusión: confirmación del diagnóstico de FM según criterios ACR 1990, 18-75 años. Criterios de exclusión: deterioro cognitivo, enfermedad reumatológica concomitante grave, esperanza de vida menor de 12 meses, analfabetismo. Se contactó con 484 sujetos, 268 se excluyeron (80 no contacto, 128 rechazan, 60 criterios de exclusión). Muestra final de 216 participantes. Medidas principales: variables socio-demográficas, historia de la enfer-medad, patologías comórbidas, Fibromyalgia Impact Questionnaire (FIQ). Resultados: 97,68% mujeres; edad 55,2 años (Desviación Estándar (DE) 8,5); 31,9% activas laboralmente; 56% estudios primarios; 14,7 años de evolución; patologías comórbidas más frecuentes: 72,2% artrosis, 64,4% depresión, 63,9% lumbalgia, 62,2% ansiedad 61,6% cervicalgia. Valor medio del FIQ (0-80) 57,4 (DE 13,1). La variabilidad del FIQ se correlaciona con el número de enfermedades comór-bidas de forma estadísticamente significativa (r=0,183; p<0,001). Según análisis de regresión múltiple se observa correlación negativa entre la presencia de patología mental, respiratoria y cardíaca y el estado funcional. Conclusión: El perfil de paciente con FM del estudio es una mujer de edad media, con estudios primarios y ama de casa. Enfermedades más prevalentes: artrosis, depresión y ansiedad. Existe una correlación negativa entre comorbilidad y estado funcional. La presencia de patología mental, respiratoria o cardíaca empeora el estado funcional.
This article aims to raise awareness among Primary Care, Health Authorities, Municipalities and Fibromyalgia Associations that it is possible to implement the Fibromyalgia 2005 Integrated Health Process of the Andalusion Health Department in the Seville Health District. The human and material resources, already exist, and only have to be organised. Primary Care plays an important role as gateway to this process.
Objectives
To assess the impact of a health education program on the quality of life and frequency of clinic visits on patients with fibromyalgia (FM).
Fibromyalgia is a chronic pathology and its main symptom is pain which usually does not respond to traditional analgesia. Its clinical characteristics and the diverse neurophysiologic findings in these patients point to a central sensitization process of the nociceptive system as the central physiopathologic axis in this disease. The knowledge of the nociceptive system functioning and its behavior in this disease has led, in the past few years, to new possibilities for the therapeutic approach. In that way, drugs with a differential mechanism of action, allowing a modulation of the nociceptive system capable of producing analgesia where other medications have failed are being developed. Different drugs with the capacity increasing the activity of biologically active amines implicated in the nociceptive inhibition process and others which are destined to reduce the excitability of the system through ion channels, are being tested with some benefit in Fibromyalgia patients and may constitute a more rational neuromodulating drug profile for this disease.This article reviews the different pharmacological strategies supported by scientific evidence and points to some future research lines that fortifies the therapeutic change taking place in the treatment approach of these patients.
Objetivo
Determinar la efectividad de los antidepresivos en el tratamiento de la fibromialgia mediante un metaanálisis de ensayos clínicos aleatorizados.
Fuentes de datos
Los datos se obtuvieron de MEDLINE (1966-2008), PsycINFO (1966-2008), Scopus (1980-2008) y la Librería Cochrane (1993- 2008). Se revisaron estudios originales, metaanálisis y revisiones del tratamiento de la fibromialgia con antidepresivos hasta agosto de 2008.
Estudios seleccionados
Se analizaron estudios aleatorizados y controlados con placebo de tratamientos con antidepresivos tricíclicos, de inhibidores de la recaptación de noradrenalina y serotonina, de inhibidores selectivos de la recaptación de serotonina (ISRS) y de inhibidores de la monoamino oxidasa (IMAO).
Análisis de los datos
Dos autores independientes analizaron los datos. Para medir los efectos se utilizaron diferencias medias estandarizadas (DMS) mediante un modelo aleatorio del efecto.
Resultados
Se incluyeron 18 estudios (con una duración media de 8 semanas; rango, 4-28) con un total de 1.427 participantes. Se encontró una fuerte asociación de los antidepresivos con la reducción del dolor (DMS, −0,43; intervalo de confianza [IC] del 95%, −0,55 a −0,30), la fatiga (DMS, −0,13; IC del 95%, −0,26 a −0,01), la depresión (DMS, −0,26; IC del 95%, −0,39 a −0,12) y las alteraciones del sueño (DMS, −0,32; IC del 95%, −0,46 a −0,18). Se encontró una fuerte asociación de los antidepresivos con la mejora de la calidad de vida relacionada con la salud (DMS, −0,31; IC del 95%, −0,42 a −0,20). La mayor reducción del dolor se observó con los antidepresivos tricíclicos (DMS, −1,64; IC del 95%, −2,57 a −0,71). Con los IMAO se observó una reducción moderada del dolor (DMS, −0,54; IC del 95%, −1,02 a −0,07), y una pequeña reducción del dolor con los ISRS (DMS, −0,39; IC del 95%, −0,77 a −0,01) y con los inhibidores de la noradrenalina y serotonina (DMS, −0,36; IC del 95%, −0,46 a −0,25).
Conclusión
En los pacientes afectados de fibromialgia, el tratamiento con antidepresivos produce una reducción del dolor y una mejora del descanso nocturno, la depresión y la fatiga, y se asocia a una mejor calidad de vida relacionada con la salud.
Background and objectiveTo evaluate the effectiveness of acupuncture as a combined modality therapy in reducing pain in paired groups (before-after) of patients with fibromyalgia in conditions of clinical practice. To determine the extent to which analgesic consumption is reduced in these patients after a cycle of acupuncture and to identify the adverse reactions due to acupuncture.
Objective
Review the effect of acuatic and aerobic exercise on patients with fibromyalgia at the consulted bibliography.
Objective
We propose a comparative study of urinary cortisol in a controlled simple group of patients diagnosed with fibromyalgia (FM) during a minimum time frame (3 years) vs. a normal group with the same characteristics of age and gender. Our objective is to demonstrate if urinary cortisol at lower levels than those found in the normal population, as long as FM is regarded, could help to evaluate the fatigue.
Fibromyalgia is defined by widespread pain and 11 of 18 tender points, often accompanied by symptoms such as fatigue, sleep disturbance, headache, irritable bowel syndrome and mood disorder. Fibromyalgia's diagnosis is eminently clinical, and currently there are no specific laboratory or technical tests. The major role in pathogenesis appears to be central and available evidence points toward dysregulation of neurotransmitter function and central pain sensitization as fundamental mechanisms. There is no evidence of abnormalities in muscle and tendon. The goal of therapy in fibromyalgia is to treat pain, and reduce physical function and sleep disturbance. The treatment of patients with fibromyalgia is difficult, and no single treatment has been successful. Here, actual evidence of the effects of pharmacological and nonpharmacological interventions on pain is summarized. Tricyclic agents, selective serotonin-reuptake inhibitors, muscle relaxants, anti-epileptics drugs, aerobic exercises, psychological treatment, patient education and combined therapies can reduce symptoms and disability effectively.
IntroductionThe aim is to detect possible personality disorders in subjects with fibromyalgia in a Primary Care centre who have been assessed by the Mental Health Department.
The goal was to find differences among fibromyalgic patients (FM), rheumatoid illness patients, and a healthy control group (n = 15 ea). The variables tested among each group were pain, depressive symptoms, anxiety, coping strategies, and childhood maltreatment. A discriminant analysis was made, obtaining two functions of high levels of fit. Patients with FM and rheumatoid illness showed equal levels of pain; however, patients with FM experienced more childhood maltreatment, currently experiencing more depression, less anxiety symptoms, and coping strategies. These functions correctly classified 53.3% of patients with FM and 60.0% of the other two groups; versus 33.3% expected at random. It is expected that by including sexual abuse in childhood and helplessness in clinical reports, improves the ability to detect patients with FM.
Fibromyalgia is a known disease, with a prevalence of around 2.5 % of the Spanish population over 20 years old. A significant aspect of the disease is that a certain amount of fibromyalgics declare that their illness appeared soon after suffering a mild or severe trauma. Patients with post-traumatic fibromyalgia show the same signs and symptoms as those with primary fibromyalgia and their prognosis is similar or somewhat worse than the latter. Among other factors determining the agreement with the diagnosis of post-traumatic fibromyalgia, is the specialty of the doctor: rheumatologists seem the most prone to accept it while the majority of orthopedists tend to reject it. According to different publications, the claim for compensation does not modify signs and symptoms or the outcome of these patients. In conclusion, forensic doctors should keep in mind the possibility that the injured patient that does not heal following the usual course of time may suffer from post-traumatic fibromyalgia.
Fibromyalgia is a known disease, with a prevalence of around 2.5 % of the Spanish population over 20 years old. A significant aspect of the disease is that a certain amount of fibromyalgics declare that their illness appeared soon after suffering a mild or severe trauma. Patients with post-traumatic fibromyalgia show the same signs and symptoms as those with primary fibromyalgia and their prognosis is similar or somewhat worse than the latter. Among other factors determining the agreement with the diagnosis of post-traumatic fibromyalgia, is the specialty of the doctor: rheumatologists seem the most prone to accept it while the majority of orthopedists tend to reject it. According to different publications, the claim for compensation does not modify signs and symptoms or the outcome of these patients. In conclusion, forensic doctors should keep in mind the possibility that the injured patient that does not heal following the usual course of time may suffer from post-traumatic fibromyalgia.
Tübingen). Di-ploma Universitario en Psiquia-tría Transcultural (París XIII). Presidenta de la Asociación Ca-talana de Logoterapia. 3 Los expertos internacionales coinciden en que el SFC-EM y la FM son enfermedades que deben ser diagnosticadas y tratadas por especialistas (en me-dicina interna, inmunología, reumatología o neuro-logía), pero son también otros médicos (de familia, psiquiatras y otros especialistas) y profesionales de enfermería quienes desempeñan papeles cruciales en estas enfermedades. Este manual pretende facilitar la no siempre fácil ta-rea de trabajar con las personas que sufren estas nuevas enfermedades. Ya que gran parte del segui-miento de la FM y del SFC-EM depende de la calidad de la comunicación que el profesional lleva a cabo con el paciente, es muy importante que este se co-munique con su paciente con la mayor eficacia posi-ble, teniendo en cuenta su complejidad. En este ma-nual se ofrecen ideas y herramientas para, en el menor tiempo posible, llevar a cabo intervenciones cortas que puedan ayudar a las personas afectadas.
Objetivo: Los autores del presente artículo se proponen un estudio comparativo del cortisol urinario en una muestra poblacional representativa con diagnó stico de fibromialgia (FM) con evolució n prolongada (mínimo 3 añ os) frente a una població n normal con iguales características de edad y sexo, con el objetivo de demostrar si la cortisoluria con valores menores que los encontrados en la població n normal en relació n con su FM podría explicar su fatiga. Pacientes y método: Se determinó la cortisoluria en un grupo de 47 mujeres con diagnó stico segú n criterios de FM de la American College of Rheumatology (ACR) 1990, con edades comprendidas entre 29 y 64 añ os, previa condició n de una correcta recogida de la muestra, mediante un FPIA (fluorescence polarization immunoassay 'inmunoaná lisis de polarizació n de la fluorescencia'). Se compararon los resultados con la cortisoluria obtenida en un grupo de 88 mujeres sanas incluidas en el mismo rango de edades que las mujeres fibromiá lgicas. Resultados: El valor mediano del cortisol urinario en las mujeres fibromiá lgicas fue de 65 mg/l, significativamente inferior al de las mujeres sanas, en las que el valor fue de 80 mg/l; po0,001. Conclusión: Un 33,4% de las mujeres con FM estudiadas presenta una concentració n de cortisol urinario significativamente inferior al grupo de mujeres sin FM. & 2008 Elsevier Españ a, S.L. Todos los derechos reservados. Objective: We propose a comparative study of urinary cortisol in a controlled simple group of patients diagnosed with fibromyalgia (FM) during a minimum time frame (3 years) vs. a normal group with the same characteristics of age and gender. Our objective is to demonstrate if urinary cortisol at lower levels than those found in the normal population, as long as FM is regarded, could help to evaluate the fatigue. Methods: We determined the urinary cortisol in a group of 47 women with a clinical diagnosis of FM using the criteria from the American College of Rheumatology (ACR) 1990, with ages between 29 and 64 years, in whom an accurate sample was collected and cortisol was determined using an FPIA method. The results were compared with the urinary cortisol obtained in a group of 88 healthy women within the same age range as those with FM.
An instrument has been developed to assess the current health status of women with the fibromyalgia syndrome. The Fibromyalgia Impact Questionnaire (FIQ) is a brief 10-item, self-administered instrument that measures physical functioning, work status, depression, anxiety, sleep, pain, stiffness, fatigue, and well being. We describe its development and validation. This initial assessment indicates that the FIQ has sufficient evidence of reliability and validity to warrant further testing in both research and clinical situations.
To develop criteria for the classification of fibromyalgia, we studied 558 consecutive patients: 293 patients with fibromyalgia and 265 control patients. Interviews and examinations were performed by trained, blinded assessors. Control patients for the group with primary fibromyalgia were matched for age and sex, and limited to patients with disorders that could be confused with primary fibromyalgia. Control patients for the group with secondary-concomitant fibromyalgia were matched for age, sex, and concomitant rheumatic disorders. Widespread pain (axial plus upper and lower segment plus left- and right-sided pain) was found in 97.6% of all patients with fibromyalgia and in 69.1% of all control patients. The combination of widespread pain and mild or greater tenderness in greater than or equal to 11 of 18 tender point sites yielded a sensitivity of 88.4% and a specificity of 81.1%. Primary fibromyalgia patients and secondary-concomitant fibromyalgia patients did not differ statistically in any major study variable, and the criteria performed equally well in patients with and those without concomitant rheumatic conditions. The newly proposed criteria for the classification of fibromyalgia are 1) widespread pain in combination with 2) tenderness at 11 or more of the 18 specific tender point sites. No exclusions are made for the presence of concomitant radiographic or laboratory abnormalities. At the diagnostic or classification level, the distinction between primary fibromyalgia and secondary-concomitant fibromyalgia (as defined in the text) is abandoned.
To evaluate and compare the quality of life of patients with fibromyalgia (FM) and rheumatoid arthritis (RA).
Forty-four women with FM and 41 with RA were studied. There were 3 evaluations, with a 3-month interval. Besides special and general clinical examinations, the following tests were applied: pain numerical scale (PNS), Health Assessment Questionnaire (HAQ), Fibromyalgia Impact Questionnaire (FIQ), Arthritis Helplessness Index (AHI), Modified Post-Sleep Inventory (PSI), and questions about sleep disorders and socioeconomic impact.
Results include the following: tender points (TP): FM = 13.9, RA = 2.9; PNS: FM = 7.2, RA = 6.8; HAQ: FM = 0.90, RA = 1.22; FIQ: FM = 47.2, RA = 42.5; AHI: FM = 32.7, RA = 31.8; sleep quality--mean duration of daily sleep: FM = 6.7 h, RA = 6.1; PSI scores: FM = 64.6, RA = 57.2. On questioning regarding economic impact, there was a decrease in family income for 65% of patients with FM and 75.1% for those with RA. Fifty-five percent of patients with FM and 66.6% of those with RA received social security aid. At followup evaluation, there was a statistically significant improvement in the following items for the patients with FM: TP count, HAQ, and AHI. The patients with RA improved in number of TP and AHI.
FM has a negative impact on quality of life, similar to RA. Clinical, functional, and economic problems related to the disease were observed. The alteration observed remained relatively stable during the study period, except for physical disability.
To determine the effectiveness of self-management education and physical training in decreasing fibromyalgia (FMS) symptoms and increasing physical and psychological well being.
A pretest-posttest control group design was used. Ninety-nine women with FMS were randomly assigned to 1 of 3 groups; 86 completed the study. The education only group received a 6-week self-management course. The education plus physical training group received the course and 6 h of training designed to assist them to exercise independently. The control group got treatment after 3 months.
The experimental programs had a significant positive impact on quality of life and self-efficacy. Helplessness, number of days feeling bad, physical dysfunction, and pain in the tender points decreased significantly in one or both of the treated groups when retested 6 weeks after the end of the program. Longterm followup of 67 treated subjects showed significant positive changes on the Fibromyalgia Impact Questionnaire primarily in the physical training group. Among all subjects, 87% were exercising at least 3 times/week for 20 min or more; 46% said they had increased their exercise level since participating in the program; 70% were practicing relaxation strategies as needed; 46% were working at least half time as opposed to 37% at pretest.
Self-efficacy of the treated groups was enhanced significantly by the program. Other changes were smaller and more delayed than had been expected. Recommendations for future trials include a longer education program, more vigorous physical training, and longterm followup.
To evaluate the effects of 6 months of pool exercise combined with a 6 session education program for patients with fibromyalgia syndrome (FM).
The study population comprised 58 patients, randomized to a treatment or a control group. Patients were instructed to match the pool exercises to their threshold of pain and fatigue. The education focused on strategies for coping with symptoms and encouragement of physical activity. The primary outcome measurements were the total score of the Fibromyalgia Impact Questionnaire (FIQ) and the 6 min walk test, recorded at study start and after 6 mo. Several other tests and instruments assessing functional limitations, severity of symptoms, disabilities, and quality of life were also applied.
Significant differences between the treatment group and the control group were found for the FIQ total score (p = 0.017) and the 6 min walk test (p < 0.0001). Significant differences were also found for physical function, grip strength, pain severity, social functioning, psychological distress, and quality of life.
The results suggest that a 6 month program of exercises in a temperate pool combined with education will improve the consequences of FM.
Objective: To describe demographic and clinical characteristics, the laboratory and radiographic findings, as well as the possible impact of the fibromyalgia syndrome in working life in our geographic area. Methods: 193 patients diagnosed of fibromyalgia syndrome according to the 1990 ACR criteria were consecutively reviewed, by protocol study. Interviews and physical examinations, as well as plain radiography and laboratory studies, were made to all patients. Descriptive statistics were used. Results: 92.70% were women with a mean age of 41.8 ± 10.15 years. Only 3 patients were previously diagnosed as having fibromyalgia syndrome. The mean evolution was 141.7 ± 118.79 months. Low back pain was the initial painful location in 21.24%. The pain predominated in the cervical and lumbar regions. 76.17% had subjective swelling, 97.41%% morning fatigue, 69.95% morning stiffness and 91.19% sleep disturbance. 78.49% of working patients have work disability caused by fibromyalgia syndrome, and 13 patients (6.7%) received disability pension. 65.38% had normal laboratory findings. Conclusion: In our country fibromyalgia syndrome presents similar demographic and clinical characteristics, as well as similar work disability, to the characteristics described in other studies.
Objective. To study, for the first time, service utilization and costs in fibromyalgia, a prevalent syndrome associated with high levels of pain, functional disability, and emotional distress.
Methods. Five hundred thirty-eight fibromyalgia patients from 6 rheumatology centers were enrolled in a 7-year prospective study of fibromyalgia outcome. Patients were assessed every 6 months with validated, mailed questionnaires which included questions regarding fibromyalgia symptoms and severity, utilization of services, and work disability.
Results. Fibromyalgia patients averaged almost 10 outpatient medical visits per year, and when nontraditional treatments were considered, this number increased to ∼1 visit per month. Patients were hospitalized at a rate of 1 hospitalization every 3 years. In each 6-month study period, patients used a mean of 2.7 fibromyalgia-related drugs. Costs increased over the course of the study. The mean yearly per-patient cost in 1996 dollars was $2,274. However, results were skewed by high utilizers, and many patients used few services and had limited costs. Total costs and utilization were independently associated with the number of selfreported comorbid or associated conditions, functional disability, and global disease severity. Compared with patients with other rheumatic disorders, those with fibromyalgia were more likely to have lifetime surgical interventions, including back or neck surgery, appendectomy, carpal tunnel surgery, gynecologic surgery, abdominal surgery, and tonsillectomy, and were more likely than other rheumatic disease patients to report comorbid or associated conditions. Almost 50% of hospitalizations occurring during the study were related to fibromyalgia-associated symptoms.
Conclusion. The average yearly cost for service utilization among fibromyalgia patients is $2,274. Fibromyalgia patients have high lifetime and current rates of utilization of all types of medical services. They report more symptoms and comorbid or associated conditions than patients with other rheumatic conditions, and symptom reporting is linked to service utilization and, to a lesser extent, functional disability and global disease severity.
To develop criteria for the classification of fibromyalgia, we studied 558 consecutive patients: 293 patients with fibromyalgia and 265 control patients. Interviews and examinations were performed by trained, blinded assessors. Control patients for the group with primary fibromyalgia were matched for age and sex, and limited to patients with disorders that could be confused with primary fibromyalgia. Control patients for the group with secondary-concomitant fibromyalgia were matched for age, sex, and concomitant rheumatic disorders. Widespread pain (axial plus upper and lower segment plus left- and right-sided pain) was found in 97.6% of all patients with fibromyalgia and in 69.1% of all control patients. The combination of widespread pain and mild or greater tenderness in ⩾ 11 of 18 tender point sites yielded a sensitivity of 88.4% and a specificity of 81.1%. Primary fibromyalgia patients and secondary-concomitant fibromyalgia patients did not differ statistically in any major study variable, and the criteria performed equally well in patients with and those without concomitant rheumatic conditions. The newly proposed criteria for the classification of fibromyalgia are 1) widespread pain in combination with 2) tenderness at 11 or more of the 18 specific tender point sites. No exclusions are made for the presence of concomitant radiographic or laboratory abnormalities. At the diagnostic or classification level, the distinction between primary fibromyalgia and secondary-concomitant fibromyalgia (as defined in the text) is abandoned.
Objective. To determine the prevalence and characteristics of fibromyalgia in the general population.
Methods. A random sample of 3,006 persons in Wichita, KS, were characterized according to the presence of no pain, non-widespread pain, and widespread pain. A subsample of 391 persons, including 193 with widespread pain, were examined and interviewed in detail.
Results. The prevalence of fibromyalgia was 2.0% (95% confidence interval [95% CI] 1.4, 2.7) for both sexes, 3.4% (95% CI 2.3, 4.6) for women, and 0.5% (95% CI 0.0, 1.0) for men. The prevalence of the syndrome increased with age, with highest values attained between 60 and 79 years (>7.0% in women). Demographic, psychological, dolorimetry, and symptom factors were associated with fibromyalgia.
Conclusion. Fibromyalgia is common in the population, and occurs often in older persons. Characteristic features of fibromyalgia–pain threshold and symptoms–are similar in community and clinic populations, but overall severity, pain, and functional disability are more severe in the clinic population.
This study demonstrates a procedural innovation designed to modify chronic pain behaviors which have been acquired through avoidance learning. Discussion focuses on avoidance learning as a seldom-investigated factor in the acquisition and maintenance of chronic pain behaviors.
In summary, we have presented the physical medicine and rehabilitation medicine approaches for treating patients with fibromyalgia and the myofascial pain syndromes. The importance of approaching these patients from a holistic and multidisciplinary standpoint has been stressed, paying attention to the physical, emotional, spiritual and behavioural components of the presentation. Although fibromyalgia and the myofascial pain syndromes are two distinct conditions, they often overlap, and when they do the myofascial component should be treated first. However, the clinician should remember that pain, tissue dysfunction and disability from pain are all separate issues and should be treated as such. Treatment in all cases should be individualized and comprehensive. It is imperative to make the patient an active participant in his care and to establish mutually agreed upon goals at the outset of treatment. It is important to establish an adequate and appropriate home exercise programme to supplement formal treatment. A good home exercise programme should stress both stretching and strengthening. Formal treatment programmes should not be geared to pain relief alone but rather to restoration of function, and return to functioning lifestyles. The clinician has available a wide array of modalities and tools to control pain, but the major goal of all treatment programmes is to restore individuals to functional lifestyles and to promote both physical and emotional flexibility, balance and 'wellness'. It is often necessary to involve the family unit as an inherent and critical part of the treatment team, particularly with the patient who continues to be dysfunctional despite apparently appropriate treatment. Although treatment always starts at the tissue level, a good treatment programme must always be holistic in nature and treat the tissues, the patient as a whole, and his or her environmental stressors and contingencies as well.
The quality of life of women with fibromyalgia was explored and compared to the quality of life of women with rheumatoid arthritis, osteoarthritis, permanent ostomies, chronic obstructive pulmonary disease, insulin dependent diabetes, and healthy controls. The women with fibromyalgia consistently scored among the lowest in all domains measured. These results suggest that fibromyalgia may adversely affect quality of life to an extent not previously recognized.
The diagnosis of teh myalgic patient can prove to be challenging for even the most experienced of clinicians. The differential diagnosis includes many diseases that often present with weakness as well as pain. The diagnosis of fibromyalgia may now be made using the positive features of the patient's illness and classified according to well-defined criteria. The process is facilitated by the demonstration of FTPs that are quite specific for the condition. The elicitation of tenderness over these points is highly reliable and valid owing to high intrarater and interrater agreements observed in multiple studies. An algorithmic approach to differential diagnosis is presented. In addition, a stepwise approach to treatment based on published studies and geared to functional outcome measures in put forward in an attempt to encourage a cost-effective approach to care of these difficult patients.
To (a) develop a standardized tender point examination protocol [Manual Tender Point Survey (MTPS)] as a diagnostic procedure to evaluate the tender point (TP) criterion for fibromyalgia syndrome (FM) and (b) determine a threshold point for positive TP.
A standardized MTPS consisted of standardized components including (a) location of the survey sites, (b) patient and examiner positioning, (c) order of examination, (d) pressure application technique, and (e) pain severity rating scores [0 (no pain) - 10 (worst pain)]. Seventy patients with FM and 70 with chronic headache were examined using the MTPS protocol.
A pain severity score of 2 (i.e., 0-1 = negative) was found to be an optimal threshold point for identifying positive TP, with sensitivity of 88.57% and specificity of 71.43%. These results are comparable to the sensitivity and specificity of the 1990 multicenter study.
The MTPS provides a step-by-step, standardized TP examination protocol, which is sensitive and specific in discriminating patients with FM from patients with chronic headache.
To compare function and disability in fibromyalgia syndrome (FMS) cases in the community versus controls, and to identify variables predicting poor function and disability.
We identified 100 FMS cases, 76 pain controls, and 135 general controls in a random survey of 3,395 noninstitutionalized adults.
FMS cases reported worse function (P < 0.00001), more days in bed (P < 0.001), and more healthy years of life lost (P < 0.0001). More FMS cases were disabled (P < 0.00001) and receiving pensions (P < 0.00001). Risk factors for disability included middle age and previous heavy manual labor. Pain, fatigue, and weakness were most often claimed to affect the ability to work Variables predicting work disability were the Fibromyalgia Impact Questionnaire (FIQ) score, a prior diagnosis of FMS, nonrestorative sleep, and past heavy physical labor. Variables influencing the FIQ score were the number of major symptoms, self-reported health satisfaction, tender point count, and education level.
FMS commonly results in loss of function and work disability.
Just as our caveman forebears were frail in the face of predatory animals, we are frail in today's society of childhood neglect or abuse, bumper-to-bumper traffic, frustration at work, and multiple daily hassles. The same neuroendocrine systems and pain regulatory mechanisms that protected early man during acute stress are still encoded in our genome, but may be maladaptive in psychologically and physiologically vulnerable people faced with chronic stress. Many patients with fibromyalgia become vulnerable because of the long-lasting psychological and neurophysiological effects of negative experiences in childhood. Ill-equipped with positive cognitive, emotional, and behavioral skills as adults, they display maladaptive coping strategies, low self-efficacy, and negative mood when confronted with the inevitable stressors of life. Psychological distress ensues, which reduces thresholds for pain perception and tolerance (already relatively low in women) even further. Converging lines of psychological and neurobiological evidence strongly suggest that chronic stress-related blunting of the HPA, sympathetic, and other axes of the stress response together with associated alterations in pain regulatory mechanisms may finally explain the pain and fatigue of fibromyalgia. Vulnerable people who can be classified by the ACR criteria as having fibromyalgia do not have a discrete disease. They are simply the most ill in a continuum of distress, chronic pain, and painful tender points in the general population.
To estimate the point prevalence of fibromyalgia syndrome (FM) among noninstitutionalized Canadian adults; and to assess the effect of demographic variables on the odds of having FM.
A screening questionnaire was administered via telephone to a random community sample of 3395 noninstitutionalized adults residing in London, Ontario. Individuals screening positive were invited to be examined by a rheumatologist to confirm or exclude FM using the 1990 American College of Rheumatology classification criteria.
One hundred confirmed cases of FM were identified, of whom 86 were women. Mean age among FM cases was 49.2 years among women, 39.3 years among men (p < 0.02). FM affects an estimated 4.9% (95% CI 4.7%, 5.1%) of adult women and 1.6% (1.3%, 1.9%) of adult men in London, for a female to male ratio of roughly 3 to one. In women, prevalence rises steadily with age from < 1% in women aged 18-30 to almost 8% in women 55-64. Thereafter, it declines. The peak prevalence in men also appears to be in middle age (2.5%; 1.1%, 5.7%). FM affects 3.3% (3.2%, 3.4%) of noninstitutionalized adults in London. Female sex, middle age, less education, lower household income, being divorced, and being disabled are associated with increased odds of having FM.
FM is a common musculoskeletal disorder among Canadian adults, especially among women and persons of lower socioeconomic status.
To evaluate the efficacy of a 6-week exercise and educational program for patients with fibromyalgia.
Forty-one subjects were randomly assigned to the program or served as waiting list controls. Program outcome was assessed with a 6-minute walk test, the Fibromyalgia Impact Questionnaire, a Self-Efficacy Scale, and a "knowledge" questionnaire (based on information provided during the educational sessions). Waiting list control subjects subsequently completed the program. Program outcome was reassessed 3 or 6 months post-program.
The program produced significant improvements in 6-minute walk distance, well-being, fatigue, self-efficacy (for controlling pain and other symptoms), and knowledge. At followup, immediate gains in walk distance, well-being, and self-efficacy were maintained, but gains in fatigue and knowledge were lost.
Short-term exercise and educational programs can produce immediate and sustained benefits for patients with fibromyalgia. The benefits of our program may be due to exercise or education since both interventions were given.
There is little empirical evidence for the effectiveness of physical and other non-pharmacological approaches to the management of fibromyalgia. Although a number of studies have been conducted into such approaches, many of these are uncontrolled, and relatively few randomized controlled trials of appropriate size and methodological rigour have been carried out. This chapter provides an overview of the evidence available under the following headings: exercise, EMG biofeedback training, electrotherapy and acupuncture, patient education and self-management programmes, multimodal treatment approaches, and other interventions. It is hard to reach firm conclusions from the literature, owing to the variety of interventions that have been evaluated and the varying methodological quality of the studies concerned. Nonetheless, in terms of specific interventions, exercise therapy has received a moderate degree of support from the literature, and has been subjected to more randomized studies than any other intervention. In contrast, there is little or no evidence available for most types of electrotherapy. In terms of overall management strategies, a multimodal programme of management, including physical, psychological and educational components and delivered in a multidisciplinary setting, has gained some support from descriptive and experimental studies, and accords with current understanding of the aetiology and clinical features of fibromyalgia. There is a clear need for further systematic evaluation of the effectiveness of non-pharmacological treatment approaches in fibromyalgia.
The Quality of Well-being Scale (QWB) is a generic measure of health related quality of life that can be used for population monitoring, measurement of clinical outcomes, or cost effectiveness analysis. We report data on the validity of the QWB for patients with fibromyalgia (FM) and compare the effect of FM to that of other chronic diseases.
The participants were 594 people recruited from a private health maintenance organization with a confirmed diagnosis of FM. The QWB was administered, along with measures of self-rated health status, physical functioning, pain, stiffness, anxiety, sleep, and depression. The QWB places levels of wellness on a continuum ranging from 0.0 (for death or the equivalent of being dead) to 1.0 (for optimum functioning without symptoms).
Patients with FM had mean QWB scores of 0.559 (SD 0.074), which is lower than scores reported for patients in most other chronic disease categories. QWB was significantly correlated with measures of physical functioning, stiffness, anxiety, depression, pain, and sleep quality.
Evidence supports the validity of the QWB for patients with FM. Patients with FM obtain lower scores on the QWB than patients with diagnoses of chronic obstructive pulmonary disease, rheumatoid arthritis, atrial fibrillation, advanced cancer, and several other chronic diseases. Although FM is generally considered a syndrome rather than a disease, substantial disability is experienced by people with this diagnosis.
Características clínicas y sociolaborales de la Fibromialgia en España: descripción de 193 pacientes
- J Albornoz
- J Povedano
- J Quijada
- De La Iglesia Jl
- A Fernández
Albornoz J, Povedano J. Quijada J, De la Iglesia JL, Fernández A, Pérez Víl-chez D, et al. Características clínicas y sociolaborales de la Fibromialgia en España: descripción de 193 pacientes. Rev Esp Reumatol 1997;24:38-44.
En: Rojo JE, Cirera E, editores. Interconsulta psiquiá-trica
- M Valdés
- El
Valdés M. El dolor. En: Rojo JE, Cirera E, editores. Interconsulta psiquiá-trica. Barcelona: Masson, S.A., 1997.
Management of fibromyalgia
- Lj Lenenthal
Lenenthal LJ. Management of fibromyalgia. Ann Intern Med 1999; 131:850-8.
A practitioner's guide
- Ms Schwartz
- Fibromyalgia
Schwartz MS. Fibromyalgia syndrome. In: Schwartz MS, et al, editors. Biofeedback. A practitioner's guide. New York: Guildford Press, 1995.
Prevalencia de la fibromialgia en la población española. Es-tudio EPISER [resumen]
- M Valverde
Valverde M. Prevalencia de la fibromialgia en la población española. Es-tudio EPISER [resumen]. Rev Esp Reumatol 2000;27:157.