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The Prevalence of Fibromyalgia in the General Population: A Comparison of the American College of Rheumatology 1990, 2010, and Modified 2010 Classification Criteria
Arthritis & Rheumatology
Abstract
Background
The ACR 1990 fibromyalgia classification criteria are based on widespread pain and tenderness. In 2010 new criteria were proposed, focusing more on multiple symptoms and these, latterly, were modified to require only self-report. The current study aimed to determine the population prevalence of fibromyalgia, and to compare differences in prevalence, using the alternative criteria.MethodsA cross-sectional survey was conducted. Questionnaires, including items on pain, symptoms, and rheumatological diagnoses, were mailed to 4600 adults in northeast Scotland. Participants with chronic widespread pain, or who met the modified 2010 criteria, plus a sub-sample of other participants were invited to a research clinic. Attendees completed an additional questionnaire, and a rheumatological examination, and were classified according to the ACR 1990, 2010 and modified 2010 criteria. The prevalence of each was calculated, weighting back to the target population by age, sex and area of residence.ResultsOf 1604 questionnaire participants, 269 were invited and 104 (39%) attended the research clinic, of whom 32 (31%) met ≥1 of the fibromyalgia criteria. The prevalence of fibromyalgia using the 1990, 2010 and modified 2010 criteria was 1.7% (95%CI: 0.7-2.8%); 1.2% (0.3-2.1%); and 5.4% (4.7-6.1%), respectively. The female/male ratio was 13.7 to 4.8 and 2.3, respectively.Conclusion
Fibromyalgia prevalence varies with the different classification criteria – specifically, prevalence is higher, and a greater proportion of men are identified, with the modified 2010 criteria, compared to those requiring clinician input. This has important implications for the use of the new criteria both in research and in clinical practice. © 2014 American College of Rheumatology.
... The prevalence of primary FMS is ~ 2-4% of the general population [8], although these epidemiological studies are primarily limited by heterogenous definitions [9]. In one UK study, the prevalence of fibromyalgia was 1.7% according to the 1990 criteria [10] (utilising tender point examination), 1.2% using the 2010 criteria [11] (clinician-determined, focused on the number of pain sites and other symptoms, without tender point exam), and 5.4% using modified 2010 criteria (self-reported symptoms) [12,13]. Prevalence is similar across different countries although there are limited data on cultural variation; with little evidence of an increased prevalence in industrialised countries [14]. ...
... Prevalence is similar across different countries although there are limited data on cultural variation; with little evidence of an increased prevalence in industrialised countries [14]. The prevalence of FMS increases with age, peaking at 50-60 years old [13] and is greater in women with a female-to-male ratio of 10:1, although epidemiological studies demonstrate ratios ranging from 2:1 to 30:1 depending on which American College of Rheumatology (ACR) fibromyalgia classification is used [8,13]. FMS complicates other chronic diseases: the prevalence of secondary FMS is much higher in rheumatalogical diseases than in the general population, affecting around 18-24% of people with rheumatoid arthritis and 14-18% with spondyloarthritis [15]. ...
... Prevalence is similar across different countries although there are limited data on cultural variation; with little evidence of an increased prevalence in industrialised countries [14]. The prevalence of FMS increases with age, peaking at 50-60 years old [13] and is greater in women with a female-to-male ratio of 10:1, although epidemiological studies demonstrate ratios ranging from 2:1 to 30:1 depending on which American College of Rheumatology (ACR) fibromyalgia classification is used [8,13]. FMS complicates other chronic diseases: the prevalence of secondary FMS is much higher in rheumatalogical diseases than in the general population, affecting around 18-24% of people with rheumatoid arthritis and 14-18% with spondyloarthritis [15]. ...
Fibromyalgia syndrome (FMS) presents a complex and challenging disorder in both the diagnosis and treatment, with emerging evidence suggesting a role of small fibre pathology (SFP) in its pathophysiology. The significance of the role of SFP in FMS remains unclear; however, recent evidence suggests degeneration and dysfunction of the peripheral nervous system, particularly small unmyelinated fibres, which may influence pathophysiology and underlying phenotype. Both skin biopsy and corneal confocal microscopy (CCM) have consistently demonstrated that ~ 50% of people with FMS have SFP. CCM, a non-invasive measure of small nerve fibres has detected small fibre loss, correlating with neuropathic pain descriptors. Additionally, quantitative sensory testing has shown abnormalities, primarily in pain pressure/mechanical pain thresholds. This narrative review provides a comprehensive understanding of the pathophysiological dimensions of FMS with a clear focus on small nerve fibres and the peripheral nervous system, offering a roadmap for future research.
... Additional symptoms include non-restorative sleep, fatigue, cognitive impairment, and intestinal problems, overlapping with symptoms present in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) [5,6]. Presentation of FM peaks between 20 and 55 years with marked an increased prevalence in women [7,8]. Epidemiology reports vary across countries and regions, with worldwide impact showing is pre-pandemic (NCT04174300 completed before 03/2020). ...
... Epidemiology reports vary across countries and regions, with worldwide impact showing is pre-pandemic (NCT04174300 completed before 03/2020). The average age for the FM cohort was 55.6 ± 7.2 years (range , and the time from primary FM diagnosis over 3 years was 10.3 ± 7.5 years (range [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21]. A subcohort of six participants composed entirely of women, with an average age of 54 years ± 8.44 and a range of between 43 and 69 years, was selected for PBMC RNAseq analysis to evaluate the effects of the MT program on the immune system of FM (see Section 2.2 for details). ...
... Total Cohort (n = 38) Mean Pre-± SD [ [7,8,9,10,11,12,13,14,15,16] 11 ± 1.79 [8,9,10,11,12,13] 11.41 ± 4.21 [5,6,7,8,9,10,11,12,13,14,15,16,17] 0.274 0.694 0.211 Physical Fatigue 12.3 ± 1.2 [10,11,12,13,14,15,16] 12.83 ± 1.17 [12,13,14,15] 9.91 ± 3.75 [6,7,8,9,10,11,12,13,14,15,16,17] 0.741 0.023 0.218 ...
Citation: Bonastre-Férez, J.; Giménez-Orenga, K.; Falaguera-Vera, F.J.; Garcia-Escudero, M.; Oltra, E. Manual Therapy Improves Fibromyalgia Symptoms by Downregulating SIK1. Int. J. Mol. Sci. 2024, 25, 9523. https://doi. Abstract: Fibromyalgia (FM), classified by ICD-11 with code MG30.0, is a chronic debilitating disease characterized by widespread pain, fatigue, cognitive impairment, sleep, and intestinal alterations, among others. FM affects a large proportion of the worldwide population, with increased prevalence among women. The lack of understanding of its etiology and pathophysiology hampers the development of effective treatments. Our group had developed a manual therapy (MT) pressure-controlled custom manual protocol on FM showing hyperalgesia/allodynia, fatigue, and patient's quality of life benefits in a cohort of 38 FM cases (NCT04174300). With the aim of understanding the therapeutic molecular mechanisms triggered by MT, this study interrogated Peripheral Blood Mononuclear Cell (PBMC) transcriptomes from FM participants in this clinical trial using whole RNA sequencing (RNAseq) and reverse transcription followed by quantitative Polymerase Chain Reaction (RT-qPCR) technologies. The results show that the salt-induced kinase SIK1 gene was consistently downregulated by MT in FM, correlating with improvement of patient symptoms. In addition, this study compared the findings in a non-FM control cohort subjected to the same MT protocol, evidencing that those changes in SIK1 expression with MT only occurred in individuals with FM. This positions SIK1 as a potential biomarker to monitor response to MT and as a therapeutic target of FM, which will be further explored by continuation studies.
... Additional symptoms include non-restorative sleep, fatigue, cognitive impairment and intestinal problems, overlapping with symptoms present in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) [5,6]. Presentation peaks between 20-55 years with marked increased prevalence in women [7,8]. Epidemiology reports vary across 2 countries and regions with worldwide impact showing 2.7% of the general population and 3.7% in the Valencian Community of Spain studied here [7][8][9]. ...
... Presentation peaks between 20-55 years with marked increased prevalence in women [7,8]. Epidemiology reports vary across 2 countries and regions with worldwide impact showing 2.7% of the general population and 3.7% in the Valencian Community of Spain studied here [7][8][9]. ...
... Patient cohort included 38 FM patients (35 females and 3 males) who fulfilled 1990 and/or 2010 ACR criteria [2,3], 50% (19/38) of them presenting comorbid ME/CFS according to Canadian and/or International diagnostic criteria [5,6], as previously described [12]. Average age for the FM cohort was 55.6 ± 7.2 years (range 43-71), and time from primary FM diagnosis over 3 years, 10.3 ± 7.5 years (range [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21]. A representative subcohort of 6 participants composed entirely by women, with an average age of 54 years ± 8.44 and a range of between 43 and 69 years, was selected for PBMC RNAseq analysis to evaluate the effects of the MT program on the immune system of FM (see section 2.2. ...
Fibromyalgia (FM), classified by ICD-11 with code MG30.0, is a chronic debilitating disease characterized by wide-spread pain, fatigue, cognitive impairment, sleep and intestinal alterations, among other. FM affects a large proportion of the world-wide population, with increased prevalence among women. The lack of understanding of its etiology and pathophysiology hampers the development of effective treatments. Our group had developed a manual therapy (MT) pressure-controlled custom manual protocol on FM showing hyperalgesia/allodynia, fatigue and patient’s quality of life benefits in a cohort of 38 FM cases (NCT04174300). With the aim of understanding the therapeutic molecular mechanisms triggered by MT, this study interrogated PBMC transcriptomes from FM participants of this clinical trial using RNAseq and RT-qPCR technologies. The results showed that the salt-induced kinase SIK-1 was consistently downregulated by MT in FM, correlating with improvement of patient symptoms. In addition, the study compared the findings in a non-FM control cohort subjected to the same MT protocol evidencing that the changes in SIK1 with MT only occurred in individuals with FM. This positions SIK-1 as a potential biomarker to monitor response to MT, and as a therapeutic target of FM, to be further explored by continuation studies.
... Fibromyalgia is a chronic condition characterised by widespread pain, cognitive symptoms, non-restorative sleep, fatigue, and other somatic symptoms (1) that reduce the quality of life (2) and limit the normal development of activities of daily living (ADLs) (3,4). The estimated worldwide prevalence in the general population is 2.7% and is more common in women (4.1%) than in men (1.4%) (5), although it could be higher, given the different percentages obtained, with 6.4% in the United States (7.7% women and 4.9% men) (6), 3.3% in Europe, and 8.3% in South America (6,7). The peak rate is in the age range of 20-55 years, although many studies have found that the prevalence in adolescents is similar to that reported in adults (7). ...
... The estimated worldwide prevalence in the general population is 2.7% and is more common in women (4.1%) than in men (1.4%) (5), although it could be higher, given the different percentages obtained, with 6.4% in the United States (7.7% women and 4.9% men) (6), 3.3% in Europe, and 8.3% in South America (6,7). The peak rate is in the age range of 20-55 years, although many studies have found that the prevalence in adolescents is similar to that reported in adults (7). The pathophysiological factors of fibromyalgia are still unclear and under extensive research (8), although it seems to be related to a pain processing problem in the brain, making patients hypersensitive to pain and hypervigilant (8). ...
... patients referred to a tertiary care pain clinic, more than 40% meet the criteria for fibromyalgia (10), with the risk of developing the syndrome being more significant if the patient already has a rheumatic disease (6,7,10). The main symptoms experienced by patients with fibromyalgia are cognitive impairment, chronic fatigue, sleep disturbances, intestinal irritability, interstitial cystitis, and mood alterations (11,12). ...
Objectives:
To summarise the available evidence and assess the effectiveness of medium and long-term physiotherapy treatment in adults with fibromyalgia (FM).
Methods:
This systematic review was registered in PROSPERO: CRD42023388356. The databases searched were MEDLINE, PEDro, Scopus, Cinhal, LatinIndex, and Cochrane, using the following keywords: "fibromyalgia", "physiotherapy", "treatment", "therapeutic exercise", "TENS", "laser therapy" and "manual therapy." The included articles analysed treatments with active or passive physiotherapy approaches in patients with FM. The variables included structural characteristics, such as: author, publication year, research question, and main outcome variables. The data on the findings of the articles comprised the following aspects: number of participants, intervention, follow-up, results, and principal conclusions.
Results:
Thirty-three articles were analysed, with an overall PRISMA score of 18.63±3.36. The active treatment methods analysed were: movement and body awareness therapies (stretching, tai chi, yoga and Pilates); hydrotherapy; physical or aerobic exercise; and multidisciplinary therapy. The passive therapies analysed were: manual therapy; repetitive transcranial magnetic stimulation (rTMS); and other therapies (hyperbaric oxygen therapy, vibration therapy, virtual reality, transcutaneous electric nervous stimulation (TENS), pain neuroscience education, and acupuncture). Evidence was found on the positive effect of physiotherapy treatment on the signs and symptoms of fibromyalgia, such as pain, impairment of physical capacity and worse quality of life.
Conclusions:
The effectiveness of the active and passive therapies analysed in the management of the symptoms and signs of the disease was positive in most of the studies. However, more specific descriptions of the treatment protocol, frequency, intensity and treatment dose are required to reach a consensus, as well as primary studies for a more extended follow-up period to better evaluate long-term effects.
... Fibromyalgia is a common reason for referral to a rheumatologist [1] and is estimated to affect from around 1 in 50 to 1 in 20 people, depending on the criteria used for classification [2]. ...
... Estimates of population prevalence are highly variable; for example, the population prevalence of fibromyalgia in the UK was estimated to be around 5.4% in 2015 [2] but, depending on the classification criteria, it can be considerably higher in other countries, for example, in Saudi Arabia, where it has been estimated to be 13.4% [3]. It is a pain state of no clear pathophysiological mechanism, with symptoms usually beginning in adolescence/early adulthood, although they can start later in life as well, and manifest as pain throughout the body, fatigue and cognitive dysfunction. ...
... The average time since being diagnosed with fibromyalgia was 8 years (range: 1 to 36yrs). The vast majority of respondents were female (93%), consistent with existing data on sex ratio of fibromyalgia diagnosis [22], rather than the prevalence of people meeting more recent criteria [2], e.g. in one study, fibromyalgia is diagnosed in women in a proportion of 9:1 [23]. Just under a quarter of respondents were in full-time employment (23%), 16.4% were in part-time employment, 18.1% were retired and 5.2% were unemployed. ...
Background
Fibromyalgia is a common reason for referral to a rheumatologist and is a centralised pain state with symptoms beginning in adolescence/early adulthood and manifests as pain throughout the body, fatigue and cognitive dysfunction. Whilst there is considerable evidence on effective treatments, diagnosis and management are complex. There is almost no evidence on how to organise health services to deliver recommended therapies. The aim of the current study was to understand patient preferences for different features of healthcare services for fibromyalgia.
Methodology
We use the Discrete Choice Experiment Method (DCE), a choice-based survey that quantifies preferences for attributes of goods, services or policy interventions, to elicit preferences in relation to alternative models of care for people with fibromyalgia. In this study, attributes describe different models of care for fibromyalgia. We based attributes and levels on earlier phases of the PACFiND project and a literature review on fibromyalgia models of care. The final analysis sample consisted of 518 respondents who completed the survey in full.
Results
The final analysis sample consisted of 518 respondents ((patients living in the UK, over 18 years old, with a diagnosis of fibromyalgia), who completed the survey in full. The model of care most preferred is one characterised by earlier diagnosis and ongoing management by a Rheumatologist, via Face-to-face or Phone/video call appointments, with a stronger preference for the latter mode of support. The most preferred treatment was Medication, followed by Physical Therapy, with the least preferred being Talking Therapy. Relative to a Waiting Time for treatment of 6 months, respondents would prefer a lower Waiting Time of 3 months and dislike waiting 12 months for treatment. Respondents showed willingness to receive Ongoing Help and Advice by a Nurse Practitioner or a GP, instead of a Specialist Rheumatologist, provided they were compensated by other changes in the model of care.
Conclusion
This study has found that, although respondents express a preference for specialist care, provided by a Rheumatologist, they may be willing to trade-off this preference against other features within a model of care. This willingness to accept a different skill-mix (e.g., appointments with a GP or a Nurse Practitioner) has important implications for practice and policy, as this is a more feasible option in settings where the availability of specialist care is highly constrained.
... Consta de 21 ítems, organizados en tres dominios: funcionalidad física, impacto global y síntomas. Existen puntos de corte para determinar la severidad del impacto 14 ...
... El objetivo principal del presente estudio fue evaluar la presencia de trastornos de equilibrio e identificar su correlación con la severidad de la FM. De la muestra, el 97,14% de los pacientes fueron mujeres, lo que es similar a lo reportado en la literatura 14,15 . En cuanto a la edad, nuestros resultados se asimilaron a la evidencia publicada 16,17 con edades entre los 30 y 65 años y promedio de 50,95 años. ...
Objetivo:
Determinar la existencia de una correlación entre trastornos del equilibrio y la severidad de la fibromialgia.
Metodología:
Se llevó a cabo un estudio observacional de corte transversal en la Unidad de Tratamiento del Dolor (UTD) del Hospital Clínico Universidad de Chile (HCUCH). Se utilizó la Escala de Berg (BBS) para evaluar los trastornos del equilibrio, el Fibromyalgia Impact Questionnaire (FIQ) para medir la severidad de la fibromialgia, y el Activities Specific Balance Confidence (ABC-16) para evaluar la confianza en el equilibrio.
Resultados:
Se reclutaron un total de 35 pacientes (97.14% mujeres), con una edad media de 50.97 años. El 97.14% de los pacientes presentó un impacto moderado a severo en el FIQ-R. La puntuación media obtenida en la Escala de Berg fue de 49.57 puntos, revelando una correlación negativa significativa entre el FIQ y el BBS (rPearson= −0.64; −0.70). La puntuación media obtenida en el ABC-16 fue del 47%, presentando una correlación moderada con la puntuación de la BBS (rPearson= 0.54). El 54.29% de los pacientes informó haber experimentado una o más caídas en los últimos 6 meses.
Conclusión:
Se encontró una correlación inversa significativa entre los trastornos de equilibrio y la severidad del impacto de la fibromialgia. Además, se observó una correlación moderada entre la confianza en el equilibrio y los puntajes de la Escala de Berg.
... [1] The 1990 American College of Rheumatology (ACR) fibromyalgia classification criteria identified a prevalence of 1.7% (95% confidence interval [CI], 0.7-2.8) among the general public, [2] which is similar to a 1.8% (95% CI, 1.7-1.9) prevalence rate for fibromyalgia in the general population reported in a 2017 systematic review. ...
... [3] The modified 2010 ACR criteria were based on use of the Widespread Pain Index and the Symptom Severity Scale and increased the prevalence of fibromyalgia among the public more than 3-fold to 5.4% (95% CI, 4.7-6.1). [2] The ACR criteria for diagnosing fibromyalgia were further revised in 2016, and now require widespread, persistent pain (≥3 months), and scores of ≥7 on the Widespread Pain Index and ≥5 on the Symptom Severity Scale (or a score of 4-6 on the Widespread Pain Index and a score of ≥9 on the Symptom Severity Scale). [4] A survey of 3276 primary care patients attending 25 practices in Kansas, United States, classified 5.5% (95% CI, 4.8-6.3) of patients as meeting 2016 ACR criteria for fibromyalgia. ...
Background
The diagnosis, etiology, and optimal management of fibromyalgia remains contentious. This uncertainty may result in variability in clinical management. We conducted a systematic review and meta-analysis of cross-sectional studies examining physicians’ knowledge, attitudes, and practices regarding fibromyalgia.
Methods
We searched MEDLINE, Embase, and PubMed from inception to February 2023 for cross-sectional surveys evaluating physicians’ attitudes toward, and management of, fibromyalgia. Pairs of independent reviewers conducted article screening, data extraction, and risk of bias assessment in duplicate. We used random-effects meta-analysis to pool proportions for items reported by more than one study and the Grading of Recommendations Assessment, Development, and Evaluation approach to summarize the certainty of evidence.
Results
Of 864 citations, 21 studies (8904 participants) were eligible for review. Most physicians endorsed fibromyalgia as a distinct clinical entity (84%; 95% confidence interval [CI], 74–92), and half (51%; 95% CI, 40–62) considered fibromyalgia a psychosocial condition. Knowledge of formal diagnostic criteria for fibromyalgia was more likely among rheumatologists (69%, 95% CI, 45–89) versus general practitioners (38%, 95% CI, 24–54) ( P = .04). Symptom relief was endorsed as the primary management goal by most physicians (73%, 95% CI, 52–90). Exercise, physiotherapy, antidepressants, nonsteroidal anti-inflammatory drugs, and non-opioid analgesics were most endorsed for management of fibromyalgia, but with wide variability between surveys. Opioids and most complementary and alternative interventions (e.g., homeopathy, chiropractic, and massage) received limited endorsement.
Conclusion
There is moderate certainty evidence to suggest that physicians are divided regarding whether fibromyalgia is a biomedical or psychosocial disorder. Physicians typically prioritize symptom relief as the primary goal of management, and often endorse management with exercise, non-opioid analgesics, nonsteroidal anti-inflammatory drugs, antidepressants, and physiotherapy (moderate to high certainty evidence); however, important practice variation exists.
... Fibromyalgia is a highly prevalent syndrome in the general population, being considered the third most common musculoskeletal condition, following lower back pain and osteoarthritis [25,29,30]. The prevalence of fibromyalgia is a parameter that varies depending on the diagnostic criteria used for its detection. ...
... The prevalence of fibromyalgia is a parameter that varies depending on the diagnostic criteria used for its detection. The most commonly used diagnostic criteria have been the 1990 American College of Rheumatology (ACR) criteria and the 2010 ACR criteria, as well as the use of various questionnaires for assessment and diagnosis of fibromyalgia conducted in different countries worldwide, resulting in different estimated prevalence values by different studies [25,29,30]. The estimated prevalence worldwide ranges from 2-3% [25,31] (Figure 1). ...
Fibromyalgia is a syndrome characterized by chronic widespread musculoskeletal pain, which may or may not be associated with muscle or joint stiffness, accompanied by other symptoms such as fatigue, sleep disturbances, anxiety, and depression. It is a highly prevalent condition globally, being considered the third most common musculoskeletal disorder, following lower back pain and osteoarthritis. It is more prevalent in women than in men, and although it can occur at any age, it is more common between the ages of thirty and thirty-five. Although the pathophysiology and etiopathogenesis remain largely unknown, three underlying processes in fibromyalgia have been investigated. These include central sensitization, associated with an increase in the release of both excitatory and inhibitory neurotransmitters; peripheral sensitization, involving alterations in peripheral nociceptor signaling; and inflammatory and immune mechanisms that develop concurrently with the aforementioned processes. Furthermore, it has been determined that genetic, endocrine, psychological, and sleep disorders may influence the development of this pathology. The accurate diagnosis of fibromyalgia remains challenging as it lacks specific diagnostic biomarkers, which are still under investigation. Nonetheless, diagnostic approaches to the condition have evolved based on the use of scales and questionnaires for pain identification. The complexity associated with this pathology makes it difficult to establish a single effective treatment. Therefore, treatment is multidisciplinary, involving both pharmacological and non-pharmacological interventions aimed at alleviating symptoms. The non-pharmacological treatments outlined in this review are primarily related to physiotherapy interventions. The effectiveness of physical exercise, both on land and in water, as well as the application of electrotherapy combined with transcranial therapy and manual therapy has been highlighted. All of these interventions aim to improve the quality of life of patients highly affected by fibromyalgia.
... Fibromyalgia is characterized by widespread body pain, and affects roughly 5% of the US adult population [50]. It affects women significantly more often than men, and the ratio of women to men with fibromyalgia is at least 2.3 to 1, depending on diagnostic criteria [50]. ...
... Fibromyalgia is characterized by widespread body pain, and affects roughly 5% of the US adult population [50]. It affects women significantly more often than men, and the ratio of women to men with fibromyalgia is at least 2.3 to 1, depending on diagnostic criteria [50]. Of patients with diagnosed fibromyalgia, 31% used opioids regularly or at high doses, while 27% used opioids intermittently or at lower doses [248]. ...
Many people in the USA have lost their lives or become addicted to opioids via prescription opioids given for chronic pain. The chronic pain epidemic has emerged due to a convergence of factors, including the medicalization of pain as well as injuries happening in the workplace, in the home, or during recreation. Opioid prescriptions rose precipitously from the late 1990’s through to approximately 2020, and despite public awareness, still are increasing. This review examines literature on integrative approaches to chronic pain as delineated by pain type. The review is organized by the most common causes of chronic pain, and randomized controlled trials, meta-analyses and systematic reviews are extracted for each cause of chronic pain. Several promising interventions may alleviate chronic pain of some causes, and some interventions may work across pain causes. Lowering inflammation through dietary or lifestyle regimens may be a general way of reducing pain. Pain can be alleviated through several adjunctive and integrative treatment approaches, which may serve to lower the need for opioid medication.
... Eleven studies [30,68,[70][71][72][73][74][75][76][77][78][79][80][81] reported rates between 0.66 [72] and 4.6% [30]. Two studies that used all-female samples had higher rates (10.5%, [71]; 13.5%, [75]). ...
... Two studies that used all-female samples had higher rates (10.5%, [71]; 13.5%, [75]). Twelve studies [71][72][73][74][75][76][77][78][79][80][81] applied the ACR 1990 criteria for diagnosing FM showing a prevalence with a range from 0.66 [72] to 13.5% [75]. Mäkelä et al. [70] used the Yunus criteria with prevalence estimates of 0.75%, while Janssens et al. [68] used DSM-IV and ICD-10 resulting a point prevalence of 3%. ...
Functional Disorders (FD) refer to persistent somatic symptoms caused by changes in the functioning of bodily processes. Previous findings suggest that FD are highly prevalent, but overall prevalence rates for FD in European countries are scarce. Therefore, the aim of the present work was to estimate the point prevalence of FD in adult general populations. PubMed and Web of Science were searched from inception to June 2022. A generalized linear mixed-effects model for statistical aggregation was used for statistical analyses. A standardized quality assessment was performed, and PRISMA guidelines were followed. A total of 136 studies were included and systematically synthesized resulting in 8 FD diagnoses. The large majority of studies was conducted in the Northern Europe, Spain, and Italy. The overall point prevalence for FD was 8.78% (95% CI from 7.61 to 10.10%) across Europe, with the highest overall point prevalence in Norway (17.68%, 95% CI from 9.56 to 30.38%) and the lowest in Denmark (3.68%, 95% CI from 2.08 to 6.43%). Overall point prevalence rates for specific FD diagnoses resulted in 20.27% (95% CI from 16.51 to 24.63%) for chronic pain, 9.08% (95% CI from 7.31 to 11.22%) for irritable bowel syndrome, and 8.45% (95% CI from 5.40 to 12.97%) for chronic widespread pain. FD are highly prevalent across Europe, which is in line with data worldwide. Rates implicate the need to set priorities to ensure adequate diagnosis and care paths to FD patients by care givers and policy makers.
... According to various data, fibromyalgia affects 2 to 4% of the population, mainly between 50 and 60 years of age [6,1,15]. In the available literature, data on the proportion of sick women and men show a very large variation [6,[16][17][18]. There is a misconception that fibromyalgia affects at least 80-90% of the female population [7,[17][18][19]. ...
... Some sources report that fibromyalgia occurs in 2-8% of the US population and 2-4% of the world population, with an estimated prevalence of women of 61-90% [10,15,[17][18][19]. However, the majority of published epidemiological studies show only a slight increase in the female/male ratio, as opposed to the observed ratio in clinical studies, where the majority are women [6,7,10,14,16,17,22,45]. ...
Pain in the course of fibromyalgia (FMS) is a serious therapeutic problem of modern medicine. Patients experience generalized pain within the musculoskeletal system, which significantly reduces the perceived level of quality of life. The aim of the study was to analyze the impact of therapeutic massage on the alleviation of pain in fibromyalgia and the change in HRQoL after the use of this type of therapy, including the classic and tensegration massage. The study group consisted of 41 people suffering from FMS (F:21; M:20). The mean age of all the studies people was 40 ± 9.6 years. All studied people participated in two short therapeutic series consisting of three procedures. The interval between the therapeutic series was two months. The series included: a single series of the classic massage and the tenseg-ration massage, respectively. Before and after each of the therapeutic series, the patients completed a survey questionnaire, based on the EQ-5D-5L standard. The analysis for independent variables was carried out using the Mann-Whitney U test, the Wilcoxon pair order test for dependent variables, and the Spearman rank coefficient was determined. The assumed level of significance was p ≤ 0.05. A greater effectiveness of the tensegration massage compared to the classic massage was confirmed by analyzing the results of EQ-5D-5L. Analysis of the relationship between the first and second measurement in each of the EQ-5D-5L domains before and after the massage indicated significant relationships in the case of the tensegration massage (p ≤ 0.05 in each domain except the self-care domain p = 0.116). In the case of classical massage, a significant relationship was noted only in the domains of: pain and discomfort (p = 0.045) and anxiety and depression (p = 0.012). A significantly higher average level on the EQ-VAS scale was confirmed after the applied tensegration massage (I-TM:76.3 ± 16.9; II-TM:87.9 ± 13.6; p < 0.001). In addition, the beneficial effect of physical activity and BMI on the effectiveness of fibromyalgia treatment and the level of HRQoL was demonstrated. Massage is an effective therapeutic method in fibromyalgia, allowing to improve health and thus HRQoL. Factors such as physical activity and BMI are also important.
... These criteria were further evaluated and then authorized. 4 A study conducted in United Kingdom based on population found occurrence of FM of 5% and chronic widespread pain (CWP) of 14%. 5 The National Health Service record in the United Kingdom. 6 FM patients experience cognitive disturbances due to the ongoing musculoskeletal pain and discomfort. ...
Objective: To compare the outcomes of Duloxetine and Amitriptyline therapy in fibromyalgia patients regarding change in Symptom Severity Scale (SSS) score and Widespread Pain Index (WPI) from baseline after three months of treatment.Methodology: This quasi-experimental study was done in the Department of Rheumatology, Pakistan Institute of Medical Sciences, Islamabad, from November 2022 to April 2023. One hundred fifty-six fibromyalgia patients of either gender between the ages of 25-70 years were included in the study. They were erratically assigned into two groups. Group A patients were given Duloxetine, while group B patients were given Amitriptyline for 12 weeks with main outcome of change in WPI and SSS scores three months after the therapy.Results: There were 2.6% (n=2/78) males and 97.4% (n=76/78) females in group A and 1.3% (n=1/78) males and 98.7% (n=77/78) females in group B (P=0.560). At baseline, the mean WPI score in group A was 15.8 ± 1.3 SD, and it was 16.1 ± 1.4 SD in group B (P=0.286), and the mean SSS score was 6.6 ± 1.6 SD in group A, and it was 6.8 ± 1.5 SD in group B (P=0.467). At 12 weeks, the mean WPI score in group A was 11.2 ± 2.2 SD, and it was 8.9 ± 3.1 SD in group B (P=0.001), and the mean SSS score was 4.5 ± 1.7 SD in group A, and it was 3.6 ± 1.3 SD in group B (P=0.001).Conclusions: Outcomes were better with Amitriptyline compared to those patients taking Duloxetine in diagnosed cases of fibromyalgia.
... Fibromyalgia is a common condition causing chronic, widespread pain which is often associated with sleep disturbance and fatigue and affects between 1.2 and 5.4% of the population [1]. Fibromyalgia is typically thought to represent characteristic features of nociplastic pain, a term recently introduced by the International Association for the Study of Pain (IASP) [2], defined as "pain that arises from altered nociception despite no clear evidence of actual or threatened tissue damage causing the activation of peripheral nociceptors or evidence for disease or lesion of the somatosensory system causing the pain". ...
Background and Objectives: Fibromyalgia has many unmet needs relating to treatment, and the delivery of effective and evidence-based healthcare is lacking. We analyzed social media conversations to understand the patients’ perspectives on the lived experience of fibromyalgia, factors reported to trigger flares of pain, and the treatments being discussed, identifying barriers and opportunities to improve healthcare delivery. Methods: A non-interventional retrospective analysis accessed detail-rich conversations about fibromyalgia patients’ experiences with 714,000 documents, including a fibromyalgia language tag, which were curated between May 2019 and April 2021. Data were analyzed via qualitative and quantitative analyses. Results: Fibromyalgia conversations were found the most on Twitter and Reddit, and conversation trends remained stable over time. There were numerous environmental and modifiable triggers, ranging from the most frequent trigger of stress and anxiety to various foods. Arthritis and irritable bowel syndrome (IBS) were the most frequently associated comorbidities. Patients with fibromyalgia reported a wide range of symptoms, with pain being a cardinal feature. The massage, meditation and acupuncture domains were the most reported treatment modalities. Opportunities to improve healthcare delivered by medical providers were identified with current frustration relating to a lack of acknowledgement of their disease, minimization of symptoms and inadequately meeting their care needs. Conclusions: We developed a comprehensive, large-scale study which emphasizes advanced natural language processing algorithm application in real-world research design. Through the extensive encapsulation of patient perspectives, we outlined the habitual symptoms, triggers and treatment modalities which provide a durable foundation for addressing gaps in healthcare provision.
... The inclusion criteria for the study were as follows: 1) RCTs that used an FMS diagnosis based on the criteria set by the American College of Rheumatology (21)(22)(23); 2) comparisons between MM interventions and either no treatment or alternative treatment modalities; 3) the inclusion of at least one outcome measure pertinent to FMS symptoms, such as quality of life, sleep quality, depression levels, and stress levels; 4) accessibility to the full, original published article; 5) emphasis on offline instructional methodologies, excluding online formats; 6) follow-up duration-the study imposed no restrictions on the follow-up duration. Short-term effects were identified as outcomes assessed immediately postintervention. ...
Background:
The effectiveness of mindfulness meditation (MM) for the treatment of fibromyalgia syndrome (FMS) is unknown and needs to be updated.
Objective:
This study aimed at investigating the effectiveness of MM for the treatment of FMS.
Study design:
A systematic review and meta-analysis.
Methods:
A comprehensive search of relevant studies published from the databases' inception through April 12, 2023 was conducted within the following databases: Cochrane Library, Embase, MEDLINE, PubMed, Clinicaltrials.gov, and PsycINFO. We included randomized controlled trials that reported at least one of the following outcome indicators: the Fibromyalgia Impact Questionnaire (FIQ), the Pittsburg Sleep Quality Index (PSQI), the Beck Depression Inventory (BDI), and the Perceived Stress Scale (PSS). Results are presented in terms of mean difference (MD), supplemented by 95% CIs The I2 statistic assessed heterogeneity across 3 distinct observational time frames. We used the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework to appraise the robustness of the evidence.
Results:
Ten randomized controlled trials were selected from 1,377 citations (n = 818). Various MM regimens were reported (type of mindfulness, duration, schemes, and ingredients). Among 818 patients, very low to moderate evidence indicated that MM could reduce FIQ in the short-term (MD = -6.20; 95% CI,-8.51 to -3.89; P < 0.05; GRADE: moderate); a lower PSQI score (MD = -1.84; 95% CI, -3.35 to -0.33; P < 0.05; GRADE: very low); a reduce BDI score (MD = -3.26; 95% CI, -5.77 to -0.76; P < 0.05; GRADE: moderate); and a decreased PSS score (MD = -4.85; 95% CI, -8.22 to -1.49; P < 0.05; GRADE: very low). At medium-term follow-up, MM consistently reduced the BDI score (MD = -2.88; 95% CI, -4.98 to -0.79; P < 0.05; GRADE: moderate) and decreased the PSS score (MD = -2.76; 95% CI, -4.82 to -0.70; P < 0.05; GRADE: moderate) but there was no significant difference in FIQ scores (MD = -2.78; 95% CI, -6.32 to 0.76; P > 0.05; GRADE: low) and PSQI scores (MD = -1.28; 95% CI, -3.35 to -0.80; P > 0.05; GRADE: very low). However, at long-term follow-up, MM still reduced FIQ scores (MD = -6.09; 95% CI, -9.01 to -3.16; P < 0.05; GRADE: moderate).
Limitations:
The relatively small sample size and the average quality of the included studies may have introduced biases. The time and method of meditation in the included studies were not completely unified, and there were confounding factors. Additionally, the limited amount of available literature is a challenge. Despite focusing on randomized controlled trials, there is heterogeneity among these studies. Future research should aim for larger, higher-quality studies to address these limitations and provide a more comprehensive understanding of MM's effectiveness in fibromyalgia management.
Conclusions:
Very low to moderate evidence shows that MM improves quality of life, relieves stress, and relieves insomnia and depression in patients with FMS in the short-term. Notably, the improvement in depression and stress levels continued into the medium-term period. Furthermore, quality of life improvement was discernible at long-term follow-up. This suggests that MM can be used as an adjunct therapy for FMS.International Prospective Register of Systematic Reviews (PROSPERO) Registration Number: CRD42023442356.
... It is characterized by extensive musculoskeletal pain along with memory problems, chronic fatigue, sleep problems, and mood disorders (Häuser et al. [30]). Fibromyalgia is a widespread syndrome among the general population, ranking as the third most common musculoskeletal condition after lower back pain and osteoarthritis (Heidari et al. [31]; Jones et al. [33]). This condition presents some variability, as its cause is often unknown, and no specific origin is identified in most cases. ...
Introduction:Fibromyalgia is a chronic condition often accompanied by cognitive impairments, such as difficulties with sustained attention, and emotional disturbances, particularly depression and anxiety. Understanding how these emotional and cognitive factors interact is crucial to improving treatment for fibromyalgia patients. This study aimed to investigate the network structure of these interactions, focusing on the relationship between depression, anxiety, and cognitive performance.Method:A total of one hundred ten participants diagnosed with fibromyalgia completed self-reported assessments of depression and anxiety, alongside cognitive performance tests. Key measures included Continuous Performance Tasks (CPT) for impulsivity and sustained attention, the Stroop Interference Index (StI), Stroop Color Naming (StC), and Stroop Word Reading (StW). Network analysis was conducted to estimate the relationships between emotional and cognitive variables and assess their centrality within the network.Results:Errors in CPT emerged as the most significant indicators of the relationship between depression and cognitive performance, with high centrality values observed for the Stroop tasks (StI, StC, and StW). Additionally, Trait Anxiety (A_T) and Beck Depression Inventory (BDI) measures showed high centrality, underscoring the critical role of emotional states in the network of cognitive and emotional variables. The centrality values for cognitive flexibility, processing speed, and inhibitory control were found to be 0.85, 0.78, and 0.72, respectively.Conclusion:This study highlights the strong association between depression symptoms and deficits in cognitive domains, emphasizing the need for integrated care approaches that address both cognitive and emotional health. Multidisciplinary treatment programs, including cognitive rehabilitation and psychological support, could improve patient outcomes by targeting the most influential variables in the cognitive-emotional network.
... Fibromyalgia is considered a pain-regulation disorder and affected individuals generally exhibit increased sensitivity to pain stimuli (hyperalgesia) and a low pain threshold (allodynia) [2]. Other frequent findings in FM include fatigue, sleep disorders, depression, anxiety, cognitive dysfunction, physical deconditioning and poor quality of life [3][4][5]. ...
Background/objective
Fibromyalgia is a non-inflammatory syndrome characterized by generalized muscle pain, with other symptoms. Numerous forms of physical training for this population have been studied through high-quality randomized clinical trials involving strength, flexibility, aerobic conditioning and multicomponent exercise interventions. This research evaluated the effectiveness of a functional exercise program at reducing pain, improving functional capacity, increasing muscle strength as well as improving flexibility, balance and quality of life in individuals with fibromyalgia.
Methods
Eighty-two women with fibromyalgia were randomized into two groups. The functional exercise group performed functional exercises in 45-minute sessions twice per week for 14 weeks. The stretching exercise group performed flexibility exercises with the same duration and frequency. Outcome measures were: visual analog scale for widespread pain; Fibromyalgia Impact Questionnaire for health-related quality of life; Timed Up and Go test for functional performance; one-repetition maximum for muscle strength, Sit and Reach test on Wells bench for flexibility; Berg Balance Scale for balance; SF-36 for general quality of life.
Results
After the intervention, the functional exercise group had a statistically significant reduction in pain (interaction p = 0.002), and improvement in health-related quality of life measured by the Fibromyalgia Impact Questionnaire (interaction p < 0.001) and in general health state domain of SF-36 (interaction p = 0.043) compared to the stretching exercise group. No significant differences between groups were found regarding improvements in functional capacity, muscle strength, flexibility or balance.
Conclusion
Functional exercise training was effective at reducing pain and improving quality of life in patients with fibromyalgia compared to stretching exercises.
Trial registration
ClinicalTrials.gov Identifier: NCT03682588 First prospectively registered in March 2018.
... Fibromyalgia (FM) is a chronic and diffuse pain syndrome characterized by widespread musculoskeletal pain and multiple concomitant symptoms, including fatigue and sleep disturbances, caused by dysfunctional sensory afferent processing in the central nervous system. 1 The prevalence of FM is estimated to be between 0.2% and 6.6% in women. 1 However, recent epidemiological studies have shown a worldwide prevalence between 2% and 8%, indicating notable growth in this clinical condition throughout the world. 2 The etiology of FM is unclear; nevertheless, central mechanisms are strongly implicated, including evidence of abnormalities in the structure, function, and molecular chemistry of the central nervous system. 3 Consistently, it has been reported that central sensitization is an important factor in the development of FM. 4 Researchers have postulated that central sensitization generates an imbalance between descending inhibitory and facilitatory pathways, which would facilitate hyperalgesia and allodynia in this clinical condition. ...
Background
Multicomponent treatment is commonly used. However, there are no studies that included graded motor imagery and therapeutic neuroscience education to multicomponent treatment for patients with fibromyalgia This study aims to compare the short-term effects (at 12 weeks) of a multicomponent treatment combined with graded motor imagery and therapeutic neuroscience education versus standard treatment in patients with FM.
Methods
The study was a single-blinded randomized controlled trial. Sixty-five women with a clinical diagnosis of FM were randomly allocated (1:1) into two groups. The experimental group ( n = 33) received a novel multicomponent treatment combined with graded motor imagery and neuroscience education. The control group ( n = 32) received a standard treatment including pharmacotherapy and standard physician education. The primary outcome was pain intensity assessed with the Numeric Pain Rating Scale (NPRS). The secondary outcomes were changes in the Fibromyalgia Impact Questionnaire (FIQ), the Pain Catastrophizing Scale (PCS), the Tampa Scale of Kinesiophobia (TSK-17), and the Pittsburgh Sleep Quality Index (PSQI) scores. All outcomes were assessed at baseline and 12 weeks.
Results
All of the participants completed the trial. The between-group mean differences at 12 weeks were: NPRS-1.18 points (95% confidence interval [CI] -0.4 to -1.8; η ² = 0.47; p < .001); FIQ-16.21 points (95% CI -10.9 to -22.1; η ² = 0.58; p < .001); PCS total domain −12.5 points (95% CI -7.2 to -17.8; η ² = 0.61; p < .001); TSK-17-6.15 points (95% CI -3.5 to -8.7; η ² = 0.52; p < .001); and PSQI-2.74 points (95% CI -1.4 to 4.0; η ² = 0.54; p < .001). All differences were statistically significant in favor of the novel multicomponent treatment group and had a large effect size.
Conclusions
In the short term, a novel multicomponent treatment, including graded motor imagery and neuroscience education, was an effective therapeutic intervention for improving clinical outcomes compared with standard treatment in women with FM. Additional studies are needed to support long-term clinical effectiveness in these patients.
... ; https://doi.org/10.1101/2024.10.11.617524 doi: bioRxiv preprint Introduction Fibromyalgia (FM) is a chronic pain syndrome characterized by widespread musculoskeletal pain, pain hypersensitivity, fatigue, sleep disturbances, depression, and anxiety 12,69 . It affects 2 -4% of the general population, with a female:male ratio of 2:1 12,24,35 . Fibromyalgia pathogenesis is associated with generalized, multimodal increased sensitivity to cold and pressure stimuli as well as dysfunctional endogenous pain modulation 61 . ...
Autoimmunity and immunoglobulin G (IgG) autoantibodies may contribute to pain in a subset of fibromyalgia (FM) patients. Previously, we saw that IgG from FM patients induces pain-like behavior in mice and binds to satellite glial cells (anti-SGC IgG). The anti-SGC IgG levels were also associated with more severe symptomatology. Lipid metabolism in FM subjects is altered with lysophosphatidylcholines (LPCs) acting as pain mediators. The relationship between autoantibodies, lipid metabolism, and FM symptomatology remains unclear. We analyzed serum lipidomics with liquid chromatography mass spectrometry, anti-SGC IgG levels, and clinical measures in 35 female FM subjects and 33 age- and body mass index-balanced healthy controls (HC). Fibromyalgia subjects with higher anti-SGC IgG levels experienced more intense pain than those with lower levels. Sixty-three lipids were significantly altered between FM subjects and HC or between FM subjects with severe (FM severe) and mild symptoms (FM mild). Compared to HC, FM subjects had lower concentrations of lipid species belonging to the classes LPC (n = 10), lysophosphatidylethanolamine (n = 7), phosphatidylcholine (n = 4), and triglyceride (n = 5), but higher concentrations of diglyceride (n = 3). Additionally, FM severe had higher LPC 19:0, 22:0, and 24:1 and lower sphingomyelin (n = 9) concentrations compared to FM mild. A positive association was seen for LPC 22:0 and 24:1 with pain intensity and anti-SGC IgG levels in FM subjects. Taken together, our results suggest an association between altered lipid metabolism and autoimmune mechanisms in FM.
Perspective
Our results suggest an association between the postulated autoimmunity in FM and lipids that can act as pain mediators.
... Despite its prevalence, the characteristics and existence of FM remain controversial, relying heavily on clinical diagnosis [6]. Some physicians question the legitimacy of fibromyalgia syndrome and worry that diagnosing it may lead to overuse of healthcare resources [7], as the diagnosis heavily relies on the examiner's clinical judgment. ...
Background/Objectives: Fibromyalgia (FM) affects up to 5% of the global population and is a leading cause of significant social and economic consequences. Higher health literacy leads to better understanding of treatment plans, improved self-care, and adherence to recommendations, enhancing overall quality of life. This study aims to determine whether different aspects of the disease are influenced by patients’ education level and literacy when applying the same therapy and to assess how patients’ perceptions of therapy outcomes vary over time based on their educational level. Methods: This study involved 140 fibromyalgia (FM) patients diagnosed using the 2016 ACR criteria, with 128 completing the study. Participants attended three visits over 28 weeks and were stratified into four groups based on educational level: Group 1—secondary school or less; Group 2—high school graduates; Group 3—college graduates; Group 4—university graduates. Patients were assigned to groups (n = 32, 32, 30, and 34, respectively) after the initial evaluation (T0). The treatment was assessed (T1) and followed up three months later (T2) to evaluate changes in functional status and quality of life. All patients underwent the same rehabilitation program, cognitive therapy, and kinesiotherapy. Results: Significant differences in disease impact on the patient’s life (FIQ total score) were observed between groups from the initial evaluation (p = 0.000). The overall FIQ score was notably affected by non-pharmacological therapy in patients with higher education. These differences continued to be significant even three months after the treatment ended (p = 0.000). Functional limitations were evident from the start (p = 0.000) and improved significantly post-treatment in patients with higher education (p = 0.000). However, subjective evaluations of disease impact (assessed by the first item of FIQ) did not consistently align with objective findings (hand grip strength). Functional limitations did not significantly differ in subjective evaluations (F1Q1) across educational levels (p = 0.045), and inverse correlations were noted between functional status and SF-12 well-being components. Conclusions: This study underscores that higher education enhances fibromyalgia management and functional outcomes, particularly when combined with non-pharmacological therapies. However, subjective perceptions may not always align with objective improvements, indicating that factors beyond education, such as personal and external influences, also impact disease management. Thus, improving health literacy through educational interventions could further benefit FM patients’ quality of life.
... The diagnosis of fibromyalgia is currently a purely clinical issue based on the severity of symptoms (Wolfe et al., 2016). Over the past few decades, several sets of diagnostic/classificatory criteria have been proposed, and depending on the set used, the prevalence of fibromyalgia may vary (Jones et al., 2015). In the general population, the prevalence ranges from 2% to 3% (Ablin et al., 2012). ...
Background
Geographic origin may represent a variable capable of influencing health status. This study aims to investigate the presence of differences of disease severity in Italian patients with fibromyalgia from different macro‐regions.
Methods
This retrospective, cross‐sectional study involved patients included in the Italian Fibromyalgia Registry. Three geographical macro‐regions were identified, comprising patients from Northern Italy, Central Italy and Southern Italy. Clinical differences (evaluated through PolySymptomatic Distress Scale [PSD], revised Fibromyalgia Impact Questionnaire [FIQR] and modified Fibromyalgia Assessment Status [FASmod]) among the geographical macro‐regions were studied using one‐way analysis of variance (ANOVA) and the Scheffé's test.
Results
A total of 6095 patients (5719 females and 376 males) were included, with 1957 from Northern Italy, 2979 from Central Italy and 1159 from Southern Italy. All studied clinical indices showed a trend indicative of greater disease severity in Southern Italy, followed by Northern Italy and then Central Italy (mean values for PSD: 19.97 ± 6.20 in Northern Italy, 18.61 ± 7.12 in Central Italy, 23.01 ± 5.66 in Souther Italy). These differences were statistically significant for the overall scores of all studied indices, evaluated with ANOVA (all p < 0.001) and in the head to head comparisons, evaluted with Scheffé's test.
Conclusions
Geographic background is significantly associated with variations in the severity of fibromyalgia in Italian patients.
Significance Statement
This is the first study to demonstrate geographical origin‐dependent intra‐national differences in the severity of fibromyalgia. The results confirm the necessity of considering fibromyalgia within the context of the biopsychosocial model and of implementing healthcare policies targeted towards the most underserved regions.
... The etiology and underlying pathologies influencing the development of fibromyalgia remain unknown, making it a prominent subject in pain analysis. The condition is associated with a spectrum of related and overlapping issues, often referred to as severe overlapping pain conditions or functional pain illnesses, depending on the healthcare practitioner consulted Fibromyalgia, a prevalent pain disorder characterized by chronic widespread pain, is estimated to impact 1 to 5% of the population [6]. Physical and psychological symptoms associated with the condition include difficulties in sleep, fatigue, stiffness, anxiety, cognitive dysfunction, and memory loss [7]. ...
Fibromyalgia is a widespread pain disorder characterized by chronic, diffuse pain, about 1 to 5% around world. While more prevalent in women and adults, it can also manifest in children and adolescents. The specific pathophysiology of fibromyalgia remains unclear, but it is associated with neuronal over sensitization, reduced conditioned pain modulation, cognitive dysfunction, memory loss, and impaired information processing. It has now been categorized as a somatic symptom disorder. This study aimed to investigate fibromyalgia, focusing on its potential hereditary connections and management practices. A key pathophysiological aspect of fibromyalgia is central sensitization, marked by increased functional connectivity with pre-receptive brain areas, decreased connectivity with antinociceptive areas, and alterations in central nervous system neurotransmitters, also in size and shape of specific brain areas. Fibromyalgia is not directly inherited from parents to offspring, it does exhibit a tendency to cluster within families. The serotonin transporter gene, characterized by single nucleotide polymorphism with "S" (short) allele, is more prevalent in individuals with fibromyalgia and psychological distress. In conclusion, fibromyalgia is a widespread pain disorder with a substantial impact on the central nervous system, resulting in significant disability and an elevated risk of chronic diseases. Early diagnosis and intervention can minimize the impact of fibromyalgia. Physical therapy and non-drug therapies should be customized for each patient. The FDA has approved three drugs including pregabalin, duloxetine, and milnacipran for fibromyalgia treatment.
... approximately 2% to 6%, depending on the diagnostic criteria sets applied by the American College of Rheumatology (ACR). 3,4 Studies in patients with spondyloarthritis showed that the frequency of FM ranged between 11.1% and 38.4%. 2 In patients with rheumatoid arthritis, this frequency ranges between 17.7% and 29%. 5 A recent study revealed that patients with primary Sjögren's syndrome had a 30% frequency of FM. 6 Patients with FM frequently utilize health care services. Despite its clinical and socio-economic importance, there are no certain biomarkers or specific diagnostic methods for FM. ...
Objective: The aim of this study is to assess the diagnostic accuracy and potential role in reflecting systemic inflammation of a broad range of blood cell-derived indexes in fibromyalgia (FM). The efficacy of hematological markers, including the systemic immune- inflammation index (SII), systemic inflammation response index (SIRI), and systemic inflammation aggregate index (AISI) in demonstrating systemic inflammation has not yet been investigated in FM.
Materials and Methods: Among the 2,829 patients assessed, a total of 502 patients and 90 age- and sex-matched individuals were involved in the study. Demographic characteristics, C-reactive protein, erythrocyte sedimentation rate, and hematological indexes [platelet- lymphocyte ratio (PLR), neutrophil-lymphocyte ratio (NLR), monocyte-lymphocyte ratio (MLR), SII, SIRI, and AISI] were calculated. Laboratory findings were compared between study groups. Receiver operating characteristic (ROC) analysis was utilized to assess their diagnostic potential.
Results: Patients had significantly higher SII, SIRI, and AISI values than controls (p=0.011, p=0.004, and p<0.001, respectively). No significant differences existed in NLR, MLR, and PLR between groups. According to the ROC analysis, SII, SIRI, and AISI exhibited statistically significant accuracy in differentiating FM from controls (p=0.010, p=0.003, and p=0.002, respectively). However, the area under the curve values (95% confidence interval) of SII, SIRI, and AISI were 0.584 (0.543-0.624), 0.594 (0.553-0.634), and 0.618 (0.569-0.648), respectively.
Conclusion: SII, SIRI, and AISI values are higher in FM, reflecting a potentially increased inflammatory status. Yet, their diagnostic performance is below the acceptable level.
... approximately 2% to 6%, depending on the diagnostic criteria sets applied by the American College of Rheumatology (ACR). 3,4 Studies in patients with spondyloarthritis showed that the frequency of FM ranged between 11.1% and 38.4%. 2 In patients with rheumatoid arthritis, this frequency ranges between 17.7% and 29%. 5 A recent study revealed that patients with primary Sjögren's syndrome had a 30% frequency of FM. 6 Patients with FM frequently utilize health care services. Despite its clinical and socio-economic importance, there are no certain biomarkers or specific diagnostic methods for FM. ...
... Fibromyalgia (FM) is a chronic disease characterized by widespread pain, fatigue, and poor sleep [1][2][3][4][5]. FM affects 1.7-4% of the population [3,[6][7][8], with a higher prevalence in women [9][10][11]. Research has shown that FM has a negative impact on the quality of life of patients [12,13]. ...
Fibromyalgia is a chronic disease that affects a considerable fraction of the global population, primarily women. Physical activity is often recommended as a tool to manage the symptoms. In this study, we tried to replicate a positive result of pain reduction through physical activity. After collecting pain and physical activity data from seven women with fibromyalgia, one patient experienced a considerable reduction in pain intensity. According to the patient, the improvement was related to physical activity. Our study was conducted to investigate the replicability of this result through personalized activity recommendations. Out of the other six patients, three experienced a reduction in pain. The remaining three patients did not experience any pain relief. Our results show that two of these were not able to follow the activity recommendations. These results indicate that physical activity may have a positive effect on chronic pain patients. To estimate how effective physical activity can be for this patient group, an intervention with longer follow-ups and larger sample sizes needs to be performed in the future.
... Fibromyalgia is characterized by fatigue, diffuse muscle pain, poor sleep and trigger points of tenderness [1,2]. The prevalence of fibromyalgia is approximately 2% of the U.S. population, but it more often affects women than men [3]. The management of fibromyalgia includes both pharmacological and nonpharmacological treatments. ...
Objective
Fibromyalgia, a chronic pain disorder, impacts approximately 2% of adults in the US. Gabapentin and pregabalin are common treatments to manage fibromyalgia-related pain. Our recent study showed the risk of adverse cardiovascular events increased in diabetic neuropathy patients who were prescribed gabapentin or pregabalin. Here, we investigated whether the prescription of gabapentin or pregabalin has similar cardiovascular risk in patients with fibromyalgia.
Methods
This retrospective cohort study leveraged electronic health records from 64 US healthcare organizations with 112 million patients. The study population included 105,602 patients first diagnosed with fibromyalgia and followed by a prescription of gabapentin, pregabalin, or other FDA-approved drugs for treating fibromyalgia from 2010 to 2019. Outcomes were deep venous thrombosis (DVT), myocardial infarcts (MI), peripheral vascular disease (PVD), strokes, heart failure, and pulmonary embolism (PE). In propensity-score-matched cohorts, 1-year and 5-year hazard ratios (HRs) were computed with their respective 95% confidence intervals (CIs). Additionally, we conducted sensitivity analyses on the subpopulations without other possible indications.
Results
For 5-year follow-up, gabapentin increased the risk of PVD (HR = 1.46, 95% CI = 1.17–1.80), MI (HR = 1.31, 95% CI = 1.03–1.66), heart failure (HR = 1.27, 95% CI = 1.10–1.48), DVT (HR = 1.80, 95% CI = 1.33–2.44), and PE (HR = 2.23, 95% CI = 1.62–3.07). Pregabalin increased the risk of DVT (HR = 1.49, 95% CI = 1.01–2.20), and PE (HR = 2.24, 95% CI = 1.43–3.50). For 1-year follow-up, gabapentin increased the risk of PVD (HR = 1.32, 95% CI = 1.11–1.57), DVT (HR = 1.35, 95% CI = 1.09–1.68), and PE (HR = 1.36, 95% CI = 1.17–1.57). Pregabalin increased the risk of PVD (HR = 1.32, 95% CI = 1.06–1.63) and PE (HR = 1.25, 95% CI = 1.03–1.52). Sensitivity analyses showed similar trends.
Conclusion
In fibromyalgia patients, the prescription of gabapentin and pregabalin moderately increased the risk of several adverse cardiovascular events. This risk, together with benefits and other adverse reactions, should be considered when prescribing these medications for fibromyalgia patients.
... 3. The patient does not demonstrate any other disorder that would otherwise explain the pain [54]. From 4.9 to 52.4% of patients with RA have concomitant FMS, which surpasses the 1-5% prevalence of FMS in the general population [55,56]. The wide range in prevalence estimates suggest that in many patients, the diagnosis of fibromyalgia is not made. ...
Residual pain is a major unmet medical need observed in patients suffering from rheumatoid arthritis (RA), which decreases their quality of life, even after achieving remission or low disease activity. The article has two aims: 1) to present mechanisms involved in the pathophysiology of residual pain, both inflammatory and non-inflammatory, i.e. neuropathic and nociplastic pain, as well as secondary pain syndromes, i.e. osteoarthritis and fibromyalgia, which can contribute to residual pain; 2) to show the limitations of current disease activity measures recommended by European Alliance of Associations for Rheumatology (EULAR) and American College of Rheumatology (ACR), which raise the need for a separate assessment of pain, and examples of methods that could be used by medical professionals to assess the pain and make a differential diagnosis. In conclusion, establishing a valid method to assess pain is essential to identify the pathomechanism of residual pain and to create treatments tailored specifically to individual RA patients.
... Other major symptoms include fatigue, sleep disorder, cognitive impairment, and depression [1]. It is a disabling condition with a worldwide prevalence of 1-5%, which makes it a significant health, social, and economic burden [2]. The clinical approach to FM raises a series of problems that originate from the absence of reliable knowledge about the pathogenesis mechanisms [3]. ...
Fibromyalgia (FM) is a central disorder characterized by chronic pain, fatigue, insomnia, depression, and other minor symptoms. Knowledge about pathogenesis is lacking, diagnosis difficult, clinical approach puzzling, and patient management disappointing. We conducted a theoretical study based on literature data and computational analysis, aimed at developing a comprehensive model of FM pathogenesis and addressing suitable therapeutic targets. We started from the evidence that FM must involve a dysregulation of central pain processing, is female prevalent, suggesting a role for the hypothalamus-pituitary-gonadal (HPG) axis, and is stress-related, suggesting a role for the HP-adrenocortical (HPA) axis. Central pathogenesis was supposed to involve a pain processing loop system including the thalamic ventroposterolateral nucleus (VPL), the primary somatosensory cortex (SSC), and the thalamic reticular nucleus (TRN). For decreasing GABAergic and/or increasing glutamatergic transmission, the loop system crosses a bifurcation point, switching from monostable to bistable, and converging on a high-firing-rate steady state supposed to be the pathogenic condition. Thereafter, we showed that GABAergic transmission is positively correlated with gonadal-hormone-derived neurosteroids, notably allopregnanolone, whereas glutamatergic transmission is positively correlated with stress-induced glucocorticoids, notably cortisol. Finally, we built a dynamic model describing a multistable, double-inhibitory loop between HPG and HPA axes. This system has a high-HPA/low-HPG steady state, allegedly reached in females under combined premenstrual/postpartum brain allopregnanolone withdrawal and stress condition, driving the thalamocortical loop to the high-firing-rate steady state, and explaining the connection between endocrine and neural mechanisms in FM pathogenesis. Our model accounts for FM female prevalence and stress correlation, suggesting the use of neurosteroid drugs as a possible solution to currently unsolved problems in the clinical treatment of the disease.
... Fibromyalgia is one of the most common causes of widespread chronic pain. [1] It is a chronic pain syndrome of unknown etiology that causes widespread musculoskeletal pain, usually accompanied by fatigue and concentration problems. Patients find it difficult to perform their daily tasks due to chronic pain. ...
Objectives: The Sphenopalatine Ganglion (SPG) is the target of interventional procedures in musculoskeletal pain, especially headaches, due to its role in the autonomic nervous system. Our study aimed to investigate the effect of transnasal sphenopalatine ganglion blockade (SPGB) on pain, functional capacity, sleep, and depression in fibromyalgia patients.
Methods: The hospital records of fibromyalgia patients who applied to the Algology outpatient clinic between January and May 2021, unresponsive to standard medical treatments, and underwent six sessions of bilateral transnasal SPGB at 10-day intervals were analyzed retrospectively. Numerical Rating Scale (NRS), functional capacity Fibromyalgia Impact Questionnaire (FIQ), sleep status Pittsburgh Sleep Quality Index (PSQI), and depression severity Beck Depression Inventory (BDI) data were collected during the treatment process.
Results: The mean NRS score of the patients before the treatment was 8.1852±1.71053, compared with 6.2593±2.29703 after the treatment. The mean FIQ score of the patients before the treatment was 73.0359±13.55302, compared with 54.2507±16.1906 after the treatment. After the treatment, the pain score, functional capacity, sleep quality, and depression of the patients were statistically significantly different than pretreatment (p<0.001).
... Fibromyalgia syndrome (FMS) is a common cause of chronic widespread pain, characterized by tenderness, diffuse stiffness, as well as fatigue, unrefreshing sleep, dysphoria, cognitive disorders, and headaches. FMS is the most common cause of diffuse musculoskeletal pain in women aged 20-55 [1]. It is more common in women compared to men, by a ratio of 7-9:1, with a prevalence ranging from 2 to 4%, which increases with age. ...
Background and Objectives: Fibromyalgia syndrome (FMS) is defined as a chronic pain syndrome that is characterized by widespread pain, tenderness, and diffuse stiffness. In addition, neuropsychological symptoms such as fatigue, sleep disorders, poor mood, cognitive impairment, and headaches are often reported. Many reports have addressed the coexistence of affective disorders and anxiety with FMS, yet few have focused on its association with obsessive compulsive disorder (OCD). We investigated the occurrence of classical patterns of OCD in participants with FMS and assessed their effect on pain perception and functional impairment. Material and Methods: The research population included 37 patients diagnosed with FMS, treated at the Rheumatology Clinic in the Sheba Medical Center, Tel-Hashomer, Israel. We used validated questionnaires including a demographic questionnaire, a questionnaire on average and maximal pain intensity, the Eysenck Personality Questionnaire-Revised (EPQ-R), the Perceived Stress Scale, the Pain Catastrophizing Scale, the Pain Obsessive questionnaire, and the Yale–Brown Obsessive Compulsive Scale (Y-BOCS). Results: Patients with FMS were found to have intrusive and obsessive thoughts regarding pain for several hours every day, causing a high degree of anxiety and high levels of pain, catastrophizing, and magnification, leading to helplessness and functional impairment. In total, 27% of the patients reported severe malfunction due to pain and pain ideation, and 49% demonstrated mild obsessive compulsive symptoms that were strongly correlated with pain intensity and functional impairment. Conclusions: Obsessive compulsive thinking patterns contribute to pain magnification and to the cognitive aspects of fibromyalgia syndrome.
... Fibromyalgia is a relatively common disorder whose primary manifestation is chronic widespread pain (Bair et al., 2020). Prevalence has increased dramatically with the development of more sensitive diagnostic criteria throughout the years, with a strong preponderance being seen in women, although with the most recent modified the American College of Rheumatology (ACR) criteria, numbers in men are also strong on the increase (Jones et al., 2015). Fibromyalgia carries a significant economic burden, not only because of the functional impairments to the patient's work and domestic life but also due to the cost of health services. ...
... Fibromyalgia is a prevalent pain disorder affecting 1-5% of the population, characterized by chronic generalized pain and accompanied by various somatic and psychological symptoms, such as fatigue, sleep disturbances, and anxiety [1,2]. The pathophysiological mechanism remains uncertain, though it is multifactorial, including abnormal pain signaling, genetic predispositions, abnormal neuroendocrine and autonomic system activity, environmental triggers, and sleep disturbances [3]. ...
Fibromyalgia, a chronic pain condition marked by abnormal pain processing, impacts a significant part of the population, leading to reduced quality of life and function. Hallmark symptoms include widespread persistent pain, sleep disturbances, fatigue, cognitive dysfunction, and mood changes. Through this updated review, we aim to contribute to the evolving understanding and management of fibromyalgia, offering insights into the diverse tools available to improve the lives of those affected by this challenging condition. Management begins with educating patients to ultimately relieve them of unnecessary testing and provide reassurance. Treatment emphasizes a comprehensive approach, combining nonpharmacological interventions such as aforementioned education, exercise, and psychotherapy, alongside pharmacologic management—namely duloxetine, milnacipran, pregabalin, and amitriptyline—which have consistent benefits for a range of symptoms across the spectrum of fibromyalgia. Notably, drugs like nonsteroidal anti-inflammatory drugs (NSAIDs) and acetaminophen are generally not recommended due to limited efficacy and associated risks. Lastly, a variety of other medications have shown promise, including NMDA-receptor antagonists, naltrexone, and cannabinoids; however, they should be used with caution due to a small amount of evidence and potential for adverse effects.
... Other essential symptoms of fibromyalgia include chronic pain, sleep problems, fatigue, and emotional issues (3). Its prevalence ranges from 2% to 4% (4). While the organic and medical etiology of fibromyalgia is not well documented, it is acknowledged that it negatively impacts the quality of life. ...
Background
In addition to pharmacological treatment, psychotherapeutic approaches are recommended for the treatment of fibromyalgia. There is a suggestion that eye movement desensitization and reprocessing (EMDR) therapy may be effective. This study aimed to investigate the impact of EMDR therapy on fibromyalgia symptoms, depression, sleep quality, and traumatic stress in fibromyalgia patients through a randomized controlled study (RCT).
Materials and methods
The sample for this study comprised 79 individuals diagnosed with fibromyalgia. Participants were randomly assigned to two groups: the “Treatment as Usual” (TAU) group and the TAU + EMDR group. Prior to the study and at six different time points (before starting the study, at the end of the 5th, 10th, and 15th sessions, 1 month later, and 3 months later), participants completed assessments, including the Fibromyalgia Impact Questionnaire (FIQ), Visual Analog Scale (VAS), Fibromyalgia ACR 2010 Diagnostic Criteria [Widespread Pain Index (WPI) and Symptom Severity Scale (SSS)], Beck Depression Inventory (BDI), Pittsburgh Sleep Quality Index (PSQI), and Trauma Symptom Checklist-40 (TSC-40).
Results
There were no differences in the sociodemographic variables between the study and experimental groups. Analysis of variance revealed a statistically significant group effect on VAS (p = 0.019), WPI (p = 0.018), BDI (p = 0.019), and TSC-40 (p = 0.21). After applying Bonferroni correction, EMDR was found to be effective for VAS, WPI, SSS, BDI, PSQI, and TSC-40 (p <0.05).
Conclusion
The results of the current study suggest that EMDR therapy is a viable alternative treatment for fibromyalgia. We believe these findings offer robust evidence supporting the efficacy of EMDR therapy in treating fibromyalgia, particularly in the context of a randomized controlled trial (RCT). The application of EMDR therapy for the treatment of patients with fibromyalgia is likely to be beneficial.
Clinical trial registration
ClinicalTrials.gov, identifier NCT06265194.
... Os distúrbios do sono pertencem aos critérios propostos pelas diretrizes diagnósticas do Colégio Americano de Reumatologia e estão relacionados com a intensidade da dor à longo prazo (Jones et al., 2015), visto que afetam a função cerebral e causam alteração na inibição da dor descedente levando à hiperalgesia (Nijs et al., 2017;Schuh-Hofer et al., 2013). Isto pode ocasionar uma maior contagem de pontos dolorosos, exacerbação de sintomas como fadiga, ansiedade e depressão, além da redução na funcionalidade em atividades de vida diária (Bigatti et al., 2008;Mun et al., 2020;Stuifbergen et al., 2010). ...
A fibromialgia (FM) é uma condição caracterizada pela dor crônica difusa, frequentemente acompanhada por distúrbios do sono. O tratamento para ter melhores resultados deve envolver fisioterapia, terapia medicamentosa e demais profissionais da equipe multidisciplinar. A Eletroestimulação Transcraniana por Corrente Contínua (ETCC) emerge como uma terapia complementar promissora para melhorar o sono e qualidade de vida dessa população. Assim, objetivou-se verificar os efeitos de dois protocolos de ETCC para melhora de tempo de sono em mulheres com FM. O Projeto foi aprovado pelo Comitê de Ética em Pesquisa do Centro de Ciências da Saúde da Universidade Federal da Paraíba (CAAE: 39796914.5.0000.5188). Realizou-se um ensaio clínico duplo-cego, randomizado, controlado por placebo, com 31 mulheres com FM há pelo menos três meses, na faixa etária entre 25 e 60 anos de idade. Foram divididas em três grupos: dois grupos receberam ETCC ativa por 5 ou 10 dias, enquanto um grupo recebeu estimulação sham. A qualidade do sono foi analisada antes e após o tratamento usando análises descritivas e o teste ANOVA fatorial. Observou-se um aumento significativo nas horas de sono após a aplicação da ETCC ativa em ambos os grupos, com uma leve superioridade para o grupo de 10 dias de estimulação. Este estudo fornece dados promissores sobre o efeito da ETCC na qualidade do sono de mulheres com FM. A melhoria do sono pode ter implicações importantes na gestão da dor e na qualidade de vida desses pacientes. No entanto, são necessárias mais pesquisas para entender completamente os mecanismos subjacentes e sua relação com sintomas de dor.
... This distribution is consistent with existing research on the demographics of fibromyalgia. [38][39][40] Among patients with available ethnicity data in HES, 94% were of white ethnicity. The largest age group comprised those aged 45-54 years (28.0%), ...
Objectives
Fibromyalgia is frequently treated with opioids due to limited therapeutic options. Long-term opioid use is associated with several adverse outcomes. Identifying factors associated with long-term opioid use is the first step in developing targeted interventions. The aim of this study was to evaluate risk factors in fibromyalgia patients newly initiated on opioids using machine learning.
Methods
A retrospective cohort study was conducted using a nationally representative primary care dataset from the UK, from the Clinical Research Practice Datalink. Fibromyalgia patients without prior cancer who were new opioid users were included. Logistic regression, a random forest model and Boruta feature selection were used to identify risk factors related to long-term opioid use. Adjusted ORs (aORs) and feature importance scores were calculated to gauge the strength of these associations.
Results
In this study, 28 552 fibromyalgia patients initiating opioids were identified of which 7369 patients (26%) had long-term opioid use. High initial opioid dose (aOR: 31.96, mean decrease accuracy (MDA) 135), history of self-harm (aOR: 2.01, MDA 44), obesity (aOR: 2.43, MDA 36), high deprivation (aOR: 2.00, MDA 31) and substance use disorder (aOR: 2.08, MDA 25) were the factors most strongly associated with long-term use.
Conclusions
High dose of initial opioid prescription, a history of self-harm, obesity, high deprivation, substance use disorder and age were associated with long-term opioid use. This study underscores the importance of recognising these individual risk factors in fibromyalgia patients to better navigate the complexities of opioid use and facilitate patient-centred care.
... 1 FM affects approximately 2% to 4% of the general population and the average female/male ratio for FM is 3/1 worldwide. 2,3 FM treatment can be divided into four main parts: patient education, physical activity, pharmacological treatment and psychotherapy. 4 The only "strong" recommendation in the latest recommendations of European League Against Rheumatism (EULAR) is exercise. ...
... Fibromyalgia (FM) is a multifaceted, invalidating syndrome mainly characterized by multisite chronic pain accompanied by fatigue, sleep problems, and brain fog [1,2]. It has a prevalence of about 1-5% in the adult population, with a worldwide average female-to-male ratio of 3:1 [3]. ...
Fibromyalgia (FM) is a multidimensional disorder in which intense chronic pain is accompanied by a variety of psychophysical symptoms that impose a burden on the patients’ quality of life. Despite the efforts and the recent advancement in research, FM pathogenesis and effective treatment remain unknown. Recently, the possible role of dietary patterns and/or components has been gaining attention. The current study aimed to investigate a potential correlation between adherence to the Mediterranean diet (MedDiet) and FM severity in a sample of Italian FM patients. An online survey was designed, composed of customized questions and validated questionnaires with the aim of investigating the intensity and type of pain, the presence of other psychophysical symptoms, the overall impact of FM, general food and lifestyle habits, and adherence to the MedDiet. The collected responses were analyzed for descriptive statistics, linear regression, and propensity score analyses. The results show that, despite considerable use of pharmaceuticals and supplements, FM participants suffered from a high-severity grade disease. However, those with good adherence to the MedDiet experienced a lower pain intensity and overall FM impact. A propensity score analysis indicates a positive influence of the MedDiet against FM severity, thus unveiling the need for well-designed intervention studies to evaluate the therapeutic potential of different dietary patterns.
Introduction
Fibromyalgia (FM) is a chronic syndrome characterised by widespread pain, fatigue, and symptoms such as sleep disturbances, cognitive impairment, and mood disorders. FM prevalence is notably higher among systemic lupus erythematosus (SLE) patients compared with the general population, often leading to diagnostic challenges. Misinterpreting FM as SLE activity can result in overtreatment. This study aimed to evaluate fibromyalgianess and its relationship with the clinical and immunological characteristics of SLE patients using comprehensive scoring methods for better diagnostic accuracy.
Materials and Methods
This cross‐sectional study included 50 SLE patients meeting the 2019 EULAR/ACR classification criteria. Patients with coexisting autoimmune diseases or severe systemic conditions were excluded. Clinical data, SLEDAI scores, and fibromyalgianess severity were assessed using the Polysymptomatic Distress Scale (PSDS). Patients were categorised into groups based on fibromyalgia diagnostic criteria: widespread pain and SLE‐FM. Statistical analysis was performed using SPSS, with p < 0.05 considered significant.
Results
Among 50 patients (45 female, 5 male; mean age 42.04 ± 12.5), 24% had fibromyalgianess, and 18% experienced widespread pain. Female patients exhibited significantly higher PSDS scores ( p < 0.05). While NSAID use was associated with increased PSDS scores ( p < 0.001), no significant relationship was found between fibromyalgianess and SLEDAI scores or organ involvement.
Conclusion
Fibromyalgianess in SLE patients primarily reflects heightened pain sensitivity and symptom severity rather than disease activity. Incorporating fibromyalgianess assessment into routine SLE management may prevent diagnostic and therapeutic pitfalls and improve treatment outcomes. Multidisciplinary approaches, including pharmacological and non‐pharmacological strategies, are essential for effective care.
Değerli okurlar; “Biyokimya Alanında Güncel Araştırmalar” kitabında yeni ve güncel birbirinden kıymetli toplamda 12 bölüme yer verilmiştir. Bu kitabın Biyokimya ve sağlık alanında bilimsel çalışma yapan tüm bilim okuyuculara önemli bir kaynak olması en büyük arzumuzdur. Bu baskının yazım, şekil, tasarım ve baskıya hazır hale getirilmesinde emeği geçen yayın evine teşekkür ederim. Saygılarımla
Değerli okurlar; “Biyokimya Alanında Güncel Araştırmalar” kitabında yeni ve güncel birbirinden kıymetli toplamda 12 bölüme yer verilmiştir. Bu kitabın Biyokimya ve sağlık alanında bilimsel çalışma yapan tüm bilim okuyuculara önemli bir kaynak olması en büyük arzumuzdur. Bu baskının yazım, şekil, tasarım ve baskıya hazır hale getirilmesinde emeği geçen yayın evine teşekkür ederim. Saygılarımla
Fibromyalgia (FM) impacts patients’ health status, functioning and quality of life. Accurate diagnosis and effective treatment planning require reliable, valid and responsive measures of these domains. This study aimed to assess the psychometric properties of performance based tests (PBTs) in FM and to quantify the availability of reliable, valid and responsive PBTs linked to key International Classification of Functioning, Disability and Health (ICF) categories related to functional impact. A systematic review was conducted following the PRISMA checklist, and four databases (PubMed, EMBASE, Cochrane Library and Web of Science) were searched. Eligible studies contained information on population, intervention (assessment), and outcomes (PBTs and their psychometric properties). The risk of bias and the methodological quality were assessed according to the COSMIN criteria. Twenty-two studies evaluating twenty-six PBTs were included. PBTs were linked to five ICF categories: exercise tolerance, muscle power and muscle endurance and changing basic body position and walking. The psychometric properties assessed were reliability, validity and responsiveness. The 6 minutes walking test was the most often assessed PBT with moderate quality of evidence for reliability, and very good methodological quality for validity. Overall, the methodological quality for reliability was rated as doubtful with very low to moderate evidence, for validity we found very good methodological quality with low to high evidence. No studies investigated criterion validity, and construct validity and responsiveness were seldom determined. Clinicians assessing FM patients should carefully select PBTs. Future research on PBTs psychometrics in FM should follow COSMIN recommendations, ensuring control of symptom variability.
Cada capítulo combina conocimientos clínicos y fisiopatológicos, destacando el uso de tecnologías diagnósticas avanzadas, biomarcadores y estrategias terapéuticas personalizadas que optimizan la atención integral del paciente. Además, se incluyen secciones sobre medicina preventiva, manejo interdisciplinario y toma de decisiones clínicas, esenciales para enfrentar los desafíos actuales en la atención médica. Este volumen es una referencia esencial para internistas, residentes y otros profesionales de la salud que buscan mantenerse actualizados en los últimos desarrollos de la medicina interna.
Fibromyalgia is a chronic condition that causes fatigue, sleep disturbances, cognitive impairment, and widespread pain in the muscles and bones. The latest evidence-based methods for diagnosing and treating fibromyalgia are examined in this article. The diagnostic criteria have improved, making the Symptom Severity Scale (SSS) and the Widespread Pain Index (WPI) crucial for patient assessment. This study searched PubMed, Scopus, and Web of Science from 1990 to 2023 and selected 44 publications for in-depth analysis. To ensure the accurate application of the criteria, the diagnosis and treatment of fibromyalgia were the focus of this investigation through the synthesis of qualitative data. Medications can relieve pain and improve quality of life when used early on. Anticonvulsants, tricyclic antidepressants, and SNRIs are options for pharmacological interventions. Hydrotherapy, mindfulness, CBT (cognitive-behavioral therapy), and physical exercise are the main non-pharmacological tools for long-term disease management. Continuous monitoring of the patient and precise modifications to interventions are essential for the success of therapy. The continuous education of patients, with detailed information, is essential for them to be empowered to manage their own symptoms, and consequently, improve their condition. This research examines the best clinical practices and prospective medical advancements for the treatment of fibromyalgia, as well as various therapeutic methods.
Fibromyalgia (FM) is a central sensitization syndrome that is strongly associated with the cerebral cortex. This study used bidirectional two-sample Mendelian randomization (MR) analysis to investigate the bidirectional causality between FM and the cortical surface area and cortical thickness of 34 brain regions. Inverse variance weighted (IVW) was used as the primary method for this study, and sensitivity analyses further supported the results. The forward MR analysis revealed that genetically determined thinner cortical thickness in the parstriangularis (OR = 0.0567 mm, PIVW = 0.0463), caudal middle frontal (OR = 0.0346 mm, PIVW = 0.0433), and rostral middle frontal (OR = 0.0285 mm, PIVW = 0.0463) was associated with FM. Additionally, a reduced genetically determined cortical surface area in the pericalcarine (OR = 0.9988 mm2, PIVW = 0.0085) was associated with an increased risk of FM. Conversely, reverse MR indicated that FM was associated with cortical thickness in the caudal middle frontal region (β = −0.0035 mm, PIVW = 0.0265), fusiform region (β = 0.0024 mm, SE = 0.0012, PIVW = 0.0440), the cortical surface area in the supramarginal (β = −9.3938 mm2, PIVW = 0.0132), and postcentral regions (β = −6.3137 mm2, PIVW = 0.0360). Reduced cortical thickness in the caudal middle frontal gyrus is shown to have a significant relationship with FM prevalence in a bidirectional causal analysis.
Objectives
This study aims to explore the diverse etiological factors associated with fibromyalgia, including trauma, stress, infections, and head injuries, and investigate their potential correlation with fibromyalgia severeness manifestation, aiming to discern fibromyalgia subgroups.
Methods
The study is a retrospective analysis, conducted with data of 182 fibromyalgia patients. Each patient’s medical history was analyzed to identify a primary etiological event preceding fibromyalgia. Following this, correlations were examined between each etiology group and different measurements, such as impact of fibromyalgia on overall function, widespread of pain, depression, anxiety, and cognitive impairments. Cluster analysis was conducted in order to distinguish between groups of symptoms and functioning.
Results
Contrary to the initial hypothesis, no direct association between a specific trigger and symptom manifestation was identified. However, cluster analyses revealed two distinct profiles based on symptom severity. Emotional trauma emerged as a potential contributor to heightened symptom severity, impacting overall function and cognitive abilities.
Discussion
Emotional trauma and stress are crucial factors exacerbating fibromyalgia (FM) symptoms, highlighting the importance of managing these elements in FM patients. This study underscores the complexity of FM, necessitating a nuanced understanding of its etiology and symptomatology. We recommend a multidisciplinary treatment approach that includes assessing and addressing chronic stress and trauma and incorporating stress management interventions to improve patient outcomes.
Good sleep and adequate physical activity are essential to health. Yet, large numbers of people are chronically deficient in sleep and physical activity. About 1 in 3 Americans get less than 7 h of sleep per night and only 1 of 4 adults regularly complete weekly physical activity in amounts recommended for good health. This chapter reviews research that has examined relationships between regular physical activity and sleep. The overall weight of evidence supports that regular physical activity is associated with better sleep quality among healthy adults, with epidemiological studies showing moderate-sized effects and more well-controlled randomized controlled trial experiments often showing larger effects. Large epidemiology studies suggest that the relationship between regular physical activity and better sleep quality may partially mediate the well-established associations between physical activity and reduced risk of mortality, cardiovascular diseases, and dementia. There is evidence that the completion of regular physical activity also is associated with better sleep quality among those with certain sleep disorders (i.e., insomnia, obstructive sleep apnea, and restless legs syndrome), mental health disorders (i.e., depression and posttraumatic stress disorder), and medical illnesses (i.e., breast cancer survivors). The evidence is inadequate to support that regular physical activity substantially improves sleep quality either (i) in children, adolescents, and older adults, (ii) in those with cancers except for breast cancer, (iii) in those with fibromyalgia, or (iv) among those with chronic kidney disease. Also, there is inadequate evidence to conclude that sleep quality is disrupted during weeks when competitive athletes engage in periods of overtraining.
The single-nucleotide polymorphism (SNP) rs4680 in the catechol-O-methyltransferase gene ( COMT ) is a missense variant (Val158Met) associated with altered activity of the COMT enzyme and suggested as a predictive feature for developing some chronic pain conditions. However, there are controversial results on its role in fibromyalgia (FM). Here, the SNP Val158Met was analyzed in 294 FM patients (without comorbidities) and 209 healthy controls (without chronic pain). The concurrent impact of Val158Met genotypes and FM comorbid disorders (depression and sleep impairment) on FM risk were tested. In addition, the genotypic distribution of FM patients in relation to pain intensity was evaluated. The G allele (Val) resulted in being more represented in the FM group (57.8%) compared with the control group (48.8%; P = 0.037). Logistic regression highlighted that having the G/G (Val/Val) homozygous genotype was associated with 2 times higher risk of having FM compared with the A/A (Met/Met) carriers ( P = 0.038), whereas depression and sleep impairment increased FM risk by 12 and 8 times, respectively ( P < 0.001). However, considering only the FM patient group, the A/A homozygous genotype was significantly associated with severe pain intensity ( P = 0.007). This study highlighted associations between the SNP Val158Met and both FM and pain intensity, suggesting a link between dopaminergic dysfunction and vulnerability to chronic pain. Further studies should explore this SNP in FM patients in conjunction with COMT enzymatic activity and other symptoms connected with the dopaminergic system such as depression or sleep impairment.
Purpose:
The transcutaneous electrical nerve stimulation (TENS) is one of the most frequently electrophysical agents employed in reducing the impact of FMS. This meta-analysis intended to determine the effectiveness of TENS on pain, disability, and quality of life (QoL) in patients with FMS.
Methods:
According to PRISMA, we performed a meta-analysis (CRD42023456439), searching in PubMed Medline, PEDro, CINAHL Complete, Web of Science, and Scopus, since inception up to October 2023. This review focused on controlled clinical trials evaluating the effect of TENS on pain, disability, and QoL in patients with FMS. The pooled effect was estimated using Cohen's standardized mean difference (SMD) and its 95% confidence interval (95%CI).
Results:
Twelve studies, providing data from 944 patients, were included (PEDro score of 5.6 points). Meta-analyses showed that TENS interventions are effective in improving pain (SMD = -0.61; 95%CI -1 to -0.16); disability (SMD = -0.27; 95%CI -0.41 to -0.12); and physical dimension of QoL (SMD = 0.26; 95%CI 0.08 to 0.44). Additionally, when TENS is used as a unique therapy, it represents the best therapeutic option for improving pain, disability, and QoL.
Conclusions:
This meta-analysis, including the largest number of studies, showed that TENS intervention is an effective therapy to reduce pain and disability and increase QoL in FMS patients.
Objective:
To validate the 2011 modification of the 2010 American College of Rheumatology (ACR) preliminary criteria for the diagnosis of fibromyalgia (2011ModCr) and develop alternative criteria in a sample of patients with diverse pain disorders that are commonly seen in everyday practice by pain specialists, rheumatologists, and psychologists.
Methods:
Eight clinicians from geographically varied locations in the US evaluated patients with chronic pain and psychiatric disorders using a standard set of questions that included the 2011ModCr questions, the Symptom Impact Questionnaire (SIQR), a 28-area pain location inventory (PLI), and the Short Form 36. Alternative diagnostic criteria were developed from the same data set using logistic regression and receiver operating curve analysis.
Results:
Complete data on 321 patients were evaluated; there were 135 patients with fibromyalgia (according to the 1990 ACR criteria) and 186 patients with 16 other common chronic pain problems. Comparing the 2011ModCr with the 1990 ACR criteria provided a sensitivity of 83%, a specificity of 67%, and a correct classification of 74%. Alternative criteria were derived from the 10-item symptom score from the SIQR symptoms and the 28-area PLI. Maximal diagnostic accuracy was obtained with ≥17 pain sites (range 0-28) and an SIQR symptom score of ≥21 (range 0-50). These alternative criteria had a diagnostic sensitivity of 81%, a specificity of 80%, and a correct classification of 80%.
Conclusion:
The 2011ModCr had robust operating characteristics. Alternative criteria based on symptom items from the SIQR and pain locations from the PLI had comparable operating characteristics, with somewhat better specificity and ease of use.
Purpose
The aim of this study is to investigate the reliability and validity of the Japanese version of the modified American College of Rheumatology (ACR) Preliminary Diagnostic Criteria for Fibromyalgia (mACR 2010-J) and the Fibromyalgia Symptom Scale (mFS-J).
Methods
According to the ACR 1990 classification criteria, patients with chronic pain were divided into the fibromyalgia group and nonfibromyalgia group (rheumatoid arthritis and osteoarthritis). Patients in both groups were assessed using mACR 2010-J and mFS-J.
Results
294 of 462 (64 %) patients in the fibromyalgia group met mACR 2010-J, whereas 4 % (9/231) of the nonfibromyalgia group did, with sensitivity of 64 %, specificity of 96 %, positive predictive value of 97 %, negative predictive value of 56 %, and positive likelihood ratio of 16.3. Mean total scores on mFS-J significantly differentiated the fibromyalgia from the nonfibromyalgia group. According to the value of the Youden index, the best cutoff score for the mFS-J was 9/10.
Conclusion
Our findings indicate that mACR 2010-J as a positive test and mFS-J as a quantification scale might be suitable for assessing fibromyalgia among Japanese chronic pain populations.
Background
Fibromyalgia (FM) is a pain condition with associated symptoms contributing to distress. The Fibromyalgia Survey Diagnostic Criteria and Severity Scale (FSDC) is a patient-administered questionnaire assessing diagnosis and symptom severity. Locations of body pain measured by the Widespread Pain Index (WPI), and the Symptom Severity scale (SS) measuring fatigue, unrefreshing sleep, cognitive and somatic complaints provide a score (0–31), measuring a composite of polysymptomatic distress. The reliability and validity of the translated French version of the FSDC was evaluated.
Methods
The French FSDC was administered twice to 73 FM patients, and was correlated with measures of symptom status including: Fibromyalgia Impact Questionnaire (FIQ), Health Assessment Questionnaire (HAQ), McGill Pain Questionnaire (MPQ), and a visual analogue scale (VAS) for global severity and pain. Test-retest reliability, internal consistency, and construct validity were evaluated.
Results
Test-retest reliability was between .600 and .888 for the 25 single items of the FSDC, and .912 for the total FSDC, with all correlations significant (p < 0.0001). There was good internal consistency measured by Cronbach’s alpha (.846 for FSDC assessment 1, and .867 for FSDC assessment 2). Construct validity showed significant correlations between the FSDC and FIQ 0.670, HAQ 0.413, MPQ 0.562, global VAS 0.591, and pain VAS 0.663 (all p<0.001).
Conclusions
The French FSDC is a valid instrument in French FM patients with reliability and construct validity. It is easily completed, simple to score, and has the potential to become the standard for measurement of polysymptomatic distress in FM.
The Fibromyalgia Survey Questionnaire (FSQ) assesses the key symptoms of fibromyalgia syndrome. The FSQ can be administrated in survey research and settings where the use of interviews to evaluate the number of pain sites and extent of somatic symptom intensity and tender point examination would be difficult. We validated the FSQ in a cross-sectional survey with FMS patients. In a cross-sectional survey, participants with physician diagnosis of FMS were recruited by FMS-self help organisations and nine clinical institutions of different levels of care. Participants answered the FSQ (composed by the Widespread Pain Index [WPI] and the Somatic Severity Score [SSS]) assessing the Fibromyalgia Survey Diagnostic Criteria (FSDC) and the Patient Health Questionnaire PHQ 4. American College of Rheumatology 1990 classification criteria were assessed in a subgroup of participants. 1,651 persons diagnosed with FMS were included into analysis. The acceptance of the FSQ-items ranged between 78.9 to 98.1% completed items. The internal consistency of the items of the SSS ranged between 0.75-0.82. 85.5% of the study participants met the FSDC. The concordance rate of the FSDC and ACR 1990 criteria was 72.7% in a subsample of 128 patients. The Pearson correlation of the SSS with the PHQ 4 depression score was 0.52 (p<0.0001) and with the PHQ anxiety score was 0.51 (p<0.0001) (convergent validity). 64/202 (31.7%) of the participants not meeting the FSDC criteria and 152/1283 (11.8%) of the participants meeting the FSDC criteria reported an improvement (slightly too very much better) in their health status since FMS-diagnosis (Chi(2) = 55, p<0.0001) (discriminant validity). The study demonstrated the feasibility of the FSQ in a cross-sectional survey with FMS-patients. The reliability, convergent and discriminant validity of the FSQ were good. Further validation studies of the FSQ in clinical and general population settings are necessary.
To develop a fibromyalgia (FM) survey questionnaire for epidemiologic and clinical studies using a modification of the 2010 American College of Rheumatology Preliminary Diagnostic Criteria for Fibromyalgia (ACR 2010). We also created a new FM symptom scale to further characterize FM severity.
The ACR 2010 consists of 2 scales, the Widespread Pain Index (WPI) and the Symptom Severity (SS) scale. We modified these ACR 2010 criteria by eliminating the physician's estimate of the extent of somatic symptoms and substituting the sum of 3 specific self-reported symptoms. We also created a 0-31 FM Symptom scale (FS) by adding the WPI to the modified SS scale. We administered the questionnaire to 729 patients previously diagnosed with FM, 845 with osteoarthritis (OA) or with other noninflammatory rheumatic conditions, 439 with systemic lupus erythematosus (SLE), and 5210 with rheumatoid arthritis (RA).
The modified ACR 2010 criteria were satisfied by 60% with a prior diagnosis of FM, 21.1% with RA, 16.8% with OA, and 36.7% with SLE. The criteria properly identified diagnostic groups based on FM severity variables. An FS score ≥ 13 best separated criteria+ and criteria- patients, classifying 93.0% correctly, with a sensitivity of 96.6% and a specificity of 91.8% in the study population.
A modification to the ACR 2010 criteria will allow their use in epidemiologic and clinical studies without the requirement for an examiner. The criteria are simple to use and administer, but they are not to be used for self-diagnosis. The FS may have wide utility beyond the bounds of FM, including substitution for widespread pain in epidemiological studies.
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.
The objective of the EPISER study was to estimate the prevalence of rheumatoid arthritis (RA), low back pain, hand and knee osteoarthritis (OA), and fibromyalgia in the adult Spanish population, and to assess the impact of these diseases on function and quality of life, and use of health and social resources.
2998 subjects aged 20 years or above were randomly selected by stratified multistage cluster sampling from the censuses of 20 municipalities. Trained rheumatologists carried out structured visits at which subjects were asked about rheumatic symptoms and sociodemographic characteristics, completed validated instruments for measuring function (HAQ) and quality of life (SF-12), and underwent a standardised physical examination. Cases were defined by previously validated criteria.
The estimated prevalences with 95% confidence intervals were as follows: RA lifetime cumulative: 0.5% (0.3 to 0.9); low back pain: 14.8% (12.2 to 17.4); symptomatic knee OA: 10.2% (8.5 to 11.9); hand OA: 6.2% (5.9 to 6.5); fibromyalgia: 2.4% (1.5 to 3.2). Most conditions significantly impaired function and quality of life.
The EPISER study has internal and external validity for application of the results to the adult Spanish population. The diseases studied affect a significant proportion of the population, with various degrees of impact on disability and quality of life resulting in a significant number of physician visits, work disability, and medication use.
Self-selection bias may threaten the internal validity of epidemiologic studies. Studies with a low level of participation are particularly vulnerable to this bias, and commentators note apparent declines in participation in recent years. The authors therefore conducted a retrospective review to survey the practice of reporting participation in epidemiologic studies, to assess changes in participation over time, and to evaluate the impact of increased biologic specimen collection on participation. The authors abstracted selected study characteristics from 355 peer-reviewed, original, analytic-epidemiology research articles published from January 1 to April 30, 2003, in 10 high-impact general epidemiology, public health, and medical journals. At least some information regarding participation was provided in 59% of cross-sectional studies, 44% of case-control studies, and 32% of cohort studies. Participation appears to have declined during 1970-2003 for all study designs. Participation declined most steeply for controls in population-based, case-control studies (-1.86% per year, 95% confidence interval: -3.03, -0.69), with steeper declines after 1990. Proportionately more studies collected biologic specimens over time, particularly for cohort and case-control study designs (p(trend) = 0.06 and 0.03, respectively), yet participation was reported separately for the biologic specimen study component in only 27% of studies. The authors conclude that epidemiologists need to address declining participation and to report participation consistently, including for biologic specimen collection.
To determine the specificity and sensitivity of the Modified 2010 American College of Rheumatology (ACR) Diagnostic Criteria for Fibromyalgia (given as a self-administered questionnaire) in clinical practice.
A cohort of patients with widespread pain, referred by primary care physicians to rheumatologists, completed the questionnaire for the Modified ACR 2010 criteria. Prior to completion of the questionnaire, patients were diagnosed by at least 1 rheumatologist as either having fibromyalgia (FM) or not having FM, using the rheumatologist's clinical assessment as the gold standard for diagnosis of FM. The Modified ACR 2010 criteria were then applied to determine whether a diagnosis of FM was satisfied by the criteria. Sensitivity and specificity were determined, using the rheumatologist's clinical assessment as the gold standard. A score ≥ 12 on the Modified ACR 2010 criteria questionnaire was also tested as the criterion to satisfy a diagnosis of FM, and subsequently to determine sensitivity and specificity. We examined the effect of using a cutoff score ≥ 13, as previous research indicated that this may be a more useful cutoff value.
A total of 451 subjects completed the questionnaire: 174 with an a priori diagnosis of FM by a rheumatologist and 277 with widespread pain who did not have an a priori clinical diagnosis of FM by a rheumatologist. The Modified ACR 2010 criteria were satisfied by 90.2% of patients with an a priori diagnosis of FM, and by 10.5% of subjects who had widespread pain, but were not diagnosed with FM when previously assessed by a rheumatologist. Thus, sensitivity and specificity are 90.2% and 89.5%, respectively, using the Modified ACR 2010 criteria. A score ≥ 12 on the Modified ACR 2010 criteria was observed in 97.4% of patients with an a priori diagnosis of FM, and 14.8% of subjects who had widespread pain, but were not diagnosed with FM when previously assessed by a rheumatologist. Thus, the sensitivity and specificity are 97.4% and 85.2%, respectively, using a cutoff score ≥ 12. Using a score of ≥ 13, however, the sensitivity was 93.1% and the specificity was 91.7%.
The Modified ACR 2010 criteria questionnaire can be used in primary care as a tool to assist physicians in the diagnosis of FM with high specificity and sensitivity. Calculating the total score on a Modified ACR 2010 criteria questionnaire, and setting the value of ≥ 13 as the cutoff for a diagnosis of FM appears to be the most effective approach. The Modified ACR 2010 criteria may reduce the need for rheumatology referral simply for the diagnosis of FM.
Objective
To evaluate fibromyalgia in the general population with emphasis on prevalence, dimensionality, and somatic symptom severity.Methods
We studied 2,445 subjects randomly selected from the German general population in 2012 using the American College of Rheumatology 2010 preliminary diagnostic criteria for fibromyalgia, as modified for survey research, and the polysymptomatic distress scale (PSD). Anxiety, depression, and somatic symptom severity were assessed with the Patient Health Questionnaire (PHQ) series, and measures of symptoms and quality of life were assessed with the European Organization for Research and Treatment of Cancer questionnaire.ResultsThe prevalence of fibromyalgia was 2.1% (95% confidence interval [95% CI] 1.6, 2.7), with 2.4% (95% CI 1.5, 3.2) in women and 1.8% (95% CI 1.1, 2.6) in men, but the difference was not statistically significant. Prevalence rose with age. Fibromyalgia subjects had markedly abnormal scores for all covariates. We found smooth, nondisordered relationships between PSD and all predictors, providing additional evidence against the hypothesis that fibromyalgia is a discrete disorder and in support of a dimensional or spectrum disorder. There was a strong correlation (r = 0.790) between the PSD and the PHQ somatic symptom severity scale; 38.5% of persons with fibromyalgia satisfied the proposed Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition criteria for a physical symptom disorder.Conclusion
The modified 2010 diagnostic criteria do not result in high levels of fibromyalgia. PSD and fibromyalgia are strongly related to somatic symptom severity. There is evidence in support of fibromyalgia as a dimensional or continuum disorder. This has important ramifications for neurobiologic and epidemiology research, and for clinical diagnosis, treatment, and ascertainment of disability.
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.
To develop simple, practical criteria for clinical diagnosis of fibromyalgia that are suitable for use in primary and specialty care and that do not require a tender point examination, and to provide a severity scale for characteristic fibromyalgia symptoms.
We performed a multicenter study of 829 previously diagnosed fibromyalgia patients and controls using physician physical and interview examinations, including a widespread pain index (WPI), a measure of the number of painful body regions. Random forest and recursive partitioning analyses were used to guide the development of a case definition of fibromyalgia, to develop criteria, and to construct a symptom severity (SS) scale.
Approximately 25% of fibromyalgia patients did not satisfy the American College of Rheumatology (ACR) 1990 classification criteria at the time of the study. The most important diagnostic variables were WPI and categorical scales for cognitive symptoms, unrefreshed sleep, fatigue, and number of somatic symptoms. The categorical scales were summed to create an SS scale. We combined the SS scale and the WPI to recommend a new case definition of fibromyalgia: (WPI > or =7 AND SS > or =5) OR (WPI 3-6 AND SS > or =9).
This simple clinical case definition of fibromyalgia correctly classifies 88.1% of cases classified by the ACR classification criteria, and does not require a physical or tender point examination. The SS scale enables assessment of fibromyalgia symptom severity in persons with current or previous fibromyalgia, and in those to whom the criteria have not been applied. It will be especially useful in the longitudinal evaluation of patients with marked symptom variability.
To determine the perceived proportion of fibromyalgia (FMS) among new consultations in rheumatology practices relative to other rheumatologic disorders.
We conducted a cross sectional random mail survey of 100 Canadian rheumatologists. The sampling frame was the 1991 membership directory of the Canadian Rheumatology Association from which 100 nonpediatric rheumatologists practising in Canada were selected by stratified random sampling.
Results from 89 respondents indicate that FMS is perceived to be one of the 3 most common diagnoses among new patient consultations across Canada. Perceived incidence was not affected by urban size or university affiliation of practice. FMS was the only rheumatologic disorder believed by a majority of respondents to have increased in proportion over the past 5 years.
In Canada, FMS appears to contribute to a high proportion of outpatient care in rheumatology.
To determine the prevalence and characteristics of fibromyalgia in the general population.
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.
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.
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.
Epidemiologic studies of fibromyalgia have so far been based on rheumatologic and general practice settings, which are poor proxies for the underlying population. The study is based on a national health interview survey carried out by the Danish Institute for Clinical Epidemiology in 1990/91 on approx. 6000 randomly selected Danish citizens. For this study 1219 subjects from the eastern part of Denmark aged 18 to 79 years were asked about widespread muscle pain. One-hundred-and-twenty-three persons fulfilled the screening criteria. Clinical examination could be performed on 65 persons (53%). Eight subjects, all female, met the 1990 American College of Rheumatism criteria for fibromyalgia. Dropouts were regarded as not having fibromyalgia. The prevalence of fibromyalgia in the Danish population between 18 and 79 years of age was found to be a minimum estimate of 0.66% (95% confidence limits 0.28%-1.29%).
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.
The Japanese version of the modified ACR preliminary diagnostic criteria for fibromyalgia and the Fibromyalgia Symptom Scale: reliability and validity
- Usui C
- Hatta K
- Aratani S
- Yagishita N
- Nishioka K
- Kanazawa T
A questionnaire using the modified
- R Ferrari
- A S Russell
Ferrari R, Russell AS. A questionnaire using the modified 2010
American College of Rheumatology criteria for fibromyalgia: specificity and sensitivity in clinical practice
American College of Rheumatology criteria for fibromyalgia:
specificity and sensitivity in clinical practice. J Rheumatol 2013;
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