Adapted Low-FODMAP Diet in IBS Patients with and without Fibromyalgia: Long-Term Adherence and Outcomes.

BACKGROUND/OBJECTIVES: A low-FODMAPs Diet (LFD) is considered a "second line" dietary strategy for irritable bowel syndrome (IBS) but, after a period of strict restriction of all FODMAP foods, it has to be adapted and tailored to each patient (AdLFD). Fibromyalgia often coexists with IBS in up to 65% of cases. Our aims were to evaluate if comorbid fibromyalgia influenced the long-term clinical outcomes and adherence to an AdLFD in IBS patients. METHODS: IBS patients with or without fibromyalgia who had started an AdLFD were enrolled. Patients had been evaluated before starting the LFD (T0). After a mean follow-up of 62.5 ± 22.7 months (T1), they were re-evaluated using questionnaires on disease severity, bowel habits, psychological status, and adherence to AdLFD. RESULTS: In total, 51 IBS patients entered the study. Nineteen of them had comorbid fibromyalgia. Thirty patients reported a reduction in symptom severity at T1 in comparison with T0. Despite some slight differences in single IBS Symptom Severity Score items, comorbid fibromyalgia did not influence the IBS-SSS total score at T1. Patients with comorbid fibromyalgia showed a higher Hospital Anxiety and Depression Scale (HADS) score at baseline. A total of 44 patients showed good long-term adherence to the AdLFD. All patients improved their HADS score and had long-term adherence to the AdLFD. CONCLUSIONS: Comorbid fibromyalgia showed only a slight influence on long-term outcomes of an AdLFD on IBS symptoms, without affecting the relief of global symptoms. No influence on long-term adherence to AdLFD was detected. Hence, this approach can be taken into account in fibromyalgia patients for a nonpharmacological management of IBS symptoms. However, multicentric studies on larger samples would be welcome in the future.

Knowledge and strategies for coping with fibromyalgia.

OBJECTIVE: To analyze the knowledge about fibromyalgia of people with this diagnosis and its repercussions in coping with the disease. METHOD: Qualitative research, based on the Social Representation Theory framework. Thirty people over 18 years old and from the state of Rio de Janeiro, Brazil, participated. Snowball sampling was applied to recruit participants and a semi-structured interview was used to produce data, between April 2020 and January 2021. Statistical and lexicographic analysis was performed using Alceste. RESULTS: Most participants were women (93%); aged 41 to 60 years old (67%); of whom 63% were married; had been diagnosed 10 years ago or more (40%); and 40% participated in support groups. They did not know the name of the disease and its causes, but they mentioned its symptoms, mainly pain. Objectification of fibromyalgia occurs in painful symptoms and the lack of signs in the body generates misunderstanding among the people they live with. They share experiences in support groups to cope with the disease. CONCLUSION: The subjective phenomenon of pain generates distrust about the disease. Diagnosis difficulties delay treatment and insufficient information generates judgments and stereotypes for patients. Prejudices and rejections have repercussions on coping with the disease.

A functional exercise program improves pain and health related quality of life in patients with fibromyalgia: a randomized controlled trial.

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.

Long versus short-term opioid therapy for fibromyalgia syndrome and risk of depression, sleep disorders and suicidal ideation: a population-based, propensity-weighted cohort study.

OBJECTIVE: Fibromyalgia syndrome (FMS) is characterised by widespread pain and is associated with mood disorders such as depression as well as poor sleep quality. These in turn have been linked to increased risk of suicidal ideation. Clinical guidelines generally do not recommended opioids in FMS, but they are routinely prescribed to a considerable proportion of FMS patients. We assessed the association of long-term opioid prescription for FMS with risk of depression, sleep disorders and suicidal ideation, when compared with short-term opioid use. METHODS: Retrospective cohort study combing several population-wide databases covering a population of five million inhabitants, including all adults who received an initial opioid prescription from 2014 to 2018 specifically prescribed for FMS. We examined the occurrence of depression, sleep disorders or suicidal ideation outcomes in patients with an initial long-term opioid prescription (>90 days) versus those who received a short-term treatment (<29 days). We employed multivariable Cox regression modelling and inverse probability of treatment weighting based on propensity scores and we performed several sensitivity analyses. RESULTS: 10 334 patients initiated short-term (8309, 80.40%) or long-term (2025, 19.60%) opioids for FMS. In main adjusted analyses, long-term opioid use was associated with an increased risk for depression (HR: 1.58, 95% CI 1.29 to 1.95) and sleep disorder (HR: 1.30, 95% CI 1.09 to 1.55) but not with suicidal ideation (HR: 1.59, 95% CI 0.96 to 2.62). In models assessing outcomes since day 90, an increased risk for suicidal ideation was observed (HR: 1.76, 95% CI 1.05 to 2.98). CONCLUSION: These findings suggest that continued opioid use for 90 days or more may aggravate depression and sleep problems in patients with FMS when compared with patterns of short-term treatment.

Executive functions and functioning in women with fibromyalgia.

BACKGROUND: Fibromyalgia (FM) is a chronic condition characterized by widespread pain that is associated with sleep, emotional, and cognitive disturbances, including in executive functions (EFs). OBJECTIVE: To investigate the relationship between EFs and functionality in women with FM. METHODS: The study included 17 women with FM, aged between 30 and 59 years, with no history of neurological disease. The EFs were assessed using the Digit Span Subtest (DS), Five Digit Test, Trail Making Test (TMT), Corsi Block-Tapping Task, Hayling Test (HT), and Verbal Fluency Task. Functionality was evaluated through the Fibromyalgia Impact Questionnaire. The Beck Depression Inventory, Hamilton Anxiety Rating Scale, and Brief Pain Inventory were used to measure depression, anxiety, and pain, which were controlled in the statistical analyses. RESULTS: The FM patients showed longer response latency on the HT and TMT. They made fewer errors on part B of the HT, and they performed worse on the DS backward and on the Corsi Block-Tapping Task forward and backward. There were moderate correlations in the expected direction between performance on the Corsi Block-Tapping Task backward and interference at work, as well as between the time to complete part B of the Trail Making Test - B (TMT-B) and fatigue. An unexpected relationship was found between errors on part B of the HT and interference at work. CONCLUSION: The results suggest lower efficiency in processes such as inhibitory control and cognitive flexibility, difficulties in working memory and non-executive processes such as processing speed. Even with pain, anxiety, and depression controlled, some relationships between EFs and functionality were observed, indicating that these symptoms do not fully explain this relationship. We suggest that cognition, particularly EFs, and broader measures of functionality be considered in the evaluation of FM.

ANTECEDENTES: A fibromialgia (FM) é uma condição crônica caracterizada por dor generalizada, associada a distúrbios do sono, emocionais e cognitivos, entre os quais os das funções executivas (FEs). OBJETIVO: Investigar a relação entre FEs e funcionalidade em mulheres com FM. MéTODOS: O estudo incluiu 17 mulheres com FM, com idades entre 30 e 59 anos, sem histórico de doença neurológica. Para a avaliação das FEs, utilizou-se Subteste de Span de Dígitos (SD), o Teste dos Cinco dígitos, o Teste de Trilhas (TT), Tarefa dos Cubos de Corsi, O Teste de Hayling (TH), e a Tarefa de Fluência Verbal. A funcionalidade foi avaliada pelo Questionário de Impacto da Fibromialgia. O Inventário de Depressão de Beck, a Escala de Ansiedade Hamilton e o Inventário Breve de Dor foram usados para mensurar depressão, ansiedade e dor, que foram controladas nas análises estatísticas. RESULTADOS: Pacientes com FM apresentaram maior latência de resposta na TH e no TT. Elas cometeram menos erros na parte B da TH, e tiveram pior desempenho no SD em ordem inversa e na Tarefa dos Cubos de Corsi nas ordens direta e inversa. Houve relações moderadas, na direção esperada, entre a Tarefa dos Cubos de Corsi na ordem inversa e interferência no trabalho, assim como entre tempo até completar a parte B do Teste de Trilhas (TT) e fadiga. Encontrou-se uma relação inesperada entre erros na parte B da TH e interferência no trabalho. CONCLUSãO: Os resultados sugerem menor eficiência em processos como controle inibitório e flexibilidade cognitiva, dificuldades na memória de trabalho e em processos não executivos, como velocidade de processamento. Mesmo com controle da dor, da ansiedade e da depressão, houve algumas relações entre FEs e funcionalidade, o que indica que esses sintomas não explicam completamente essa relação. Sugere-se considerar a cognição, particularmente as FEs, e medidas mais abrangentes de funcionalidade na avaliação da FM.

Can electroencephalography (EEG) identify the different dimensions of pain in fibromyalgia? A pilot study.

BACKGROUND: Electroencephalography (EEG) is a promising tool for identifying the physiological biomarkers of fibromyalgia (FM). Evidence suggests differences in power band and density between individuals with FM and healthy controls. EEG changes appear to be associated with pain intensity; however, their relationship with the quality of pain has not been examined. We aimed to investigate whether abnormal EEG in the frontal and central points of the 10-20 EEG system in individuals with FM is associated with pain's sensory-discriminative and affective-motivational dimensions. The association between EEG and the two dimensions of emotional disorders (depression and anxiety) was also investigated. METHODS: In this cross-sectional pilot study, pain experience (pain rating index [PRI]) and two dimensions of emotional disorders (depression and anxiety) were assessed using the McGill Pain Questionnaire (PRI-sensory and PRI-affective) and Hospital Anxiety and Depression Scale (HADS), respectively. In quantitative EEG analysis, the relative spectral power of each frequency band (delta, theta, alpha, and beta) was identified in the frontal and central points during rest. RESULTS: A negative correlation was found between the relative spectral power for the delta bands in the frontal (r= -0.656; p = 0.028) and central points (r= -0.624; p = 0.040) and the PRI-affective scores. A positive correlation was found between the alpha bands in the frontal (r = 0.642; p = 0.033) and central points (r = 0.642; p = 0.033) and the PRI-affective scores. A negative correlation between the delta bands in the central points and the anxiety subscale of the HADS (r = -0.648; p = 0.031) was detected. CONCLUSION: The affective-motivational dimension of pain and mood disorders may be related to abnormal patterns of electrical activity in patients with FM. TRIAL REGISTRATION: Retrospectively registered on ClinicalTrials.gov (NCT05962658).

Recognizing and Treating Major Depression in Fibromyalgia: A Narrative Primer for the Non-Psychiatrist.

Fibromyalgia (FM) affects 2% to 8% of the general population. FM patients often experience self-stigma and feel rejected by healthcare providers and families, resulting in isolation and distressing symptoms of pain, fatigue, and poor cognitive functioning, increasing the risk of depressive symptoms. Major Depressive Disorder (MDD) is the most common comorbidity in FM patients (Any depression: 43%; MDD: 32%). Genome-wide association studies (GWAS) have identified a common genetic risk loci for major depression and fibromyalgia. Given that even minor symptoms of depression worsen the outcomes of FM patients, clinicians are challenged to identify and manage depression in these patients. However, due to overlapping symptoms, limited screening, and contamination bias, MDD often goes undiagnosed and presents a critical challenge. Unrecognized and untreated MDD in FM patients can exacerbate fatigue, sleep disturbances, and pain, reduce physical functioning, and increase the risk of developing comorbid conditions, such as substance abuse and cardiovascular disease. These comorbidities are associated with a lower treatment response rate, a higher dropout rate, and a greater risk of relapse. Clinicians may effectively identify and treat MDD in FM patients with appropriate pharmacologic agents combined with aerobic exercise and cognitive-behavioral therapies for core FM symptoms, thus significantly reducing symptom severity for both MDD and FM. Such a comprehensive approach will result in a much-improved quality of life. MedLine content was searched via PubMed to identify eligible articles between 1995 and 2023 using search terms fibromyalgia, major depressive disorder, and treatment of depression in fibromyalgia, and the most current information is presented. In this primer for clinicians caring for FM patients, we describe clinically relevant pharmacologic and non-pharmacologic management approaches for treating MDD in FM patients.

Psychometric properties of Polish version of the 36-item WHODAS 2.0 in individuals with fibromyalgia.

Fibromyalgia (FM) is chronic, widespread musculoskeletal pain and accompanying fatigue, sleep disturbances, cognitive, psychological, and somatic symptoms. The aim of the study is to assess the psychometric properties of the Polish version of the 36-item WHODAS 2.0 in FM patients. This is a cross-sectional study involving 456 FM polish patients. The World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) 36-item version, the Fibromyalgia Impact Questionnaire (FIQ) and Beck's Depression Inventory (BDI) were used as an assessment tool in the study. The internal consistency of the 36-item WHODAS 2.0 was assessed using Cronbach's alpha. Values ranging from 0.824 to 0.951 were obtained. The interclass correlation coefficients (ICC) were very high. Internal structure of the 36-item WHODAS 2.0 was checked with Confirmatory Factor Analysis (CFA). RMSEA = 0.069, CFI = 0.963, TLI = 0.96, SRMR = 0.081 proved exactness of original six-dimensional structure of WHODAS 2.0. External validity was assessed by correlating the 36-item WHODAS 2.0 scores with the scores of two previously validated tools: FIQ and BDI. Positive correlations were obtained between the 36-item WHODAS 2.0 and these tools. Based on the conducted research, it has been shown that the 36-item WHODAS 2.0 is a reliable and valid tool for assessing disability in individuals with FM in Poland.

Disability Assessment with WHODAS 2.0 of People with Fibromyalgia in Poland: A Cross Sectional-Study.

BACKGROUND Fibromyalgia (FM) is a multifactorial syndrome characterized by chronic widespread pain, fatigue, sleep and cognitive impairment and functional symptoms. The aim of this study was to assess disability and its associated factors. The study was conducted among 691 patients with fibromyalgia in Poland using an online survey. MATERIAL AND METHODS This was a cross-sectional study of the disability of patients with fibromyalgia aged 18 years and over in Poland. The study was conducted by means of an online questionnaire distributed to patients affiliated with the National Association of Patients with Fibromyalgia. A total of 691 records were analyzed. The World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) 36-item version was used to assess disability. The Beck Depression Inventory was used to assess the participants' emotional state. Sociodemographic and selected health data were collected. RESULTS The study group had a significant general level of disability as measured by the WHODAS 2.0 (mean=49.69). The greatest limitations were found in the following areas: life activity (mean=73.43), social participation (mean=64.59), and mobility (mean=62.07). The categorical sociodemographic variables that statistically significantly differentiated the participants in terms of general level of disability were occupational status (P<0.005), pain level (P<0.001), number of medications taken (P=0.005), and level of depression (P<0.001). CONCLUSIONS Disability is present in fibromyalgia and is a major concern. Understanding the determinants of disability in fibromyalgia can contribute to the development of effective therapies and symptom relief.

Pain neuroscience education and motor imagery-based exercise protocol for patients with fibromyalgia: A randomized controlled trial.

BACKGROUND: This study is a randomized controlled, biopsychosocial study investigating the effectiveness of pain neuroscience education (PNE) and motor imagery-based exercise protocol (MIEP) on fibromyalgia pain. METHODS: Our study has four groups (MIEP n = 12, PNE n = 12, MIEP + PNE n = 14, Control n = 12) and all participants (n = 50) consist of patients diagnosed with fibromyalgia with chronic back pain. The primary outcome measure was pain intensity, and secondary outcome measures were beliefs, kinesiophobia, anxiety-depression, cognitive-mood, self-esteem, and body awareness. RESULTS: A statistically significant decrease in pain intensity was observed in all experimental groups, without any group being superior (Visual Analog Scale [VAS]: MIEP + PNE p = .003, 95% confidence interval [CI], -4.7078 to -0.9922; MIEP p = .003, 95% CI, -5.4806 to -1.0194; PNE p = .002, 95% CI, -3.6139 to -1.5461). There was a significant improvement in organic beliefs in both groups where PNE was applied (MIEP + PNE: p = .017, 95% CI, -7.8211 to -0.3189; PNE: p = .003, 95% CI, -9.7999 to -0.0401). A significant superiority in organic pain beliefs was detected in the MIEP + PNE group compared to the control group (p = .008, 95% CI, 1.7241-9.4959). CONCLUSIONS: According to this study, in which MIEP and PNE were combined, there was a decrease in pain intensity when both applications were applied together and when they were applied one by one. MIEP has improved her motor imagery ability, improved pain and increased body awareness. PNE has improved people's organic pain beliefs; removed people from fears, catastrophizing, and negative thoughts about pain; improved easier management of psychological processes and cognitive-emotion regulation ability.

Depression with comorbid juvenile-onset fibromyalgia syndrome novel treatment plan using interpersonal psychotherapy: A case report.

BACKGROUND: Fibromyalgia syndrome (FMS) affects 2% to 4% of people, with increasing prevalence in Saudi Arabia reaching 13.4%. FMS can occur in adolescents, known as juvenile-onset fibromyalgia (JFM) with comorbidities including depression, anxiety, and psychological stress. Our patient presented to the child and adolescent psychiatry clinic at King Saud University Hospital Medical City. A year before coming to our clinic, at the age of 15 she was initially diagnosed with JFM followed by a comorbid persistent depressive disorder. METHODS: As a novel treatment method, a combination treatment approach was used, including a pharmacological intervention with Duloxetine, and a non-pharmacological intervention with interpersonal psychotherapy for adolescents. She completed 16 weeks of therapy while monitoring for duloxetine response and side effects. RESULTS: Depressive symptoms were in remission by treatment's end and continued to be in her first month posttreatment follow-up, and the FMS symptoms were also controlled. CONCLUSION: Our present case highlights a combined approach to treat depression and JFM in adolescents as a novel intervention method thus we strongly recommend utilizing it for similar cases.

The effect of fibromyalgia syndrome on female patients diagnosed with chronic migraine.

OBJECTIVE: To compare pain, quality of life, sleep, anxiety and depression, central sensitization, and functionality between chronic migraine (CM) patients with comorbid fibromyalgia syndrome (FMS) and patients with CM alone. METHOD: Thirty three female patients with CM and thirty three female patients with CM+FMS were enrolled in the study. Demographic and clinical characteristics of the patients were recorded. FM was diagnosed based on the 2016 American College of Rheumatology diagnostic criteria. All participants were evaluated with Allodynia Symptom Checklist, Short Form-36 (SF-36), Pittsburgh Sleep Quality Index (PSQI), Hospital Anxiety and Depression Scale (HADS), Migraine Disability Assessment (MIDAS) and Headache Impact Test (HIT-6) questionnaires, and Central Sensitization Inventory (CSI). FM patients were also evaluated with Fibromyalgia Impact Questionnaire (FIQ). RESULTS: The average number of headache days was significantly higher in patients with CM+FMS (p = 0.006). Among migraine accompanying symptoms, the number of patients with phonophobia was significantly higher in patients with CM+FMS (p = 0.008). While CSI score was 39.0 ±â€¯11.7 in CM patients, it was 52.2 ±â€¯9.2 in CM+FMS patients. CSI scores were higher in CM+FMS patients (p < 0.001). SF-36 sub-cores, including physical function, energy/fatigue, emotional well-being, and general health scores, were lower in CM+FMS patients (p < 0.05). Sleep duration was significantly lower and use of medication to sleep was more common in same group (p < 0.05). FIQ score in CM+FMS patients was associated with quality of life scores, sleep quality, anxiety, and central sensitization scores (p < 0.05). CONCLUSION: In patients with chronic migraine, FMS comorbidity negatively affects the quality of life and significantly increases central sensitization.

[Cognitive training and physical therapy for fibromyalgia : Results of the KogTraP pilot study]. / Kognitives Training und physikalische Therapie bei Fibromyalgie : Ergebnisse der KogTraP-Pilotstudie.

BACKGROUND: The effectiveness of additive cognitive training in groups to the standard physical-medical therapy for primary and secondary fibromyalgia syndrome (p/sFMS) and a subsequent home-based self-training phase (STP) was analyzed. METHODS: In the prospective controlled randomized study, 32 people with confirmed p/sFMS were included, whereby 4 patients could not be evaluated. During 2 weeks of acute inpatient therapy, the control group (CG; n = 12) received standard physical-medical therapy and the intervention group (IG, n = 16) also received social-communicative cognitive group training (once/day, 60 min). In the subsequent 3­months, STP training was continued by both groups. RESULTS: Outcome parameters at baseline (U1), at discharge (U2), and after a quarter year (U3) were pain, well-being/depressive mood, general health, and cognitive parameters (memory functions, cognitive speed). Both groups showed significant pain relief (U2 vs. U1), which was 10% more in the IG. A significant improvement in mood could be seen in both groups, but only the IG no longer achieved depressive values in the follow-up (U3). An improvement in the general state of health was also detected in both groups, which was only maintained in the IG until the end of the STP. Cognitive performance remained the same in the IG at U2, while there was a reduction in the CG; cognitive speed could only be further improved in the IG during the STP. Adding cognitive training to a standard physical-medical clinical therapy resulted in significant pain relief and improvement of depression in patients during a hospital stay.

Retrospective Analysis of Fibromyalgia: Exploring the Interplay Between Various Triggers and Fibromyalgia's Severity.

OBJECTIVES: This study aimed to explore the diverse etiological factors associated with fibromyalgia (FM), including trauma, stress, infections, and head injuries, and investigate their potential correlation with FM severeness manifestation, aiming to discern FM subgroups. METHODS: The study was a retrospective analysis, conducted with data of 182 FM patients. Each patient's medical history was analyzed to identify a primary etiological event preceding FM. Following this, correlations were examined between each etiology group and different measurements, such as the impact of FM on overall function, widespread pain, depression, anxiety, and cognitive impairments. Cluster analysis was conducted 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 2 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 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.

Comparative effectiveness of Maitland Spinal Mobilization versus myofascial techniques on pain and symptom severity in women with Fibromyalgia syndrome: A quasi-randomized clinical trial with 3-month follow up.

OBJECTIVE: The aim of this experimental study was to determine which manual therapy approach is more effective in addressing health status by improving symptoms (sensory, cognitive, emotional, and social) in patients with fibromyalgia. MATERIAL AND METHODS: A quasi-randomized clinical trial with 3-month follow-up was conducted in 52 female patients (age 52.5 ± 8.1 years) affected by rheumatologist-diagnosed Fibromyalgia and evaluated at the Asociación de Fibromialgia y Síndrome de Fatiga Crónica (AFINSYFACRO) in Móstoles and AFIBROM, Madrid, Spain. Two manual therapy approaches were applied: the myofascial technique approach (MTA) and Maitland Mobilization Approach (MMA). The study examined the following outcomes: Widespread Pain, Symptom Severity, Impact on Quality of Life, Perceived Pain, Sensitization-Associated Pain, Sleep Quality, Physical Activity, and Psychological, Cognitive, and Emotional Factors. Patient Satisfaction was also assessed. RESULTS: No significant differences were found between groups over time for most variables. However, the MTA group showed significant improvements in pain intensity, central sensitization, general health, sleep quality, and anxiety compared with the MMA group. CONCLUSIONS: Despite the lack of between-group differences in all variables over time, MTA may be useful in the treatment of fibromyalgia, reducing pain, central sensitization, and negative emotional symptoms, as well as improving general health and sleep quality. Due to problems during the study, randomization was abandoned. This problem becomes a virtue by taking advantage of the situation to apply statistical compensation methods, which will serve as a guide for future research that suffers from this problem. We suggest the inclusion of longer follow-up periods in future studies.

Exploring the Overlooked Depression, Anxiety, Insomnia and Fibromyalgia Syndrome Burden in Arab Women with Type 2 Diabetes: New Avenues for Chronic Disease Management.

Background and Objectives: Although physical health is always studied for women with diabetes, the mental health aspect is generally overlooked for this chronic disease. The present study aimed to examine the prevalence of psychosomatic symptoms, namely, fibromyalgia syndrome, depression, anxiety, and insomnia, and how these symptoms related to the medications used in a cohort of women diagnosed with type 2 diabetes (DM) in Jordan. Materials and Methods: This cross-sectional study recruited women diagnosed with type 2 diabetes, and validated scales (PSRS, PHQ-9, GAD-7, and ISI-A) for fibromyalgia syndrome, depression, anxiety, and insomnia were used. The associations between the different medications used and the dependent variables were examined using four separate multivariate logistic regression models. Results: Data were analyzed from 213 participants. Of them, 27.2% met the threshold for fibromyalgia syndrome diagnosis, 38% met the threshold for severe depression, 36.2% met the threshold for severe anxiety, and 39.9% met the threshold for severe insomnia. Fibromyalgia syndrome symptoms were significantly associated with glimepiride (OR = 1.92, CI = 1.00-3.68), ß-blockers (OR = 2.21, CI = 1.03-4.70), diuretics (OR = 3.13, CI = 1.26-7.78), herbal remedies (OR = 2.12, CI = 0.98-4.55), and prescriptions for centrally acting medication (OR = 2.78, CI = 1.24-6.29). Significant associations were found between depression and diuretics (OR = 2.62, CI = 1.05-6.67), over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) (OR = 3.49, CI = 1.69-7.23), and herbal remedies (OR = 5.07, CI = 2.40-10.69). In addition, anxiety was significantly related to diuretics (OR = 2.48, CI = 1.02-6.02), and OTC NSAIDs (OR = 2.60, CI = 1.29-5.21). Significant associations were evident between insomnia and ß-blockers (OR = 3.23, CI = 1.51-6.95), acetaminophen (OR = 2.09, CI = 1.06-4.08), NSAIDs (OR = 4.61, CI = 2.18-9.76), and herbal remedies (OR = 5.95, CI = 2.71-13.07). Conclusions: Medications are associated with high burden of fibromyalgia syndrome, depression, anxiety, and insomnia. These findings underscore the importance of revising and optimizing the pharmacotherapy of these vulnerable patients, performing close mental health monitoring and the implementation of non-pharmacological interventions by integrating mental health services for women with chronic diseases such as diabetes.

Physicians' knowledge, attitudes, and practices regarding fibromyalgia: A systematic review and meta-analysis of cross-sectional studies.

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.

Incongruence in Perceptions of Pain: Associations with Mental Health in Couples Living with Fibromyalgia.

Guided by the theory of dyadic illness management, this study examined the association between the within-couple incongruence regarding perceptions of pain experienced by adults with fibromyalgia (AwFM) and symptoms of depression and anxiety in AwFM and their partners. Participants included 204 couples. Three second-order dyadic variables were created from the couples' perceptions of pain interference experienced by AwFM: (1) absolute magnitude of incongruence in perception of pain, (2) average perception of pain, and (3) direction of incongruence (i.e., who perceives pain to be higher). Structural equational modeling was used to examine the association between the three dyadic variables and AwFM and partner symptoms of depression and anxiety, adjusting for covariates. These steps were repeated for pain severity. Higher average perception of pain interference within the couple was associated with greater symptoms of depression and anxiety in AwFM and partners. AwFM exhibited greater symptoms of depression when their perception of their pain interference was higher than their partner's. Incongruence variables were not significantly associated with AwFM or partners' anxiety symptoms. Near identical results were found for pain severity. A dyadic approach to mental health treatment, which includes enhanced communication skills, should be adopted to optimize the mental health of couples living with fibromyalgia.

Impact of migraine and fibromyalgia on temporomandibular disorder: A retrospective study on pain, psychological factors and quality of life.

OBJECTIVES: This study assessed the impact of migraine and fibromyalgia (FM) in TMD patients, focusing on pain, anxiety, depression, and quality of life (QoL). Additionally, we investigated how these variables relate to the total number of comorbidities to gain insights into their interactions. METHODS: A retrospective data collection was conducted during January 2016 to December 2022, involving 409 adult TMD patients. TMD patients were categorised into four groups: those without comorbidity (TMD-only) and those with comorbid migraine and/or fibromyalgia (TMD + MG, TMD + FM and TMD + MG + FM). Quantitative variables were compared among them. Linear regression was used to analyse the associations between these variables. RESULTS: Most of study population were women (79%) with a mean age of 44.43 years. TMD + MG patients reported longer pain duration, higher pain scores and greater pain interference compared with TMD-only patients. Similarly, TMD + FM patients had higher pain intensity than patients with TMD only. Both the TMD + MG and TMD + FM groups had higher levels of anxiety, depression, and health impairment compared with patients with TMD only. Patients with all three pain conditions (TMD + MG + FM) experienced the longest pain duration, highest pain intensity, psychological distress, and impaired QoL. The result showed positive associations between pain outcomes, psychological measures, pain's impact on QoL, and the number of comorbidities and a negative association between overall health states and the number of comorbidities. CONCLUSIONS: These findings underscore the importance of considering the presence of comorbidities and addressing physical and psychological aspects in the management of TMD patients.