Efectos de la terapia manual en personas con fibromialgia: Revisión sistemática y metaanálisis / Effects of Manual Therapy in People with Fibromyalgia: Systematic Review and Meta-Analysis

Resumen Objetivo: El objetivo de esta revisión sistemática con metaanálisis es sintetizar la evidencia científica disponible sobre los efectos de la terapia manual aplicada de forma aislada en comparación a otras intervenciones en el dolor, la capacidad funcional, la impresión global de mejoría y severidad de síntomas autopercibida en personas con fibromialgia. Metodología: Se realizó una revisión sistemática y metaanálisis con búsqueda electrónica en MEDLINE, WoS, SCOPUS, PEDro, CENTRAL y LILACS. Resultados: Once estudios cumplieron con los criterios de selección y seis fueron incluidos en una síntesis cuantitativa. El dolor al terminar el tratamiento tuvo una diferencia de medias de -0.42 (IC al 95% -1.14, 0.30, p = 0.25), el estado funcional al terminar el tratamiento tuvo una diferencia de medias de -0.15 (IC al 95% -0.69, 0.40, p = 0.60), la impresión global de salud al terminar el tratamiento tuvo una diferencia de media de -1.13 (IC al 95% -1.68, -0.57 p = <0.00) y posterior a doce meses una diferencia de media de -0.48 (IC al 95% -0.78, -0.19 p = <0.00), la impresión global de severidad después de la intervención tuvo una diferencia de medias de -0.62 (IC al 95% -1.22, -0.03, p = 0.04) y posterior a doce meses una diferencia de medias de -0.43 (IC al 95% -1.18, 0.32, p = 0.26). Conclusiones: La terapia manual aislada es una intervención que podría mejorar significativamente la autopercepción del estado global de mejoría y severidad de síntomas a corto plazo en comparación a agentes físicos placebo. Sin embargo, no es mejor que otras intervenciones para disminuir el dolor y mejorar la capacidad funcional.

Abstract Objective: The aim of this systematic review with meta-analysis is to synthesize the available scientific evidence on the effects of manual therapy applied in isolation in comparison to other interventions on pain, functional capacity, global impression of improvement, and self-perceived severity of symptoms in people with fibromyalgia. Methodology: A systematic review with meta-analysis was conducted with electronic search of MEDLINE, WoS, SCOPUS, PEDro, CENTRAL, and LILACS. Results: Eleven studies met the selection criteria and six were included in a quantitative synthesis. Pain at the end of treatment had a mean difference of -0.42 (95% CI -1.14, 0.30, p = 0.25), functional status at the end of treatment had a mean difference of -0.15 (95% CI - 0.69, 0.40, p = 0.60), the global impression of health at the end of treatment had a mean difference of -1.13 (95% CI -1.68, -0.57 p = <0.00) and a mean difference of -0.48 after twelve months (95% CI -0.78, -0.19 p = <0.00), the global impression of severity after the intervention had a mean difference of -0.62 (95% CI -1.22, -0.03, p = 0.04 ) and a mean difference of -0.43 after twelve months (95% CI -1.18, 0.32, p = 0.26). Conclusions: Isolated manual therapy is an intervention that could significantly improve the self-perception of the global state of improvement and severity of symptoms in the short term compared to sham physical agents. However, it is not better than other interventions to reduce pain and improve functional capacity.

Osteomielitis, perimplantitis y fractura vertical radicular mandibular en un paciente con fibromialgia: presentación de caso / Osteomyelitis, Peri-implantitis and Mandibular Root Vertical Fracture in a Patient with Fibromyalgia: Case Report / Osteomielite, peri-implantite e fratura vertical da raiz mandibular em um paciente com fibromialgia: relato de caso

Introducción: se considera la osteomielitis mandibular un proceso patológico poco frecuente. La mayor parte de los casos presentados involucran pacientes con osteorradionecrosis y aquellos pacientes con ingesta de algunos medicamentos antirresortivos. El objetivo es informar un caso inusual de una paciente con osteomielitis, perimplantitis y fractura vertical radicular con antecedentes de fibromialgia. Presentación del caso: mujer de 70 años de edad, no fumadora ni consumidora de alcohol, que acudió con un dolor posteroinferior izquierdo de un año de evolución. Presentaba una profundidad de son-deo mayor de 12 mm en el órgano dental (od) 37, sangrado a la palpación, dolor y movilidad grado ii. En el od 36 fue notoria la exposición clínica del tercio superior del implante dental, sin movilidad, con una profundidad de 4 mm. El tratamiento consistió en una exodoncia atraumática del od 37, donde se identificó una fractura radicular vertical. Discusión: actualmente, los implantes dentales permiten restablecer la salud bucodental. Sin embargo, ellos también pueden inducir una osteomielitis en los maxilares. La terapia instaurada redujo ostensiblemente la morbilidad del implante dental implicado y regeneró la zona intervenida.

Introduction: Mandibular osteomyelitis is considered a rare pathological process. Most of the cases pre-sented involve patients with osteoradionecrosis and those patients with intake of some antiresorptive drugs. The objective of this report is to report an unusual case of a patient with osteomyelitis, peri-im-plantitis and vertical root fracture with a history of fibromyalgia. Case presentation: A 70-year-old female patient, non-smoker or alcohol consumer, who presented with lower left postero-pain of one year's evolution. She presented a probing depth greater than 12 mm in dental organ (od) 37, bleeding on palpation, pain and grade II mobility. At the level of do 36, the clinical exposure of the upper third of the dental implant was notorious, without mobility, with a depth of 4 mm. The treatment consisted of an atraumatic extraction of do 37, where a vertical root fracture was identified. Discussion: Currently, dental implants make it possible to restore oral health. However, they can also induce osteomyelitis in the jaws. The established therapy ostensibly reduced the morbidity of the involved dental implant and regeneration of the intervened area

Introdução: a osteomielite mandibular é considerada um processo patológico raro. A maioria dos casos apresentados envolve pacientes com osteorradionecrose e aqueles pacientes com uso de alguns medi-camentos antirreabsortivos. O objetivo deste relato é relatar um caso incomum de um paciente com osteomielite, periimplantite e fratura radicular vertical com histórico de fibromialgia. Apresentação do caso: paciente do sexo feminino, 70 anos, não fumante ou etilista, que apresentou dor póstero-infe-rior esquerda com um ano de evolução. Apresentava profundidade de sondagem maior que 12 mm no órgão dentário (od) 37, sangramento à palpação, dor e mobilidade grau ii. Ao nível de do 36, foi notória a exposição clínica do terço superior do implante dentário, sem mobilidade, com profundidade de 4 mm. O tratamento consistiu em uma extração atraumática de do 37, onde foi identificada uma fratura vertical da raiz. Discussão: atualmente, os implantes dentários possibilitam o restabelecimento da saúde bucal. No entanto, eles também podem induzir osteomielite nos maxilares. A terapia instituída reduziu ostensivamente a morbidade do implante dentário envolvido e a regeneração da área intervencionada

Effectiveness of exercise interventions for fibromyalgia syndrome:a Meta-analysis / 中国组织工程研究

OBJECTIVE:Exercise intervention is one of the main treatments for fibromyalgia,but there is no consistent conclusion on the choice of different exercise modalities.In this article,a network Meta-analysis was used to comprehensively and quantitatively evaluate the effects of different exercise modalities on fibromyalgia syndrome. METHODS:PubMed,EMbase,Scoups,The Cochrane Library,Web of Science,CNKI,WanFang Database,and China Biomedical Literature Database were searched for relevant literature,with a search timeframe from the establishment of each database to June 2023.The outcome indicators included five continuous variables,including fibromyalgia impact questionnaire-revised(FIQ)scores,visual analogue scale(VAS)scores,quality of life,quality of sleep,and depression.The Cochrane Risk of Bias Assessment Tool was used to evaluate the quality of the included literature.RevMan 5.4 software was used to perform effect sizes,subgroup analyses,and sensitivity analyses of the data.Stata 17 software was used to perform reticulation and network Meta-analysis of the data. RESULTS:A total of 13 articles with 14 randomized controlled trials were finally included.The overall methodological quality of the literature was high.The results of traditional Meta-analysis showed that,compared with the control group,exercise therapy significantly improved the FIQ score[standardized mean difference(SMD)=-0.67,95％confidence interval(CI):-0.83 to-0.50,P<0.01],VAS score(SMD=-0.72,95％CI:-0.90 to-0.54,P<0.01),quality of life(SMD=1.03,95％CI:0.45 to 1.61,P=0.000 5),sleep quality(SMD=-0.62,95％CI:-0.98 to-0.25,P=0.001),and depression(SMD=-0.63,95％CI:-1.09 to-0.18,P=0.007).Network Meta-analysis showed that the probability of optimal intervention effect of exercise modalities on FIQ scores was ranked as:mind-body exercise(86.5)>resistance exercise(70.5)>aerobic exercise(41.7);the probability of optimal intervention effect of exercise modalities on VAS scores was ranked as:resistance exercise(85.3)>mind-body exercise(74.3)>aerobic exercise(34.5). CONCLUSION:Exercise therapy significantly improves FIQ scores,VAS scores,quality of life,sleep quality,and depression in patients with fibromyalgia syndrome.Mind-body exercise and resistance exercise are the most effective exercise modalities to reduce FIQ scores and VAS scores in patients with fibromyalgia syndrome.

Precipitating and aggravating factors in patients with fibromyalgia syndrome: a cross-sectional study / 中华风湿病学杂志

Objective:To investigate the precipitating and aggravating factors in patients with fibromyalgia (FMS) compared to patients with rheumatoid arthritis (RA).Methods:This study was conducted from January 2015 to November 2021, using a cross-sectional survey research method, based on references to develop a patient-reported "onset and exacerbation triggers questionnaire", and surveyed patients with FMS and RA at the same time, and counted the types and proportions of onset and exacerbation triggers in the two groups of patients and used the chi-square test to make comparisons between the groups.Results:A total of 415 patients with FMS and 200 patients with RA participated the survey. 146 patients with FMS (35.2%) and 38 patients with RA (19.0%) reported morbidity triggers. Experiencing physical injury (71, 17.1%), wind-cold/cold-dampness (30 patients, 7.2%), mental stress (26, 6.2%), and exercise fatigue (10 patients, 2.4%) were the common morbidity triggers for FMS. More FMS patients reported to have experienced physical injuries and mental stress before the onset of the disease compared to RA patients [8.2%(17/200), χ2=5.41, P=0.020; 1.5%(3/200), χ2=6.82, P=0.009]. Exacerbation triggers were reported by 319 patients with FMS (76.9%) and 137 patients with RA (68.5%), in the order of weather changes (219 patients, 52.7%), physical labor (192 patients, 46.2%), mood swings (147 patients, 35.4%), sleep deprivation (145 patients, 34.9%), and mental stress (130 patients, 31.3%). The proportion of FMS patients with symptom exacerbation due to physical labor [46.2%(192/415)], mood swings[35.4%(147/415)], sleep deprivation[34.9%(145/415)], mental stress[31.3%(130/415)], and infection [9.3%(39/415)] was significantly higher than that of RA patients [35.0%(70/200), χ2=7.00, P=0.008; 19.5%(39/200), χ2=16.22, P<0.001; 13.5%(27/200), χ2=30.79, P<0.001; 17.5%(35/200), χ2=13.14, P<0.001; 3.0%(6/200), χ2=8.15, P=0.004). Conclusion:More than a third of FMS patients reported precipitating factors, and nearly four fifths FMS patients reported at least one aggravating trigger. FMS patients are likely to be more sensitive to environmental changes and perceived stress than RA patients.

The (in)visibility of fibromyalgia through its symptoms and the challenges of its diagnosis and therapy / La (in)visibilidad de la fibromialgia a través de sus síntomas y los desafíos de su diagnóstico y terapia / A (in)visibilidade da fibromialgia por seus sintomas e os desafios do seu diagnóstico e terapêutica

ABSTRACT Objective: To analyze the social representations of fibromyalgia based on its symptoms and their influences on diagnosis and therapy. Methods: Qualitative research with the application of the Theory of Social Representations and snowball sampling method. Semi-structured interviews were conducted with 30 adults diagnosed with fibromyalgia in the city of Rio de Janeiro, Brazil, between April 2020 and January 2021. Statistical and lexicographical analysis was performed using Alceste software. Results: Pain, as a subjective phenomenon, complicates its legitimacy, diagnosis, and therapy, enhancing suffering. Insufficient information generates judgments, stereotypes, and prejudices. Final Considerations: Stigmas, prejudices, the variety and invisibility of symptoms make it difficult to objectify the disease within the Cartesian-biomedical frameworks, generating diagnostic pilgrimage, mistakes, and challenges in treatment. Such representations hinder relationships and the management of the disease. Deconstructing them is a way to better care for those with fibromyalgia. Raising awareness and spreading qualified information are important allies.

RESUMEN Objetivo: Analizar las representaciones sociales de la fibromialgia basadas en sus síntomas y sus influencias en el diagnóstico y la terapia. Métodos: Investigación cualitativa con la aplicación de la Teoría de las Representaciones Sociales y método de muestreo en bola de nieve. Se realizaron entrevistas semiestructuradas con 30 personas adultas, diagnosticadas con fibromialgia, en la ciudad de Río de Janeiro, Brasil, entre abril de 2020 y enero de 2021. Se llevó a cabo un análisis estadístico y lexicográfico mediante el software Alceste. Resultados: El dolor, como fenómeno subjetivo, dificulta su legitimidad, el diagnóstico y la terapia, intensificando el sufrimiento. La información insuficiente genera juicios, estereotipos y prejuicios. Consideraciones finales: Los estigmas, prejuicios, la variedad y la invisibilidad sintomática dificultan la objetivación de la enfermedad en los modelos cartesianos-biomédicos, generando una peregrinación diagnóstica, errores y desafíos en el tratamiento. Tales representaciones obstaculizan las relaciones y el manejo de la enfermedad. Desconstruirlas es un camino para mejorar el cuidado de quienes tienen fibromialgia. Sensibilizar a las personas y difundir información cualificada son aliados importantes.

RESUMO Objetivo: Analisar as representações sociais da fibromialgia baseadas em seus sintomas e suas influências no diagnóstico e na terapêutica. Métodos: Pesquisa qualitativa com aplicação da Teoria das Representações Sociais e método de amostragem snowball. Realizaram-se entrevistas semiestruturadas com 30 pessoas adultas, diagnosticadas com fibromialgia, na cidade do Rio de Janeiro, Brasil, entre abril de 2020 e janeiro de 2021. Foi realizada análise estatística e lexicográfica pelo software Alceste. Resultados: A dor, como fenômeno subjetivo, dificulta sua legitimidade, o diagnóstico e a terapêutica, potencializando o sofrimento. Informações insuficientes geram julgamentos, estereótipos e preconceitos. Considerações finais: Estigmas, preconceitos, a variedade e a invisibilidade sintomatológica dificultam a objetivação da doença nos moldes cartesianos-biomédicos, gerando peregrinação diagnóstica, equívocos e desafios no tratamento. Tais representações interditam as relações e o manejo da doença. Desconstruí-las é um caminho para melhor cuidar dos que têm fibromialgia. Sensibilizar as pessoas e difundir informações qualificadas são importantes aliados.

Fibromigraine: a cohort study retrospective / Fibroenxaqueca: um estudo de coorte retrospectivo

OBJECTIVE: To diagnose fibromyalgia in patients with migraine and assess the quality of life of these patients. METHODS: A prospective, cross-sectional study was carried out, comparing groups, in a non-randomized sample, consisting of patients diagnosed with migraine. The sample was evaluated using the Widespread Pain Index (WPI) and Symptom Severity Scale (SSS) questionnaires to diagnose fibromyalgia. Quality of life and level of depression were assessed, respectively, using the Headache Impact Test-6 (HIT-6) and Patient Health Questionnaire-9 (PHQ-9). RESULTS: We interviewed 100 patients (5 men and 95 women) diagnosed with migraine, with a mean age of 37.1±11.0 years, ranging from 19 to 64 years. Thirty-four patients (34%) had migraine and fibromyalgia concomitantly. Migraine predominated in females, both in the presence and absence of fibromyalgia. In both groups, there was no difference in headache characteristics. In the group with fibromyalgia, there was a predominance of allodynia and a higher PHQ-9 score (p<0.001). CONCLUSIONS: Patients with migraine are more predisposed to depression when there is an association with fibromyalgia

OBJETIVO: Diagnosticar fibromialgia em pacientes com enxaqueca e avaliar a qualidade de vida desses pacientes. MÉTODOS: Foi realizado um estudo prospectivo, transversal, comparando grupos, em uma amostra não randomizada, composta por pacientes com diagnóstico de enxaqueca. A amostra foi avaliada por meio dos questionários Widespread Pain Index (WPI) e Symptom Severity Scale (SSS) para diagnóstico de fibromialgia. A qualidade de vida e o nível de depressão foram avaliados, respectivamente, por meio do Headache Impact Test-6 (HIT-6) e do Patient Health Questionnaire-9 (PHQ-9). RESULTADOS: Foram entrevistados 100 pacientes (5 homens e 95 mulheres) com diagnóstico de enxaqueca, com idade média de 37,1±11,0 anos, variando de 19 a 64 anos. Trinta e quatro pacientes (34%) apresentavam enxaqueca e fibromialgia concomitantemente. A enxaqueca predominou no sexo feminino, tanto na presença como na ausência de fibromialgia. Em ambos os grupos, não houve diferença nas características da dor de cabeça. No grupo com fibromialgia houve predomínio de alodinia e maior escore no PHQ-9 (p<0,001). CONCLUSÕES: Pacientes com enxaqueca estão mais predispostos à depressão quando há associação com fibromialgia

Knowledge and strategies for coping with fibromyalgia / Conocimiento y estrategias para el enfrentamiento a la fibromialgia / Saberes e estratégias no enfrentamento da fibromialgia

ABSTRACT 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.

RESUMEN Objetivo: Analizar el conocimiento sobre fibromialgia de personas con este diagnóstico y sus repercusiones en el afrontamiento de la enfermedad. Método: Investigación cualitativa, basada en el marco de la Teoría de la Representación Social. Participaron 30 personas mayores de 18 años, del estado de Rio de Janeiro, Brasil. Se aplicó un muestreo de bola de nieve para reclutar participantes y se utilizó una entrevista semiestructurada para producir datos, entre abril de 2020 y enero de 2021. El análisis estadístico y lexicográfico fue realizado por Alceste. Resultados: La participación mayoritaria fue de mujeres (93%); de 41 a 60 años (67%); el 63% estaban casados; diagnosticado hace 10 años o más (40%); el 40% participó en grupos de apoyo. Desconocían el nombre de la enfermedad y sus causas, pero citaban sus síntomas, principalmente dolor. La objetivación de la fibromialgia se produce en los síntomas dolorosos y la falta de señales en el cuerpo genera incomprensión en las personas con las que se convive. Comparten experiencias en grupos de apoyo para afrontar la enfermedad. Conclusión: El fenómeno subjetivo del dolor genera desconfianza sobre la enfermedad. Las dificultades de diagnóstico retrasan el tratamiento y la información insuficiente genera prejuicios y estereotipos en los pacientes. Los daños y rechazos repercuten en el afrontamiento de la enfermedad.

RESUMO Objetivo: Analisar os saberes sobre a fibromialgia de pessoas com este diagnóstico e suas repercussões no enfrentamento da doença. Método: Pesquisa qualitativa amparada no referencial da Teoria das Representações Sociais. Participaram 30 pessoas acima de 18 anos, do estado do Rio de Janeiro, Brasil. Aplicou-se snowball sampling para recrutar os participantes e entrevista semiestruturada para produção de dados, entre abril de 2020 e janeiro de 2021. Realizou-se análise estatística e lexicográfica pelo Alceste. Resultados: A participação majoritária foi de mulheres (93%); idade de 41 a 60 anos (67%); 63% eram casados; com diagnóstico há 10 anos ou mais (40%); 40% participavam em grupos de apoio. Desconheciam o nome da enfermidade e suas causas, mas citaram os seus sintomas, majoritariamente a dor. A objetivação da fibromialgia ocorre nos sintomas dolorosos, por sua vez, a falta de sinais no corpo gera incompreensão nas pessoas com as quais se convive. Compartilham experiências em grupos de apoio para enfrentar a doença. Conclusão: O fenômeno subjetivo da dor gera desconfiança quanto à enfermidade. As dificuldades do diagnóstico retardam o tratamento, e a insuficiência de informações gera julgamentos e estereótipos para os doentes. Os preconceitos e rechaços repercutem no enfrentamento da doença.

Executive functions and functioning in women with fibromyalgia / Funções executivas e funcionalidade em mulheres com fibromialgia

Abstract 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.

Resumen 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.

Low-intensity resistance training promotes a reduction of mechanical hyperalgesia and increase of muscle strength in rats submitted to the diffused chronic muscle pain model / Treinamento resistido de baixa intensidade promove redução da hiperalgesia mecânica e aumento da força muscular em ratos submetidos ao modelo de dor crônica muscular difusa

ABSTRACT BACKGROUND AND OBJECTIVES: Fibromyalgia syndrome (FMS) is characterized by different factors, such as chronic diffuse muscle pain (CDMP), fatigue and psycho-emotional changes. Among the animal models that mimic FMS, the acid saline model is consolidated in the development and maintenance of CDMP. Resistance training (RT) has been an effective method for reducing pain in FMS. Thus, the aim of the present study was to evaluate the effects of resistance training on nociceptive and motor responses in an animal model of chronic diffuse muscular pain. METHODS: Twenty-four male Wistar rats were allocated into four groups: resistance training, RT control, amitriptyline (AMITRIP) and AMITRIP control; all treatment protocols lasted 4 weeks. CDMP was induced in all mice. Then, the animals were treated with low-intensity RT (40% 1 maximum repetition) and AMITRIP (10 mg/kg/day). The mechanical paw withdrawal threshold, locomotor activity and muscle strength were evaluated. RESULTS: Animals treated with both RT and AMITRIP showed an increase in the mechanical paw withdrawal threshold (p<0.05) compared to their controls, suggesting a reduction in mechanical hyperalgesia. There was no improvement in locomotor activity in all groups (p>0.05). Animals with CDMP that underwent RT showed an increase in hindlimb muscle strength (p<0.0001) compared to the RT control group. CONCLUSION: Low-intensity resistance training resulted in antihyperalgesic effects and improved muscle strength in animals submitted to the CDMP model.

RESUMO JUSTIFICATIVA E OBJETIVOS: A síndrome da fibromialgia (SFM) é caracterizada por diferentes fatores, como dor crônica muscular difusa (DCMD), fadiga e alterações psicoemocionais. Dentre os modelos animais que mimetizam a SFM, o modelo de salina ácida é consolidado no desenvolvimento e na manutenção da DCMD. O treinamento resistido (TR) tem sido um método eficaz para redução da dor na SFM. Assim, o objetivo do presente estudo foi avaliar os efeitos do TR na resposta nociceptiva e motora em modelo animal de dor crônica muscular difusa. MÉTODOS: Vinte e quatro ratos machos Wistar foram alocados em quatro grupos: treinamento resistido (TR), controle do TR, amitriptilina (AMITRIP) e controle da AMITRIP, todos os protocolos de tratamento tiveram duração de 4 semanas. A DCMD foi induzida em todos os ratos. Em seguida, os animais foram tratados com TR de baixa intensidade (40% 1 repetição máxima) e AMITRIP (10 mg/kg/dia). Foram avaliados o limiar mecânico de retirada de pata, a atividade locomotora e a força muscular. RESULTADOS: Animais tratados tanto com TR quanto com AMITRIP apresentaram aumento do limiar mecânico de retirada de pata (p<0,05) em relação aos seus controles, sugerindo redução da hiperalgesia mecânica. Não foi observada melhora da atividade locomotora em todos os grupos (p>0,05). Animais com DCMD que realizaram TR obtiveram aumento da força muscular dos membros posteriores (p<0,0001) em comparação ao grupo controle do TR. CONCLUSÃO: Treinamento resistido de baixa intensidade resultou em efeitos anti-hiperalgésicos e melhora da força muscular em animais submetidos ao modelo de DCMD.

Intervención fisioterapéutica en fibromialgia / Physiotherapeutic intervention in fibromyalgia

Introducción: La fibromialgia afecta el movimiento corporal. Provoca dolor en puntos claves, causa molestias musculoesqueléticas y limita la actividad de las personas. Se ha descrito que la fisioterapia mejora de calidad de vida de estos pacientes. Objetivo: Identificar los test de evaluación y los procesos de intervención fisioterapéutica utilizados en la fibromialgia. Métodos: Se realizó una revisión de literatura en PubMed, ScientsDirect, SciELO y LILLACS, con la terminología MeSH y DeCS, entre 2017 y 2022. Resultados: La escala visual análoga y la algometría por presión son los test utilizados para el dolor. La hidroterapia, el cupping, la punción seca, el masaje sueco, los ejercicios respiratorios y los aeróbicos resultan los métodos de intervención con más uso. Conclusiones: Los procesos de intervención se deben plantear según las evaluaciones del dolor y la funcionalidad en la persona. El tratamiento fisioterapéutico de la fibromialgia debe tener un componente de ejercicio físico aérobico y fuerza para disminuir la fatiga; devolverle al músculo su funcionalidad y aumentar la capacidad aeróbica(AU)

Introduction: Fibromyalgia affects body movement. It causes pain in key points, it causes musculoskeletal discomfort and it limits the persons's activity. It has been described that physiotherapy improves the quality of life of these patients. Objective: To identify the evaluation tests and physiotherapy intervention processes used in fibromyalgia. Methods: A literature review was carried out in PubMed, ScientsDirect, Scielo and LILLACS, with the terminology MeSH and DeCS, from 2017 to 2022. Results: The visual analogue scale and pressure algometry are the tests used for pain. Hydrotherapy, cupping, dry needling, Swedish massage, breathing exercises and aerobics are the most commonly used intervention methods. Conclusions: Intervention processes should be planned according to the evaluations of pain and functionality in the person. The physiotherapy treatment of fibromyalgia must have a component of aerobic physical exercise and strength to reduce fatigue, to return the muscle to its functionality and increase aerobic capacity(AU)

Prevalence of fibromyalgia in a Brazilian series of patients with multiple sclerosis / Prevalência de fibromialgia em uma série brasileira de pacientes com esclerose múltipla

Abstract Background The prevalence of pain in patients with multiple sclerosis is remarkable. Fibromyalgia has been considered as one of the forms of chronic pain encompassed in multiple sclerosis, but data are restricted to studies from Europe and North America. Objective To assess the prevalence of fibromyalgia in a series of Brazilian patients with multiple sclerosis and the characteristics of this comorbidity. Methods The present cross-sectional study included 60 consecutive adult patients with multiple sclerosis. Upon consent, participants underwent a thorough evaluation for disability, fatigue, quality of life, presence of fibromyalgia, depression, and anxiety. Results The prevalence of fibromyalgia was 11.7%, a figure similar to that observed in previous studies. Patients with the comorbidity exhibited worse scores on fatigue (median and interquartile range [IQR]: 68 [48-70] versus 39 [16.5-49]; p < 0.001), quality of life (mean ± standard deviation [SD]: 96.5 ± 35.9 versus 124.8 ± 28.8; p = 0.021), anxiety (mean ± SD: 22.7 ± 15.1 versus 13.8 ± 8.4; p = 0.021), and depression (median and IQR: 23 [6-28] versus 6 [3-12.5]; p = 0.034) indices than patients without fibromyalgia. There was a strong positive correlation between depression and anxiety scores with fatigue (r = 0.773 and r = 0.773, respectively; p < 0.001). Conversely, a moderate negative correlation appeared between the Expanded Disability Status Scale (EDSS), fatigue, and depression scores with quality of life (r= −0.587, r= −0.551, r= −0.502, respectively; p < 0.001). Conclusion Fibromyalgia is a comorbidity of multiple sclerosis that can enhance fatigue and decrease quality of life, although depression, anxiety, and disability are factors that can potentiate the impact of the comorbidity.

Resumo Antecedentes A prevalência de dor em pacientes com esclerose múltipla é significativa. A fibromialgia é considerada uma forma de dor crônica encontrada na esclerose múltipla, mas os dados são restritos a estudos europeus e da América do Norte. Objetivo Avaliar a prevalência de fibromialgia em uma série de pacientes com esclerose múltipla e as características desta comorbidade. Métodos O presente estudo transversal incluiu consecutivamente 60 pacientes adultos com esclerose múltipla. Após o consentimento, os participantes foram submetidos à avaliação para determinação de incapacidade, fadiga, qualidade de vida, presença de fibromialgia, depressão e ansiedade. Resultados A prevalência de fibromialgia foi de 11,7%, similar ao observado em estudos prévios. Pacientes com a comorbidade apresentaram piores escores de fadiga (mediana e intervalo interquartil [IIQ]: 68 [48-70] versus 39 [16,5-49]; p < 0,001], qualidade de vida (média ± desvio padrão [DP]: 96,5 ± 35,9 versus 124,8 ± 28,8; p = 0,021), ansiedade (média ± DP: 22,7 ± 15,1 versus 13,8 ± 8,4; p = 0,021) e depressão (mediana e IIQ: 23 (6-28) versus 6 (3-12,5); p = 0,034] do que pacientes sem fibromialgia. Houve correlação positiva forte dos escores de depressão e de ansiedade com a fadiga (r = 0,773 e r = 0,773, respectivamente; p < 0,001). Concomitantemente, houve correlação negativa moderada entre os escores de escala de estado de incapacidade expandida, fadiga e depressão com a qualidade de vida (r = - 0,587, r = - 0,551, r = - 0,502, respectivamente; p < 0,001). Conclusão A fibromialgia é uma comorbidade de esclerose múltipla que pode aumentar a fadiga e diminuir a qualidade de vida, embora depressão, ansiedade e incapacidade sejam fatores potencializadores dessa morbidade associada.

Etiologia e fisiopatologia da fibromialgia / Etiology and pathophysiology of fibromyalgia

A fibromialgia é uma condição crônica de etiologia desconhecida e desvinculada de marcadores laboratoriais específicos para diagnóstico, devido à pobre caracterização da etiopatogenia. Em geral, as alterações comuns à fibromialgia também são observadas em outras condições de dor crônica, tornando a patogênese controversa entre diferentes condições patológicas. A etiologia desconhecida dificulta o diagnóstico e, consequentemente, repercute em um tratamento não tão eficaz de pacientes com fibromialgia. A restauração de desordens sistêmicas confere amplo espectro de possibilidades terapêuticas com potencial de orientar profissionais a estabelecer metas e métodos de avaliação. Diante disso, essa revisão narrativa se volta para debater hipóteses etiológicas e fisiopatológicas no desenvolvimento da fibromialgia.

Fibromyalgia is a chronic condition of unknown etiology unrelated to specific laboratory markers for diagnosis because of poor etiopathogenesis. In general, the changes common to fibromyalgia are also seen in other chronic pain conditions, making the pathogenesis controversial among different pathological conditions. The unknown etiology makes the diagnosis difficult and consequently has repercussions on a not so effective treatment of patients with fibromyalgia. The restoration of systemic disorders provides a wide spectrum of therapeutic possibilities with the potential to guide professionals in establishing goals and evaluation methods. Therefore, this narrative review discusses the etiological and pathophysiological hypotheses involved in the development of fibromyalgia.

¿Qué nos ofrece la comunidad para el tratamiento de la fibromialgia? reporte de una experiencia en la región metropolitana de Santiago / What the community has to offer for the fibromyalgia treatment? a report of an experience in the metropolitan region of Santiago

La fibromialgia es un síndrome polisintomático caracterizado por dolor crónico generalizado no articular e idiopático, cuya terapia, tanto farmacológica como no farmacológica, debe ser individualizada a cada paciente e involucrar equipos multidisciplinarios de trabajo. Objetivo del Estudio: Realizar una base de datos para agrupar los recursos comunitarios disponibles para llevar a cabo las terapias no farmacológicas con evidencia en el tratamiento del dolor crónico no oncológico en las comunas de San Joaquín, Macul, Puente Alto, La Florida, La Pintana y San Miguel, Región Metropolitana, Chile. Materiales y Métodos: Se llevó a cabo una búsqueda en internet mediante palabras clave de recursos comunitarios dentro de las comunas antes mencionadas que cumplieran criterios de evidencia en el tratamiento de fibromialgia, además de contactar a servicios municipales y fundaciones orientadas al manejo del dolor no oncológico en la Región Metropolitana, para la confección de una base de datos y un mapa interactivo de fácil acceso y uso con los recursos encontrados. Resultados: Nuestra búsqueda arrojó un total de 78 recursos comunitarios, tanto públicos como privados, que ofrecen alternativas de tratamiento no farmacológico para el manejo del dolor crónico no oncológico y fibromialgia en las cinco comunas descritas. Conclusiones: La fibromialgia es un síndrome polisintomático de difícil manejo frecuente en nuestro país, que incluye como parte de su tratamiento integral diversas medidas no farmacológicas con evidencia reciente, que gracias a la confección de las herramientas creadas para este estudio se espera facilitar el acceso a los recursos disponibles en una zona determinada del Gran Santiago, tanto a los pacientes que padecen estas dolencias como a los profesionales de la salud que indican este tipo de terapias.

Fibromyalgia is a polysymptomatic syndrome characterizedby chronic generalized non-articular and idiopathic pain, whose pharmacological and non-pharmacological therapy must be individualized for each patient and involve multidisciplinary work teams. Objective of the study: To create a database to group the community resources available to carry out non- pharmacological therapies with evidence in the treatment of chronic non-cancer pain in the communes of San Joaquín, Macul, Puente Alto, La Florida, La Pintana and San Miguel, from Metropolitan Region, Chile. Materials and Methods: An internet search was carried out using keywords of community resources within the aforementioned communes that met evidence criteria in the treatment of fibromyalgia, in addition to contacting municipal services and foundations oriented to non- oncological pain management in the Metropolitan Region, for the preparation of a database and an interactive map of easy access and use with the resources found. Results: Our search yielded a total of 78 community resources, both public and private, that offer non- pharmacological treatment alternatives for the management of chronic non-cancer pain and fibromyalgia in the five districts described. Conclusions: Fibromyalgia is a polysymptomatic syndrome of difficult management, common in our country, which includes as part of its comprehensive treatment various non-pharmacological measures with recent evidence, which, thanks to the preparation of the tools created for this study, is expected to facilitate access to resources available in a given area of Santiago de Chile, both to patients suffering from these ailments and to health professionals who indicate this type of therapy.

Cross-sectional evaluation of socioeconomic and clinical factors and the impact of fibromyalgia on the quality of life of patients during the COVID-19 pandemic

Abstract BACKGROUND: The fibromyalgia impact questionnaire (FIQ) relates to the functional capacity, professional situation, psychological disorders, and physical symptoms, and can identify the factors that determine the impact of the syndrome and characteristics of its carriers; the higher the score, the greater the impact of fibromyalgia on the quality of life. OBJECTIVE: To evaluate the impact of fibromyalgia on the quality of life of individuals with fibromyalgia, who were categorized according to the FIQ during the coronavirus disease pandemic. DESIGN AND SETTING: A cross-sectional study was conducted at an institution of higher education in Taquara, RS, Brazil. METHODS: A quantitative study was carried out, with the application of a sociodemographic and clinical questionnaire, and the FIQ in 163 Brazilian individuals with a medical diagnosis of fibromyalgia. Data were collected using SurveyMonkey software. RESULTS: Of the female carriers, 98.2% were living in urban areas, working, and under pharmacological and complementary treatment. The FIQ results showed that seven of the 10 items had the maximum score. The items "physical function" and "feel good" had intermediate scores, and the item "missed work" had a low score. The average total score was 79.9 points, indicating that fibromyalgia had a severe impact on the participants' lives. A severe impact of fibromyalgia was observed in 61.3% of the participants, a moderate impact in 30.7%, and a low impact in 8%. CONCLUSION: The survey findings suggest a severe impact in the majority of the Brazilian fibromyalgic population.

Diagnosis of fibromyalgia: diagnostic feasibility and accuracy of thermography

INTRODUCTION: Studies have suggested using thermography as a resource to diagnose fibromyalgia, although there has been no evidence confirming this hypothesis so far. OBJECTIVE: To evaluate the sensitivity and specificity of computerized infrared thermography as an auxiliary method for diagnosing fibromyalgia. METHODS: It is a diagnostic accuracy studywith cross-sectional design. One hundred and three individuals were evaluated for global pain using the Visual Analogue Scale. The measurement of pain at tender points was assessed by algometry, and skin temperature was assessed by thermography. To evaluate sensitivity and specificity, the analysis was performed using the Receiver Operating Characteristic Curve, measured by the area under the curve with their respective confidence intervals. RESULTS: Thermography has not been very sensitive or specific for pain (tender points) and diagnosis of fibromyalgia, according to the evaluation of the Receiver Operating Characteristic Curve, with an area under the curve equal to or lower than 0.75. CONCLUSION: In this study the thermography was not sensitive and specific as a tool for diagnosing the fibromyalgia syndrome. This study highlights important clinical implications concerning the current methods for diagnosing it, which, despite all efforts, are still subjective and poorly reproducible.

Relationship between the Widespread Pain Index and the PainMAP software for pain sites measurement in patients with Widespread Pain / Relação entre o Índice de Dor Espalhada e o software PainMAP para medida de localização da dor em pacientes com dor espalhada

ABSTRACT BACKGROUND AND OBJECTIVES: Identifying pain sites is essential to managing patients with Widespread Pain. Several instruments have been developed, including pain drawings, a grid system and computerized methods. However, it is not yet known whether the Widespread Pain Index matches an automated method (painMAP) for quantifying the number of pain areas. Therefore, this study aimed to identify the relationship between the Widespread Pain Index and the painMAP software to measure pain sites in participants with Widespread Pain. METHODS: A pre-planned secondary analysis of data collected from 311 patients with musculoskeletal pain was conducted. The Widespread Pain Index and the painMAP software assessed pain sites. Spearman's correlation coefficient investigated the correlation between the Widespread Pain Index and the painMAP software. RESULTS: A total of 98 participants with Widespread Pain were included in this study. Most participants were female (67; 83.7%), with a mean age of 57,7±11,5 years, mean height of 1.6 (0.1) meters and mean weight of 73.2 (11.8) kilograms. The mean pain intensity was 6.7 (2.0), and the pain duration was 92.3 (96.3) months. The mean number of pain sites in the Widespread Pain Index was 10.1 (3.7), and in the painMAP software, it was 11.7 (8.8). A weak positive correlation (rho = 0.26, 95% CI 0.45 to 0.04, p = 0.022) between the Widespread Pain Index and the painMAP software was found. CONCLUSION: The Widespread Pain Index and the painMAP software showed a weak correlation for assessing pain sites in participants with Widespread Pain.

RESUMO JUSTIFICATIVA E OBJETIVOS: A identificação dos locais de dor é um aspecto essencial no manejo de pacientes com Dor Espalhada. Vários instrumentos foram desenvolvidos, incluindo desenhos de dor, um sistema de grade e métodos computadorizados. No entanto, ainda não se sabe se o Índice de Dor Espalhada coincide com um método automatizado (painMAP) para quantificar o número de áreas de dor. Portanto, este estudo teve como objetivo identificar a relação entre o Índice de Dor Espalhada e o painMAP para medir as áreas doloridas em participantes com esse quadro de dor. MÉTODOS: Uma análise secundária pré-planejada de dados coletados de 311 pacientes com dor musculoesquelética foi realizada. O Índice de Dor Espalhada e o painMAP avaliaram as áreas de dor. O coeficiente de correlação de Spearman foi utilizado para investigar a correlação entre o Índice de Dor Espalhada e o software painMAP. RESULTADOS: Um total de 98 participantes com Dor Espalhada foram incluídos neste estudo. A maioria dos participantes era do sexo feminino (67;83,7%), com média de idade de 57,7±11,5 anos, média de altura de 1,6 (0,1) metros e média de peso de 73,2 (11,8) quilogramas. A média de intensidade da dor foi de 6,7 (2,0) e da duração da dor de 92,3 (96,3) meses. O número médio de áreas de dor no Índice de Dor Espalhada foi de 10,1(3,7) e no software painMAP foi de 11,7 (8,8). Uma correlação positiva fraca (rho=0,26, IC de 95% 0,45-0,04, p=0,022) entre o Índice de Dor Espalhada e o painMAP foi encontrada. CONCLUSÃO: O Índice de Dor Espalhada e o painMAP mostraram correlação positiva fraca para avaliar as áreas de dor em participantes com dor espalhada.

Effects of general practice mode combined with duloxetine on psychological status,sleep quality and serum cytokines in patients with fibromyalgia syndrome / 实用医学杂志

Objective The aim of this study was to investigate the effects of general practice mode combined with duloxetine on psychological status,sleep quality and serum inflammatory cytokines in patients with Fibromyalgia Syndrome(FMS).Methods A total of 105 FMS patients in Chengde Central Hospital from January 2019 to December 2021 were divided into the combined group(53 cases)and the control group(52 cases)by the random number table method.The two groups were treated with general practice mode combined with duloxetine or duloxetine alone.The single course of treatment lasted for 4 weeks.Their efficacy and safety were evaluated after 2 courses of intervention.Visual analogue scale(VAS),Hamilton Anxiety assessment scale(HAMA),Hamilton Depression Scale(HAMD)and Pittsburgh Sleep Quality Index(PSQI)were performed before and after treatment.The pain,psychological status and sleep quality of the patients were evaluated.Blood samples were taken to measure the serum levels of tumor necrosis factor-α(TNF-α),interleukin-1(IL-1)and IL-6 before and after treatment.Results The total effective rate in the study group was 96.23%,which was higher than that in the control group(82.69%,P<0.05).Compared with those before treatment,VAS,HAMA,HAMD and PSQI scores,serum TNF-α,IL-1 and IL-6 levels in the two groups were all decreased after treatment,and those in the study group were lower than those in the control group(P<0.05).There was no statistically significant difference in the incidence of adverse reactions between two groups(7.55%vs.19.23%,P>0.05).Conclusion General practice mode combined with duloxetine was safe and effective in the treatment of FMS,which could significantly relieve anxiety and depression of patients,improve their sleep quality,and reduce the level of serum inflammatory cytokines.

Recent advance in laboratory-related indicators of fibromyalgia syndrome / 中华神经医学杂志

Fibromyalgia syndrome (FMS), also known as fibromyalgia, is clinically characterized by diffuse chronic muscle and bone pain, accompanied by fatigue, sleep disturbances, depressive episodes, and cognitive and intestinal dysfunction. Due to lack of clear specific laboratory indicators and appropriate imaging examinations, FMS diagnosis is mostly based on clinical symptoms, but FMS clinical symptoms of lack specificity, and current clinical diagnostic criteria are mostly exclusive criteria, which is prone to missed diagnosis and misdiagnosis. In order to further promote the standardized diagnosis and treatment of FMS, this paper makes extensive references to laboratory-related diagnostic indexes of FMS (Tau, adiponectin, serum cathepsin S, cystatin C, serum ferritin, nitric oxide, neutrophil/lymphocyte ratio, platelet distribution width and mean platelet volume) at home and abroad, aiming to provide new ideas for early diagnosis and intervention of FMS.

Physical activity and quality of life of patients with fibromyalgia

Background: Fibromyalgia Syndrome (FMS) has been linked to decreased social functioning, poor mental health, and quality of life (QOL). Increased physical functioning and activity can result in improvements in social, mental and overall health, as well as lowered depression and anxiety levels. Objectives: The aim of this study was to determine physical activity levels and QOL amongst patients diagnosed with fibromyalgia in the Johannesburg region of South Africa. Methods: The research design was cross-sectional. Descriptive and quantitative data were collected. FMS patients (n=38) completed an online questionnaire on the Google Forms platform. The questionnaire was comprised of four components, namely Demographics, the Global Physical Activity Questionnaire (GPAQ), the Fibromyalgia Impact Questionnaire (FIQR), and the Short Form-36 (SF-36). During data analysis, descriptive characteristics and correlations were computed. The significance level was set at p ≤ 0.05. Results: Results revealed high FIQR scores (67%) accompanied with low QOL scores (<50% in all domains). There was no correlation between physical activity and FIQR, and physical activity and QOL. Conclusion: High scores on the impact of FMS were associated with lower overall QOL scores. However, the relationship between physical activity, and the impact of FMS and QOL remain inconclusive.