Feasibility of therapeutic music listening in fibromyalgia: a randomised controlled pilot study.

BACKGROUND: Fibromyalgia patients can benefit from music approaches as complementary treatments. In the literature, it was shown that these interventions managed pain conditions as well as reduced complaints, increased relaxation, and improved moods. OBJECTIVE: This study aimed at evaluating music therapy, in the form of therapeutic music listening, specifically for patients with fibromyalgia, to treat chronic pain by reducing pain perception, increasing well-being, and improving quality of life. METHODS: Twenty-four patients with fibromyalgia were recruited to take part in this feasibility pilot study that adopted a between-subject and within-subject design. Participants were randomised into three groups: (1) standard care, (2) standard care plus preferred music listening, (3) standard care plus Melomics-Health music listening, composed by an algorithm. Participants in experimental groups listened to 30 min of music at home, twice a day for a month. Patients' perceptions of changes following the listening, the intensity of pain and its interference in their lives, physical and mental well-being, and reported attitudes towards listening to music were evaluated respectively through the patients' global impression of change, the brief pain inventory, the Short Form Healthy Survey-12, and the cognitive behavioural assessment-outcome evaluation. RESULTS: The study showed that music listening can significantly affect mental well-being compared to no music. Moreover, the effects in the Melomics-Health group are maintained at follow-up. No significant effect on pain perception was noted. CONCLUSIONS: The study provides information supporting a possible role of music listening in improving well-being of patients with fibromyalgia.

Capsaicin 8% dermal patch in clinical practice: an expert opinion.

INTRODUCTION: Neuropathic pain (NP) is caused by a lesion or disease of the somatosensory system, which can severely impact patients' quality of life. The current-approved treatments for NP comprise of both centrally acting agents and topical drugs, including capsaicin 8% dermal patches, which is approved for the treatment of peripheral NP. AREAS COVERED: The authors summarize literature data regarding capsaicin use in patients who suffer from NP and discuss the clinical applications of this topical approach. EXPERT OPINION: Overall, the capsaicin 8% dermal patch is as effective in reducing pain intensity as other centrally active agents (i.e. pregabalin). Some studies have also reported fewer systemic side effects, a faster onset of action and superior treatment satisfaction compared with systemic agents. In our opinion, capsaicin 8% dermal patches also present additional advantages, such as a good systemic tolerability, the scarcity of adverse events, the possibility to combine it with other agents, and a good cost-effective profile. It is important to note that, as the mechanism of action of capsaicin 8% is the 'defunctionalization' of small afferent fibers through interaction with TRPV1 receptors, the peripheral expression of this receptor on nociceptor fibers, is crucial to predict patient's response to treatment.

Development of the Italian version of the Tampa Scale of Kinesiophobia (TSK-I): cross-cultural adaptation, factor analysis, reliability, and validity.

STUDY DESIGN: Evaluation of the psychometric properties of a translated and culturally adapted questionnaire. OBJECTIVE: Translating, culturally adapting, and validating the Italian version of the Tampa Scale of Kinesiophobia (TSK-I) to allow its use for Italian-speaking patients with low back pain. SUMMARY OF BACKGROUND DATA: Increasing attention is being given to standardized outcome measures as a means of improving interventions for low back pain. A translated form of the TSK in patients with low back pain has never been validated in the Italian population. METHODS: The development of the TSK-I questionnaire involved its translation and back-translation, a final review by an expert committee, and testing of the prefinal version to establish its correspondence to the original English version. Psychometric testing included factor analysis, reliability by internal consistency (Cronbach's alpha) and test-retest repeatability (Intraclass Coefficient Correlation), discriminant validity (Pearson correlation) by comparing TSK-I to a visual analogue scale, the Roland Morris Disability Questionnaire, Beck's Depression Inventory and Anxiety Inventory. RESULTS: It took the authors 5 months to achieve a shared version of the TSK-I, which proved to be satisfactorily acceptable when administered to 178 subjects. Factor analysis indicated a 2-factor 13-item solution (38% of explained variance). The questionnaire showed acceptable internal consistency (alpha = 0.772) and high test-retest reliability (ICC = 0.956). Discriminant validity showed moderate to low correlations with visual analogue scale (r = 0.345), the Roland Morris Disability (r = 0.337), and Beck's Depression Inventory and Anxiety Inventory (r = 0.258 and r = 283). The subscales were also psychometrically analyzed. CONCLUSION: The TSK was successfully translated into Italian, showing a good factorial structure and psychometric properties, and replicating the results of existing English versions of the questionnaire. Its use is recommended for research purposes.

Neurophysiological evidence of antidromic activation of large myelinated fibres in lower limbs during spinal cord stimulation.

STUDY DESIGN: This study was designed to verify the hypothesis of a constant, antidromic activation of fibers traveling along peripheral sensory nerves during spinal cord stimulation (SCS). OBJECTIVE: To investigate the neurophysiological characteristics (latency, amplitude, waveform) of potentials recorded in peripheral sensory nerves during the SCS. SUMMARY OF BACKGROUND DATA: SCS is widely used for the relief of chronic benign pain resistant to conservative therapies, but its antalgic mechanism is poorly understood. Antidromic activation of peripheral nerve fibers is one of the hypothesized antalgic mechanisms, but very few neurophysiological studies have been conducted on this subject. METHODS: Sixteen patients undergoing a percutaneous test trial of SCS for chronic pain in the lower limb (4 males, 12 females, mean age of 54.2, and age range 41-77 years) were enrolled. Diagnoses included: failed back surgery syndrome, complex regional pain syndrome type I, painful lumbosacral radiculopathy, and painful peripheral neuropathy. All patients had a lead percutaneously implanted in the epidural space at a vertebral level ranging from T9-T12. Nerve action potentials were generally recorded in nonpainful leg but, when the pain was outside the investigated nerve territory, a bilateral recording was performed. Twenty-one different studies were carried out on 16 patients. RESULTS: The results confirmed the hypothesis that cutaneous afferents were regularly activated by SCS. CONCLUSION: The authors hypothesize that this antidromic activation could represent a possible antalgic mechanism of SCS in patients with peripheral neuropathic pain, but further neurophysiological studies will be needed to elucidate this hypothesis.