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ABSTRACT BACKGROUND AND OBJECTIVES Fibromyalgia and generalized pain represent a global health problem and are distinct musculoskeletal disorders, but there is an overlap in the clinical presentation between these conditions. However, no study has compared pain characteristics between patients with fibromyalgia and patients with generalized pain. Therefore, the present study aimed to compare pain characteristics and functional limitation of patients with fibromyalgia and patients with generalized pain. METHODS A pre-planned secondary analysis of data collected from 311 patients with musculoskeletal pain was performed. Pain characteristics included pain intensity, pain duration, pain area, symptoms of central sensitization, presence of neuropathic-like symptoms, and the conditioned pain modulation. The Patient-Specific Functional Scale assessed functional limitation. RESULTS 98 patients with generalized pain were identified, being 58 (59.18%) classified in the fibromyalgia group and 40 (40.82%) classified in the generalized pain group. Significant differences were found between groups for Widespread Pain Index, Symptom Severity Scale, and Polysymptomatic Distress Scale. Participants with fibromyalgia presented higher values of pain intensity (fibromyalgia = 7.29±2.07, generalized pain = 6.05±2.47; p=0.008), neuropathic-like symptoms (fibromyalgia = 17.74±7.62, generalized pain = 12.17±6.41; p=0.005), and symptoms of central sensitization (fibromyalgia = 51.32±14.26, generalized pain = 33.97±14.65; p<0.001), when compared with generalized pain. There was no significant difference in conditioned pain modulation and functional limitation between groups. CONCLUSION Patients with fibromyalgia exhibited unfavorable pain characteristics, including pain intensity, neuropathic-like symptoms, and symptoms of central sensitization compared to patients with generalized pain. However, pain duration, functional limitation, and conditioned pain modulation did not present meaningful differences between groups.
RESUMO JUSTIFICATIVA E OBJETIVOS Fibromialgia e dor generalizada representam um problema de saúde global e são distúrbios musculoesqueléticos distintos, mas há uma sobreposição na apresentação clínica entre essas condições. Entretanto, nenhum estudo comparou as características da dor entre os pacientes com estas condições. Portanto, o presente estudo teve como objetivo comparar as características da dor e a limitação funcional de pacientes com fibromialgia e dor generalizada. MÉTODOS Realizou-se uma análise secundária pré-planejada de dados coletados de 311 pacientes com dor musculoesquelética. As características da dor incluíram: intensidade da dor, duração da dor, área da dor, sintomas de sensibilização central, presença de sintomas neuropáticos e a modulação condicionada da dor. A escala de funcionalidade específica do paciente avaliou a limitação funcional. RESULTADOS Identificou-se 98 pacientes com dor generalizada, sendo 58 (59,18%) classificados no grupo de fibromialgia e 40 (40,82%) no grupo de dor generalizada. Diferenças significativas foram encontradas entre os grupos para o índice de dor generalizada, escala de severidade de sintomas e escala polissintomática de sofrimento. Os participantes com fibromialgia apresentaram maiores valores de intensidade da dor (fibromialgia = 7,29±2,07, dor generalizada = 6,05 ± 2,47; p=0,008), sintomas neuropáticos (fibromialgia = 17,74±7,62, dor generalizada = 12,17 ± 6,41; p=0,005) e sintomas de sensibilização central (fibromialgia = 51,32±14,26, dor generalizada = 33,97±14,65; p<0,001), quando comparados à dor generalizada. Não houve diferença significativa na modulação condicionada da dor e na limitação funcional entre os grupos. CONCLUSÃO Pacientes com fibromialgia exibiram características de dor desfavoráveis, incluindo intensidade de dor, sintomas neuropáticos e sintomas de sensibilização central, quando comparados a pacientes com dor generalizada. Entretanto, a duração da dor, a limitação funcional e a modulação condicionada da dor não apresentaram diferença significativa entre os grupos.
ABSTRACT
OBJECTIVE: The aim of the review was to appraise clinical practice guidelines and their recommendations for the treatment of lumbar spinal stenosis. METHODS: PubMed, Medline, CINAHL, Embase, and Cochrane Central Register of Controlled Trials were searched up until 25/01/2020 for clinical practice guidelines on the management of lumbar spinal stenosis with a systematic process to generate recommendations and were publicly available. RESULTS: Ten guidelines were included, with a total of 76 recommendations for the treatment of lumbar spinal stenosis. Only 4 of the 10 guidelines were of satisfactory methodological quality according to the AGREE II instrument. Around three-quarters of recommendations (72.4%) were presented with poor evidence, with the remaining 21 presenting (27.6%) fair evidence. No recommendation presented good evidence. Recommendations were made on four types of interventions: surgery, injections, medications, and other nonsurgical treatments, with supporting evidence similar for all four treatment types. Positive recommendations were more common for injections (12/13=92.3%) and surgery (10/15=66%) than for nonsurgical treatments (6/21=28.6%) or medications (1/27=3.75%). CONCLUSIONS: Ten guidelines on the management of lumbar spinal stenosis were identified in the systematic review, but only four were of adequate methodological quality. While the evidence underpinning the various types of interventions was similar, guidelines tended to endorse surgery and injections but not nonsurgical interventions and medicines. These results support the need for greater rigor and inclusion of steps to minimize bias in the production of guidelines.