Virtual embodiment in fibromyalgia.

Chronic pain alters the experience of owning a body and leads to disturbances in bodily perception. We tested whether women with fibromyalgia (FM) are receptive to bodily illusions of owning a visible and progressively invisible body in immersive virtual reality (VR), and what modulates this experience. Twenty patients participated in two experimental sessions; each session included two conditions in a counterbalanced order. We found that patients with FM could indeed experience virtual embodiment. Sentiment analysis revealed significantly more positive reactions to the progressively invisible body, yet twice as many patients declared they preferred the illusion of a visible virtual body. A linear mixed model revealed that the strength of embodiment was positively associated with body perception disturbances and negatively associated with FM symptoms intensity. No effect of pain during the VR experience nor interoception awareness on embodiment was found. The results indicated that patients with FM are receptive to virtual bodily illusions and that the impact of the embodiment depends on affective reactions, the level of cognitive body distortions, and the intensity of symptoms. Importantly, there is a large variation among patients which should be considered in future VR-based interventions.

Recomendaciones SER sobre el manejo de los pacientes con fibromialgia. Parte II: educación del paciente y formación de los profesionales / Recommendations by the Spanish Society of Rheumatology on the Management of Patients with Fibromyalgia. Part II

Objetivo: Evitar el deterioro de los pacientes con fibromialgia por actuaciones perjudiciales en la práctica clínica potencialmente evitables. Métodos: Un panel multidisciplinar de expertos identificó las áreas clave, analizó la evidencia científica y formuló las recomendaciones a partir de esta evidencia y de técnicas cualitativas de «evaluación formal» o «juicio razonado». Resultados: Se han elaborado 39 recomendaciones sobre diagnóstico, tratamientos no eficaces ni seguros, educación del paciente y formación del profesional. En esta parteII se reflejan las 12 recomendaciones, referidas a las dos últimas áreas. Conclusiones: Un buen conocimiento de la fibromialgia por el paciente mejora el afrontamiento y la aceptación de la enfermedad reduciendo la gravedad de algunas manifestaciones clínicas. Los profesionales sanitarios que tratan a los pacientes con fibromialgia deben tener una buena formación sobre esta enfermedad para mejorar los resultados del tratamiento y la relación con el paciente.(AU)

Objective: To prevent the deterioration of patients with fibromyalgia due to potentially avoidable harmful actions in clinical practice. Methods: A multidisciplinary panel of experts identified key areas, analysed the scientific evidence and formulated recommendations based on this evidence and qualitative techniques of «formal assessment» or «reasoned judgement». Results: Thirty-nine recommendations were made on diagnosis, ineffective and unsafe treatments, patient education and practitioner training. This partII shows the 12 recommendations, referring to the latter two areas. Conclusions: Good knowledge of fibromyalgia on the part of patients improves their coping and acceptance of the disease and reduces the severity of some clinical manifestations. Healthcare professionals treating patients with fibromyalgia should be well trained in this disease to improve treatment outcomes and patient relationships.(AU)

Recomendaciones SER sobre el manejo de los pacientes con fibromialgia. Parte I: diagnóstico y tratamiento / Recommendations by the Spanish Society of Rheumatology on Fibromyalgia. Part 1: Diagnosis and Treatment

Objetivo: Evitar el deterioro de los pacientes con fibromialgia por actuaciones perjudiciales en la práctica clínica potencialmente evitables. Métodos: Un panel multidisciplinar de expertos identificó las áreas claves, analizó la evidencia científica y formuló las recomendaciones a partir de esta evidencia y de técnicas cualitativas de «evaluación formal» o «juicio razonado». Resultados: Se han elaborado 39 recomendaciones sobre diagnóstico, tratamientos no eficaces ni seguros, educación del paciente y formación del profesional. En esta parte I se reflejan las 27 primeras, referidas a las 2 primeras áreas. Conclusiones: Establecer el diagnóstico mejora el afrontamiento del paciente y reduce los costes sanitarios. Se deben evitar AINE, opioides mayores y benzodiacepinas por los efectos adversos. No existe una evidencia sólida que justifique la asociación de fármacos. Tampoco existe una buena evidencia para recomendar ningún tipo de terapia complementaria. Las cirugías muestran más complicaciones y un grado de satisfacción menor por el paciente por lo que deben evitarse si la indicación no está claramente establecida.(AU)

Objective: To prevent the impairment of fibromyalgia patients due to harmful actions in daily clinical practice that are potentially avoidable. Methods: A multidisciplinary team identified the main areas of interest and carried out an analysis of scientific evidence and established recommendations based on the evidence and “formal evaluation” or “reasoned judgment” qualitative analysis techniques. Results: A total of 39 recommendations address diagnosis, unsafe or ineffective treatment interventions and patient and healthcare workers’ education. This part I shows the first 27 recommendations on the first 2 areas. Conclusions: Establishing a diagnosis improves the patient's coping with the disease and reduces healthcare costs. NSAIDs, strong opioids and benzodiazepines should be avoided due to side effects. There is no good evidence to justify the association of several drugs. There is also no good evidence to recommend any complementary medicine. Surgeries show a greater number of complications and a lower degree of patient satisfaction and therefore should be avoided if the surgical indication is not clearly established.(AU)

Recommendations by the Spanish Society of Rheumatology on the management of patients with fibromyalgia. Part II.

OBJECTIVE: To prevent the deterioration of patients with fibromyalgia due to potentially avoidable harmful actions in clinical practice. METHODS: A multidisciplinary panel of experts identified key areas, analysed the scientific evidence and formulated recommendations based on this evidence and qualitative techniques of "formal assessment" or "reasoned judgement". RESULTS: Thirty-nine recommendations were made on diagnosis, ineffective and unsafe treatments, patient education and practitioner training. This part II shows the 12 recommendations, referring to the latter two areas. CONCLUSIONS: Good knowledge of fibromyalgia on the part of patients improves their coping and acceptance of the disease and reduces the severity of some clinical manifestations. Healthcare professionals treating patients with fibromyalgia should be well trained in this disease to improve treatment outcomes and patient relationships.

Recommendations by the Spanish Society of Rheumatology on Fibromyalgia. Part 1: Diagnosis and treatment.

OBJECTIVE: To prevent the impairment of fibromyalgia patients due to harmful actions in daily clinical practice that are potentially avoidable. METHODS: A multidisciplinary team identified the main areas of interest and carried out an analysis of scientific evidence and established recommendations based on the evidence and "formal evaluation" or "reasoned judgment" qualitative analysis techniques. RESULTS: A total of 39 recommendations address diagnosis, unsafe or ineffective treatment interventions and patient and healthcare workers' education. This part I shows the first 27 recommendations on the first 2 areas. CONCLUSIONS: Establishing a diagnosis improves the patient's coping with the disease and reduces healthcare costs. NSAIDs, strong opioids and benzodiazepines should be avoided due to side effects. There is no good evidence to justify the association of several drugs. There is also no good evidence to recommend any complementary medicine. Surgeries show a greater number of complications and a lower degree of patient satisfaction and therefore should be avoided if the surgical indication is not clearly established.

Recommendations by the Spanish Society of Rheumatology on the Management of Patients with Fibromyalgia. Part II. / Recomendaciones SER sobre el manejo de los pacientes con fibromialgia. Parte II.

OBJECTIVE: To prevent the deterioration of patients with fibromyalgia due to potentially avoidable harmful actions in clinical practice. METHODS: A multidisciplinary panel of experts identified key areas, analysed the scientific evidence and formulated recommendations based on this evidence and qualitative techniques of «formal assessment¼ or «reasoned judgement¼. RESULTS: Thirty-nine recommendations were made on diagnosis, ineffective and unsafe treatments, patient education and practitioner training. This partII shows the 12 recommendations, referring to the latter two areas. CONCLUSIONS: Good knowledge of fibromyalgia on the part of patients improves their coping and acceptance of the disease and reduces the severity of some clinical manifestations. Healthcare professionals treating patients with fibromyalgia should be well trained in this disease to improve treatment outcomes and patient relationships.

Recommendations by the Spanish Society of Rheumatology on Fibromyalgia. Part 1: Diagnosis and Treatment. / Recomendaciones SER sobre el manejo de los pacientes con fibromialgia. Parte I: diagnóstico y tratamiento.

OBJECTIVE: To prevent the impairment of fibromyalgia patients due to harmful actions in daily clinical practice that are potentially avoidable. METHODS: A multidisciplinary team identified the main areas of interest and carried out an analysis of scientific evidence and established recommendations based on the evidence and "formal evaluation" or "reasoned judgment" qualitative analysis techniques. RESULTS: A total of 39 recommendations address diagnosis, unsafe or ineffective treatment interventions and patient and healthcare workers' education. This part I shows the first 27 recommendations on the first 2 areas. CONCLUSIONS: Establishing a diagnosis improves the patient's coping with the disease and reduces healthcare costs. NSAIDs, strong opioids and benzodiazepines should be avoided due to side effects. There is no good evidence to justify the association of several drugs. There is also no good evidence to recommend any complementary medicine. Surgeries show a greater number of complications and a lower degree of patient satisfaction and therefore should be avoided if the surgical indication is not clearly established.

Diagnóstico y tratamiento del dolor neuropático / Diagnosis and treatment of the neuropathic pain

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Eficacia del tratamiento multidisciplinario del dolor crónico incapacitante del aparato locomotor / Multidisciplinary treatment of chronic pain with disability

FUNDAMENTOS Y OBJETIVO: El dolor crónico incapacitante es especialmente devastador en la población laboral activa y en muchos casos no responde a las terapias convencionales. La importancia de los factores psicosociales y ocupacionales, además de los biológicos, en el establecimiento del dolor ha determinado el desarrollo de programas de tratamiento multidisciplinario con éxito en otros países. El objetivo de este estudio fue describir los resultados terapéuticos de un programa de tratamiento multidisciplinario para el dolor crónico incapacitante en una muestra seleccionada de pacientes en situación de baja laboral resistente a tratamiento médico. PACIENTES Y MÉTODO: Setenta pacientes (58 mujeres, edad media [DE], 42 [9] años) con dolor crónico del aparato locomotor en situación de baja laboral (media [DE]: 7 [4] meses de baja) afectados de fibromialgia (51 por ciento), lumbalgia crónica (16 por ciento), dolor miofascial regional (15 por ciento), síndrome cervicocraneal (3 por ciento), espondilitis anquilosante (3 por ciento), y otros (12 por ciento). Todos los pacientes habían sido tratados previamente con medicación, terapia física y otras medidas (cirugía, 12 por ciento). Ninguno de los pacientes presentaba los criterios de exclusión establecidos en nuestro programa (rechazo a la vuelta al trabajo, presencia de litigio laboral). Los pacientes siguieron un tratamiento multidisciplinario intensivo diario de 4 semanas que incluyó técnicas médicas de control del dolor, terapia cognitivo-conductual y terapia física y ocupacional. El período medio de seguimiento fue de 10 (4) meses (extremos, 1-24 meses) postratamiento. RESULTADOS: Tras el tratamiento se observó una mejoría en las variables clínicas, como dolor (escala analógica visual 1-10 cm), 7,4 (1,5) frente a 3,2 (2) (p < 0,01); ansiedad (escala de ansiedad de Hamilton), 19 (7) frente a 14 (8) (p < 0,01); depresión (inventario de depresión de Beck), 16 (8) frente a 10 (8) (p < 0,01); capacidad funcional (Health Assessment Questionnaire), 1,6 (0,4) frente a 0,6 (0,5) (p < 0,001). Al alta, el 73 por ciento de los pacientes se reincorporó a su trabajo. El 69 por ciento de los pacientes tratados mantuvo las ganancias adquiridas y la situación laboral activa al final del seguimiento. CONCLUSIÓN: El abordaje multidisciplinario orientado a la reincorporación laboral es eficaz para el tratamiento de los pacientes con síndrome de dolor crónico incapacitante refractario (AU)