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3.
Ann Intern Med ; 172(5): ITC33-ITC48, 2020 03 03.
Artigo em Inglês | MEDLINE | ID: mdl-32120395

RESUMO

Fibromyalgia is characterized by chronic, widespread musculoskeletal pain and associated fatigue, sleep disturbances, and other cognitive and somatic symptoms. For many patients, these symptoms persist for years and lead to frequent health care use; for some, fibromyalgia and its symptoms can be debilitating. Although many treatments are available, management remains challenging. This article highlights the clinical features of fibromyalgia, discusses diagnostic criteria and their evolution, and reviews treatment options.


Assuntos
Fibromialgia , Fibromialgia/diagnóstico , Fibromialgia/fisiopatologia , Fibromialgia/psicologia , Fibromialgia/terapia , Humanos , Educação de Pacientes como Assunto , Guias de Prática Clínica como Assunto , Prognóstico , Encaminhamento e Consulta , Fatores de Risco
4.
PLoS One ; 15(2): e0228077, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32017772

RESUMO

N-of-1 trials allow inference between two treatments given to a single individual. Most often, clinical investigators analyze an individual's N-of-1 trial data with usual t-tests or simple nonparametric methods. These simple methods do not account for serial correlation in repeated observations coming from the individual. Existing methods accounting for serial correlation require simulation, multiple N-of-1 trials, or both. Here, we develop t-tests that account for serial correlation in a single individual. The development includes effect size and precision calculations, both of which are useful for study planning. We then use Monte Carlo simulation to evaluate statistical properties of these serial t-tests, namely, Type I and II errors, and confidence interval widths, and compare these statistical properties to those of analogous usual t-test. The serial t-tests clearly outperform the usual t-tests commonly used in reporting N-of-1 results. Examples from N-of-1 clinical trials in fibromyalgia patients and from a behavioral health setting exhibit how accounting for serial correlation can change inferences. These t-tests are easily implemented and more appropriate than simple methods commonly used; however, caution is needed when analyzing only a few observations.


Assuntos
Ensaios Clínicos como Assunto , Amitriptilina/uso terapêutico , Fibromialgia/tratamento farmacológico , Humanos , Método de Monte Carlo , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico , Tamanho da Amostra
5.
PLoS One ; 15(1): e0227674, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31929578

RESUMO

INTRODUCTION: We characterized dermal innervation in patients with fibromyalgia syndrome (FMS) as potential contribution to small fiber pathology. METHODS: Skin biopsies of the calf were collected (86 FMS patients, 35 healthy controls). Skin was immunoreacted with antibodies against protein gene product 9.5, calcitonine gene-related peptide, substance P, CD31, and neurofilament 200 for small fiber subtypes. We assessed two skin sections per patient; on each skin section, two dermal areas (150 x 700 µm each) were investigated for dermal nerve fiber length (DNFL). RESULTS: In FMS patients we found reduced DNFL of fibers with vessel contact compared to healthy controls (p<0.05). There were no differences for the other nerve fiber subtypes. DISCUSSION: We found less dermal nerve fibers in contact with blood vessels in FMS patients than in controls. The pathophysiological relevance of this finding is unclear, but we suggest the possibility of a relationship with impaired thermal tolerance commonly reported by FMS patients.


Assuntos
Derme/inervação , Derme/patologia , Fibromialgia/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Derme/irrigação sanguínea , Epiderme/inervação , Epiderme/patologia , Feminino , Humanos , Perna (Membro) , Pessoa de Meia-Idade , Adulto Jovem
6.
PLoS One ; 15(1): e0228158, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31971993

RESUMO

BACKGROUND: Experimental and clinical studies suggested an analgesic effect on chronic pain by motor cortex activation. The present study explored the complex mechanisms of interaction between motor and pain during performing the slow and fast finger tapping task alone and in concomitant with nociceptive laser stimulation. METHOD: The participants were 38 patients with fibromyalgia (FM) and 21 healthy subjects. We used a simultaneous multimodal method of laser-evoked potentials and functional near-infrared spectroscopy to investigate metabolic and electrical changes during the finger tapping task and concomitant noxious laser stimulation. Functional near-infrared spectroscopy is a portable and optical method to detect cortical metabolic changes. Laser-evoked potentials are a suitable tool to study the nociceptive pathways function. RESULTS: We found a reduced tone of cortical motor areas in patients with FM compared to controls, especially during the fast finger tapping task. FM patients presented a slow motor performance in all the experimental conditions, requesting rapid movements. The amplitude of laser evoked potentials was different between patients and controls, in each experimental condition, as patients showed smaller evoked responses compared to controls. Concurrent phasic pain stimulation had a low effect on motor cortex metabolism in both groups nor motor activity changed laser evoked responses in a relevant way. There were no correlations between Functional Near-Infrared Spectroscopy (FNIRS) and clinical features in FM patients. CONCLUSION: Our findings indicated that a low tone of motor cortex activation could be an intrinsic feature in FM and generate a scarce modulation on pain condition. A simple and repetitive movement such as that of the finger tapping task seems inefficacious in modulating cortical responses to pain both in patients and controls. The complex mechanisms of interaction between networks involved in pain control and motor function require further studies for the important role they play in structuring rehabilitation strategies.


Assuntos
Eletroencefalografia , Fibromialgia/complicações , Córtex Motor/fisiopatologia , Dor/complicações , Dor/fisiopatologia , Espectroscopia de Luz Próxima ao Infravermelho , Adulto , Estudos de Casos e Controles , Potenciais Evocados , Feminino , Humanos , Masculino
7.
Medicine (Baltimore) ; 99(4): e18833, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31977878

RESUMO

BACKGROUND: Fibromyalgia (FM) is a chronic pain syndrome characterized by widespread musculoskeletal pain and multiple symptoms. It is a common clinical condition whose etiology is unclear. Currently, there is no gold standard treatment for FM. Management of this condition is therefore aimed at reducing symptoms and maintaining the individual's ability to function optimally. Based on the principal symptoms and characteristics of individuals with FM, we hypothesized that the implementation of a multicomponent treatment (with physical exercise, cognitive behavioral therapy adding to a graded motor imagery program, and therapeutic neuroscience education) would be more effective than conventional treatment in women with FM. This paper describes the rationale and methods of study intended to test the effectiveness of multicomponent treatment versus conventional treatment in patients with FM. METHOD/DESIGN: Fifty-six female individuals between 18 and 65 years of age, who were referred to the physical therapy department of the Rehabilitar Center in Chile, will be randomized into two treatment arms. The intervention group will receive a multicomponent treatment program for duration of 12 weeks. The control group will receive a conventional treatment for this condition for 12 weeks. The primary outcome measure will be the pain intensity score, measured by the numeric pain rating scale (NPRS), and the secondary outcomes will be the FM Impact Questionnaire (FIQ), and affective components of pain, such as catastrophizing using the Pain Catastrophizing Scale (PCS), fear of movement using the Tampa Scale Kinesiophobia (TSK), and sleep quality as measured by the Pittsburgh Sleep Quality Index (PSQI). DISCUSSION: This paper reports the design of a randomized clinical trial aimed at assessing the effectiveness of the multicomponent treatment versus conventional treatment in women with FM. TRIAL REGISTRATION: Brazilian registry of clinical trials UTN number U1111-1232-0862. Registered 22 April 2019.


Assuntos
Terapia Cognitivo-Comportamental/métodos , Terapia por Exercício/métodos , Fibromialgia/terapia , Adulto , Idoso , Catastrofização/prevenção & controle , Catastrofização/psicologia , Feminino , Fibromialgia/psicologia , Humanos , Pessoa de Meia-Idade , Dor/psicologia , Medição da Dor , Ensaios Clínicos Controlados Aleatórios como Assunto , Adulto Jovem
8.
J Oral Facial Pain Headache ; 34(1): 83­91, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31247058

RESUMO

AIMS: To investigate the associations between signs of painful temporomandibular disorders (TMD) and number of tender points (TPs) and fibromyalgia in adolescents, as well as the relationship between TPs and pressure-pain threshold (PPT) in individuals presenting with local, regional, or widespread pain as a way to investigate the presence of central sensitization (CS). METHODS: The sample consisted of 690 Brazilian adolescents with and without signs of painful TMD, aged 12 to 14 years old. Painful TMD was classified according to the Research Diagnostic Criteria for TMD (RDC/TMD) Axis I. The criteria established by Yunus were applied to assess juvenile fibromyalgia and TPs. Mann-Whitney and chi-square tests were applied to test the associations between signs of painful TMD and demographic variables. Regression models were used to estimate the association between signs of painful TMD and number of TPs and to determine which additional predictive variables were associated with TPs. Regression analyses were performed to test the associations between PPT values and number of TPs. Fisher test was used to estimate the association between signs of painful TMD and FM. RESULTS: Significant associations between signs of painful TMD and the number of TPs (P < .001), as well as between TPs and the PPT values for local, regional, and widespread pain (P < .001), were found. No association between signs of painful TMD and fibromyalgia was found (P = .158). CONCLUSION: Individuals with signs of painful TMD presented with more TPs compared to pain-free adolescents. Moreover, the higher the number of TPs, the lower the PPT. This finding suggests that adolescents with signs of painful TMD are at increased risk of presenting with CS.


Assuntos
Fibromialgia , Transtornos da Articulação Temporomandibular , Adolescente , Brasil , Sensibilização do Sistema Nervoso Central , Criança , Dor Facial , Humanos , Limiar da Dor
9.
Int J Biometeorol ; 64(3): 513-520, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31797039

RESUMO

To compare the efficacy of intermittent and consecutive balneological outpatient treatment (hydrotherapy and peloidotherapy) in fibromyalgia syndrome (FMS). A parallel 1:1, single-blind, pilot study was performed. Patients were recruited from musculoskeletal disorders outpatient clinic. Eligible participants were patients aged 18-60, diagnosed as FMS according to ACR 2010 criteria. They were randomly assigned to either consecutive or intermittent treatment groups. Both groups received 20 min of full body immersion in a tap water pool at 38-39 °C and 30 min of mud pack application on the back region at 45 °C. Delivery of the treatment was five times weekly during 2 weeks in consecutive group and two times weekly during 5 weeks in intermittent group. The primary outcomes were pain intensity and the number of patients achieving a minimal clinically important difference (MCID) on Fibromyalgia Impact Questionnaire (FIQ) at the 1st month after the completion of the treatment. Statistical analyses were based on intention to treat method. The assessing physician was blinded. Pain intensity significantly decreased in all post-treatment evaluations of both groups (except after treatment in the intermittent group). There was no significant difference between the groups. MCID for FIQ was achieved in 6 (24%) patients in the consecutive group and 12 (48%) in the intermittent group at the 1st month. There was no statistical difference in the secondary judgment criteria. The consecutive and intermittent deliveries of balneological outpatient treatment (hydrotherapy and peloidotherapy) seem to have similar effects on the clinical status of patients with FMS.


Assuntos
Fibromialgia , Hidroterapia , Adolescente , Adulto , Feminino , Fibromialgia/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Pacientes Ambulatoriais , Projetos Piloto , Método Simples-Cego , Resultado do Tratamento , Adulto Jovem
10.
J Oral Rehabil ; 47(2): 150-157, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31545529

RESUMO

BACKGROUND: Both temporomandibular disorders myalgia (TMDM) and fibromyalgia (FM) have been linked to central and peripheral changes in serotonin availability. The precursor of serotonin, tryptophan (TRP), is mainly catabolised via another pathway to produce kynurenine (KYN), but whether changes of this pathway are present in TMDM and FM are still unclear. OBJECTIVE: The aim was to explore blood plasma concentrations of TRP and KYN in TMDM and FM in an attempt to identify novel associations for future research. METHODS: Plasma of 113 female participants (17 TMDM, 40 FM and 56 healthy pain-free controls) were analysed for TRP and KYN concentrations. The degradation of TRP via the KYN pathway was indicated by the KYN to TRP ratio (KYN/TRP). Pain intensities were assessed with the Graded Chronic Pain Scale (GCPS) and Visual Analogue Scale (VAS). Psychological symptoms were evaluated using the Hospital Anxiety and Depression Scale (HADS), Patient Health Questionnaire (PHQ-9) and General Anxiety Disorder scale (GAD-7). RESULTS: In TMDM there was a negative correlation between TRP and pain intensity (rs  = -0.55 P = .023) and positive correlations between KYN/TRP and pain intensity (rs  = 0.59 P = .013). In FM, KYN/TRP was negatively correlated with anxiety symptoms (rs  = -0.36 P = .022) and a trend towards significantly lower TRP levels was found compared to controls (P = .05). CONCLUSION: The association between KYN/TRP and pain intensity as well as anxiety ratings in this small exploratory study may indicate that KYN/TRP could be a relevant indicator for symptom severity in TMDM and FM. Further investigations of the KYN pathway in chronic myalgia are warranted.


Assuntos
Fibromialgia , Transtornos da Articulação Temporomandibular , Feminino , Humanos , Cinurenina , Projetos Piloto , Triptofano
11.
Rio de Janeiro; s.n; 2020. 100 p.
Tese em Português | LILACS, BDENF - Enfermagem | ID: biblio-1096705

RESUMO

A Fibromialgia é uma doença crônica, de etiologia multifatorial complexa cujo principal sintoma é a dor física. No entanto, as repercussões são imensuráveis, causando transtornos psíquicos, emocionais, cognitivos e limitações no cotidiano das pessoas, que passam a viver em função da doença e do tratamento, se abstendo da vida funcional. Portanto é fundamental a compreensão de que é possível, não apenas ter o controle da situação, mas também gerenciar a própria dor, entendendo como e quando ela se desencadeia, prevenindo o aparecimento, investindo no autocuidado, prezando a conscientização corporal, mudanças nos hábitos de vida, levando em consideração a cultura, o contexto em que vivem e a visão de mundo. Objetivo geral: analisar a experiência de mulheres que vivenciam a Fibromialgia em relação ao estilo de vida e suas repercussões no autogerenciamento cotidiano da dor. Objetivos específicos: Identificar nas narrativas de vida de mulheres com Fibromialgia situações que expressem as experiências de dor; descrever as atividades relacionadas à cultura e transformações do estilo de vida; discutir recursos para o autogerenciamento da dor a partir da perspectiva transcultural. Utilizou-se como referencial teórico o Cuidado Transcultural de Madeleine Leininger. Trata-se de uma pesquisa de natureza qualitativa, guiada pelo método Narrativas de Vida, desenvolvida em 2019, com 14 mulheres que vivenciam a fibromialgia, integrantes do grupo interdisciplinar de tratamento e acompanhamento no Laboratório de Fisiologia Aplicada à Educação Física do Instituto de Educação Física e Desportos da Universidade do Estado do Rio de Janeiro (LAFISAEF-IEFD/UERJ). A pesquisa foi aprovada pelo Comitê de Ética da UERJ sob o Protocolo n°04899018.1.0000.5282. Os dados foram produzidos por meio da entrevista aberta e observação participante seguido da análise temática orientada por Bertaux. A partir da organização dos dados emergiram três categorias: "Processo de adoecimento e as experiências de dor", "Os fenômenos culturais e mudanças de estilo de vida" e "Reaprendendo a (con)viver e autogerenciar a dor". A análise foi fundamentada na Teoria Transcultural em diálogo com outros autores da literatura pertinente, que possibilitou a análise a partir de uma perspectiva de valorização e compreensão dos aspectos culturais, crenças e significados deste grupo de mulheres. A cultura permite compreender a sua in­fluência nas questões ligadas à saúde, es­clarecendo fenômenos e fatos específicos de grupos, uma vez que cada família possui suas próprias formas de cuidar, herdadas cultural­mente. As participantes ressignificaram seus modos de viver, transformando padrões comportamentais em relação a alimentação, atividade física, relações familiares, sociais, aprenderam a lidar com suas emoções e na capacidade de resolução de problemas, no autogerenciamento da dor, com mais autonomia, domínio e autoconhecimento, melhorando a qualidade de vida. As questões que desencadeavam a dor foram identificadas e trabalhadas no grupo. Este estudo contribui para a saúde das pessoas que vivenciam a fibromialgia ressaltando os benefícios quando elas conseguem autogerenciar os sinais e sintomas que desencadeiam a dor e quando assumem o protagonismo do próprio processo.


Fibromyalgia is a chronic disease of complex multifactorial etiology whose main symptom is physical pain. However, the repercussions are immeasurable, causing psychic, emotional, cognitive disorders and limitations in the daily lives of people, who live due to the disease and treatment, abstaining from functional life. Therefore, it is essential to understand that it is possible not only to have control of the situation, but also to manage the pain itself, understanding how and when it triggers, preventing the onset, investing in self-care, valuing body awareness, changes in the habits of the patient, considering the culture, the context in which they live and worldview. The main purpose is to analyze the experience of women who experience fibromyalgia regarding to their lifestyle habits and its repercussions on daily pain management. Specific purposes: to identify, in life narratives of women with Fibromyalgia, situations that express the pain experiences; to describe the activities related to culture and lifestyle changes; to discuss resources for pain self-management from transcultural perspective. The theoretical framework used was Madeleine Leininger's Transcultural Care. This is a qualitative research, guided by the Narratives of Life method, developed in 2019, with 14 women who experience fibromyalgia, members of the interdisciplinary treatment and monitoring group at the Laboratory of Physiology Applied to Physical Education of the Institute of Physical Education. and Sports at the Rio de Janeiro State University (LAFISAEF-IEFD / UERJ). The research was approved by the UERJ Ethics Committee under Protocol No. 04899018.1.0000.5282. Data were produced through open interview and participant observation followed by thematic analysis guided by Bertaux. From the organization of the data emerged three categories: "Process of illness and pain experiences", "Cultural phenomena and lifestyle changes" and "Relearning to (live) and self-manage pain". The analysis was based on the Transcultural Theory in dialogue with other authors of the pertinent literature, which allowed the analysis from a perspective of valorization and understanding of the cultural aspects, beliefs and meanings of this group of women. Culture allows us to understand its influence on health issues, clarifying group-specific phenomena and facts, as each family has its own culturally inherited forms of care. The participants re-signified their ways of living, transforming behavioral patterns in relation to food, physical activity, family and social relationships, learned to deal with their emotions and problem solving skills, self-management of pain with more autonomy, mastery and self-knowledgement, improving the quality of life. The issues that triggered the pain were identified and worked on in the group. This study contributes to the health of people experiencing fibromyalgia by emphasizing the benefits when they can self-manage the signs and symptoms that trigger pain and when they take the lead in the process itself.


Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Idoso , Fibromialgia , Fibromialgia/enfermagem , Saúde da Mulher , Enfermagem , Dor Crônica , Autogestão , Hábitos , Dor , Pesquisa Metodológica em Enfermagem , Fibromialgia/psicologia
12.
Artigo em Russo | MEDLINE | ID: mdl-31851167

RESUMO

AIM: Selection of the clinical characteristics of pain syndrome in the orofacial region in temporomandibular joint pain dysfunction syndrome (TMJ PDS). MATERIAL AND METHODS: One hundred and two patients with TMJ PDS were examined using the Verbal Descriptive Pain Rating Scale of the orofacial area. The Clinical Index of TMJ dysfunction (CID) by Helkimo M. was used for objectification of the level of musculo-tonic disorders in the area of the chewing muscles. The psychopathological status of patients with TMJ PDS was assessed with HRDS and SCL-90-R. RESULTS: A significant proportion of patients with TMJ PDS, in addition to algic symptoms, have hypertonus of the facial muscles, the nature and severity of which require not only a special diagnostic assessment, but also follow-up treatment. The analysis of data allowed us to identify three clinical groups of patients: with isolated (muscular-tonic), neurological symptoms; with mixed (combination of muscular-tonic and somatoform manifestations) neurological and psychopathological symptoms and with somatoform symptoms. CONCLUSION: Patients with TMJ PDS are clinically heterogeneous and require clinical differentiation, distinguishing the common group of patients with muscular dysfunction accompanied by pain and emotional response to it (anxiety and minor depressive symptoms) and the group of patients with a somatoform disorder (and manifestations as general anxiety).


Assuntos
Fibromialgia , Síndromes da Dor Miofascial , Transtornos da Articulação Temporomandibular , Síndrome da Disfunção da Articulação Temporomandibular , Dor Facial , Fibromialgia/complicações , Humanos , Síndromes da Dor Miofascial/complicações , Articulação Temporomandibular , Transtornos da Articulação Temporomandibular/complicações , Síndrome da Disfunção da Articulação Temporomandibular/complicações
13.
J Opioid Manag ; 15(6): 469-477, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31850508

RESUMO

OBJECTIVES: To investigate opioid prescribing patterns among patients with fibromyalgia (FM) in terms of age, gender, race, type of opioids, and to examine changes in opioid prescription over the past 8 years compared to the US Food and Drug Administration (FDA)-approved FM medications. DESIGN: Retrospective review of data using the Healthcare Enterprise Repository for Ontological Narration database. The collected data were analyzed descriptively and a chi-square test for trend was used to analyze a possible linear relationship between the proportions of opioid and non-opioid users along the time. PARTICIPANTS: Patients with a diagnosis of FM who had received opioid prescriptions from January 1, 2010 to December 31, 2017, and FM patients who had received prescriptions of FDA-approved FM medications in the same period. MAIN OUTCOME MEASURE: Trends in opioid and non-opioid prescriptions in patients with FM. RESULTS: The opioid medications were prescribed more frequently in 2010 (40 percent) and 2011 (42 percent), but the percentages have decreased since 2012 and reached the lowest numbers in 2016 (27 percent). The chi-square test for trend shows that from 2010 to 2017 the prescriptions of opioids had a statistically significant (p < 0.0001) decrease. CONCLUSION: This study suggests that the frequency of prescribed opioids in FM patients has decreased since 2012. This decline could be attributed to (1) FDA monitoring programs, (2) national efforts to increase awareness of the addictive and harmful effects of opioids, and (3) the growing research on the efficacy of non-opioid therapies to treat chronic pain conditions including FM.


Assuntos
Analgésicos não Entorpecentes , Analgésicos Opioides , Dor Crônica/tratamento farmacológico , Fibromialgia , Padrões de Prática Médica , Analgésicos não Entorpecentes/uso terapêutico , Analgésicos Opioides/uso terapêutico , Fibromialgia/tratamento farmacológico , Humanos , Dor , Estudos Retrospectivos , Estados Unidos
14.
Artigo em Inglês | MEDLINE | ID: mdl-31878319

RESUMO

The aim of this study was to analyze the effects of a 24 week exergame intervention and 24 weeks of detraining on lower-limb strength, agility, and cardiorespiratory fitness in women with fibromyalgia (FM). It was performed as a single-blinded randomized controlled trial of 55 women with FM. University facilities were used. The 24 week exergame intervention was focused on mobility, postural control, upper- and lower-limb coordination, aerobic fitness, and strength. Participants performed 120 min of exergaming per week, which was divided into two sessions. Twenty-four weeks after the end of the intervention, participants were re-evaluated. A chair-stand test, 10 step stair test, and six-minute walk test were conducted to assess lower-body strength, agility, and cardiorespiratory fitness, respectively. The exergame intervention significantly improved lower-limb strength and cardiorespiratory fitness. However, no significant effects on agility were observed. After the detraining period, lower-limb strength and agility returned to their baseline level, but improvements in cardiorespiratory fitness were sustained over time. Exergaming was therefore shown to be beneficial for physical fitness in people with FM. However, exergames had to be played regularly to maintain the benefits. This long-term intervention (24 weeks) may have changed the lifestyle of women with FM, which could explain why cardiorespiratory fitness improvements remained after the detraining period. Future research should focus on lifestyle changes after long-term interventions.


Assuntos
Aptidão Cardiorrespiratória , Exercício Físico/fisiologia , Fibromialgia/terapia , Força Muscular/fisiologia , Aptidão Física/fisiologia , Equilíbrio Postural/fisiologia , Amplitude de Movimento Articular/fisiologia , Adulto , Idoso , Terapia por Exercício , Feminino , Humanos , Pessoa de Meia-Idade , Espanha
15.
Rev Assoc Med Bras (1992) ; 65(10): 1265-1274, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31721958

RESUMO

OBJECTIVE: We reported our multidisciplinary protocol for the management of fibromyalgia associated with imbalance. Our aim was to verify the effectiveness of a proprioceptive training program as a complementary therapy for a traditional protocol of education, mindfulness, and exercise training for the management of fibromyalgia associated with imbalance. METHODS: Retrospective cohort study on 84 women, with primary fibromyalgia associated to imbalance. A group of patients performed traditional exercise training; in a second group the training was supplemented with proprioception exercises. Each session lasted from 40 to 60 minutes and was performed three times a week for 12 weeks. RESULTS: After three months of training and eight months after the end of the training, the balance evaluation revealed significant differences in the comparison of the Timed Up and Go test, Berg Balance Scale, and Tinetti scale with the baseline, there was a better improvement in the proprioceptive training group (p<0.05). A reduction in pain and improvement in functional and muscular performance and quality of life were observed in both groups (p<0.05), but with no significant differences between them in the Numeric Pain Rating Scale, Fibromyalgia Impact Questionnaire, and Short Form Health Survey (p>0.05). Fifteen months after the end of the program, the effects of training were not maintained. CONCLUSION: The present study revealed that training supplemented with proprioception exercises has beneficial effects on clinical findings and improves balance in patients with fibromyalgia, even if the positive results did not persist after the interruption of the rehabilitative program in the long term.


Assuntos
Terapia por Exercício/métodos , Fibromialgia/terapia , Equilíbrio Postural , Transtornos das Sensações/terapia , Protocolos Clínicos , Feminino , Fibromialgia/complicações , Humanos , Estudos Retrospectivos , Transtornos das Sensações/etiologia , Inquéritos e Questionários
16.
Best Pract Res Clin Rheumatol ; 33(3): 101416, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31703789

RESUMO

Psychological factors such as adverse childhood experiences, traumatic life events, interpersonal conflicts and psychological distress play an important role in the predisposition, onset and severity of chronic widespread pain (CWP) and fibromyalgia syndrome (FMS). Therefore, psychological therapies might have the potential to reduce disability as well as symptom and economic burden in patients with CWP and FMS. Recent interdisciplinary guidelines have suggested different strengths of recommendation for psychological therapies for FMS. The aims of this narrative review are to summarise: • Mechanisms of actions. • Evidence on efficacy, tolerability and safety. • Knowledge gaps and needs for future research of psychological therapies for CWP and FMS for non-mental health professionals.


Assuntos
Dor Crônica/psicologia , Fibromialgia/psicologia , Psicoterapia/métodos , Humanos
17.
Best Pract Res Clin Rheumatol ; 33(3): 101423, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31703796

RESUMO

Fibromyalgia (FM) is one of the most common conditions that rheumatologists encounter. It is characterised by chronic widespread pain, fatigue, sleep disturbances and impaired cognition. The prevalence of comorbid FM among populations with rheumatoid arthritis (RA), axial spondyloarthritis (axSpA) and psoriatic arthritis (PsA) are considerably higher than among the general population, with pooled prevalence estimates of 18-24% in RA, 14-16% in axSpA and 18% in PsA. Prevalence estimates should be interpreted with care as the criteria for FM have not been validated for use in patients with inflammatory arthritis. Comorbid FM appears to affect assessment of disease severity in these conditions, particularly patient-reported outcome measures, and may influence response to treatment. There is a need for better identification, classification and management of FM in the context of inflammatory rheumatic diseases.


Assuntos
Artrite Psoriásica/complicações , Artrite Reumatoide/complicações , Fibromialgia/epidemiologia , Espondilartrite/complicações , Adulto , Artrite Psoriásica/epidemiologia , Artrite Reumatoide/epidemiologia , Comorbidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Espondilartrite/epidemiologia
18.
Recurso na Internet em Português | LIS - Localizador de Informação em Saúde, LIS-bvsms | ID: lis-LISBR1.1-46852

RESUMO

Síndrome caracterizada por dor muscular generalizada crônica, dor à palpação da musculatura, alterações do sono, cansaço e problemas com o humor, a concentração e a memória.


Assuntos
Fibromialgia , Doenças Reumáticas
19.
Medicine (Baltimore) ; 98(41): e17289, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31593081

RESUMO

INTRODUCTION: Fibromyalgia (FM) is a chronic condition characterized by chronic pain, fatigue and loss of function which significantly impairs quality of life. Although treatment of FM remains disputed, some studies point at the efficacy of interdisciplinary therapy. This study aims to analyze the effectiveness, cost-utility and benefits of a multicomponent therapy on quality of life (main variable), functional impact, mood and pain in people suffering from FM that attend primary care centers (PCCs) of the Catalan Institute of Health (ICS). METHODS AND ANALYSIS: A 2-phase, mixed methods study has been designed following Medical Research Council guidance. Phase 1: Pragmatic randomized clinical trial with patients diagnosed with FM that attend one of the 11 PCCs of the ICS Gerència Territorial Terres de l'Ebre. We estimate a total sample of 336 patients. The control group will receive usual clinical care, while the multicomponent therapy group (MT group) will receive usual clinical care plus group therapy (consisting of health education, exercise and cognitive-behavioural therapy) during 12 weeks in 2-hourly weekly sessions. ANALYSIS: the standardized mean response and the standardized effect size will be assessed at 3, 9, and 15 months after the beginning of the study using multiple linear regression models. Utility measurements will be used for the economic analysis. Phase 2: Qualitative socio constructivist study to evaluate the intervention according to the results obtained and the opinions and experiences of participants (patients and professionals). We will use theoretical sampling, with 2 discussion groups of participants in the multicomponent therapy and 2 discussion groups of professionals of different PCCs. A thematic content analysis will be carried out. ETHICS AND DISSEMINATION: This study protocol has been approved by the Clinical Research Ethics Committee of the Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (code P18/068). Articles will be published in international, peer-reviewed scientific journals. TRIAL REGISTRATION: Clinical-Trials.gov: NCT04049006.


Assuntos
Terapia Cognitivo-Comportamental/métodos , Terapia por Exercício/métodos , Fibromialgia/terapia , Educação de Pacientes como Assunto/métodos , Atenção Primária à Saúde/métodos , Qualidade de Vida , Adulto , Terapia Cognitivo-Comportamental/economia , Terapia Combinada , Análise Custo-Benefício , Terapia por Exercício/economia , Estudos de Viabilidade , Feminino , Fibromialgia/economia , Fibromialgia/psicologia , Implementação de Plano de Saúde , Humanos , Masculino , Aceitação pelo Paciente de Cuidados de Saúde , Cooperação do Paciente , Educação de Pacientes como Assunto/economia , Atenção Primária à Saúde/economia , Ensaios Clínicos Controlados Aleatórios como Assunto , Projetos de Pesquisa
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