Serum antioxidants and nitric oxide levels in fibromyalgia: a controlled study
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Fibromyalgia is a condition of chronic pain of muscle fibrous tissue, which is characterized by subjective complains as sleepless, sleep, disorders, morning fatigue and pain of the body in characteristic areas when we make pressure, these areas are know as tender points and other subjective complains. The aim of our study was thought quantification of these elements of the fibromyalgia to formulate characteristic criteria and by using them is easily to diagnose patients with such disorders because the key problem is yet the absence of objective criteria for this disorder. During the patient examination which is based in above-mentioned criteria, only in last 10 years of post war period, we have diagnosed with efficiency a large number of patients with characteristic subjective symptoms of fibromyalgia. Therefore, 56 patients have been hospitalized form such a disorder. Statistical data of these patients shows us that, 44 of total patients with fibromyalgia had safe fibromyalgia or (78.6%), with reliable fibromyalgia have been 10 patients or (17.8%) and with doubtful fibromyalgia the other 2 patients or (3.6%). From this total number of patients, 40 patients were females between 20 and 50 years old and the other 16 of them were male between ages of 22 to 55. By completing the characteristic criteria which are very sensitive and very valuable, most of patients (around 80%) had pain in the upper posterior of the body.
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Oh TH, Stueve MH, Hoskin TL, Luedtke CA, Vincent A, Moder KG, Thompson JM: Brief interdisciplinary treatment program for fibromyalgia to twelve months outcome. Objective: To evaluate the impact and long-term benefit of a brief 1½-day fibromyalgia treatment program. Design: We assessed 6–12-mo outcome of 521 participants who underwent a 1½-day interdisciplinary fibromyalgia treatment program in a tertiary medical center. We administered three self-reported instruments: the Fibromyalgia Impact Questionnaire, the Short Form-36 Health Status Questionnaire, and a satisfaction survey, at baseline, and 6–12 mos after completing the fibromyalgia treatment program. The difference in the Fibromyalgia Impact Questionnaire and Short Form-36 scores before and after the fibromyalgia treatment program was the main outcome measure. Results: Compared with baseline, the Fibromyalgia Impact Questionnaire total score was decreased by a mean (SD) of 7.2 (17.7) points at follow-up (P < 0.001). All Fibromyalgia Impact Questionnaire subscales improved significantly at follow-up (all P < 0.001), except depression score (P = 0.67). The Short Form-36 scores improved significantly in all areas at follow-up (all P < 0.001), except general health perception (P = 0.58) and role emotional (P = 0.13). Conclusions: A brief 1½-day fibromyalgia treatment program improves symptoms and quality of life in patients with fibromyalgia for 6–12 mos. Further clinical investigations are needed to compare this fibromyalgia treatment program with other programs and interventions.
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Abstract Until recently, nobody knew how many people had fibromyalgia. Several surveys suggest that while 2 percent of the adult U.S. population have full-blown fibromyalgia (3.5 percent of adult women and 0.5 percent of adult men), 11 percent have chronic widespread pain and 20 percent have chronic regional pain. Recently, Dr. Larry Bradley at the University of Alabama has found that for every diagnosed fibromyalgia patient in the United States, there is an undiagnosed individual who has the requisite tender points, but never seeks medical attention for this. This has been termed community fibromyalgia. A survey in Great Britain found that 13 percent of the population had chronic widespread pain, 72 percent of whom sought medical attention for it. Of those, 21 percent fulfilled the ACR criteria for fibromyalgia. In other words, of individuals with chronic neuromuscular pain, less than half have diagnosed fibromyalgia or community fibromyalgia. Fibromyalgia is the third or fourth most common reason for consulting a rheumatologist. Approximately 15–20 percent of all patients seeking rheumatology referrals have fibromyalgia. The 5,000 rheumatologists in the United States who are trained in internal medicine and subspecialize in managing more than 150 musculoskeletal and immune system disorders are very familiar with the diagnosis and treatment of fibromyalgia.
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Abstract Objective. To determine the frequency of a precipitating event occurring prior to the onset of fibromyalgia syndrome, in a consecutive series of patients. Outcome in patients in whom there was a causative factor was compared with that in patients with primary fibromyalgia. Methods. Records of patients presenting over a 4‐year period who fulfilled criteria for fibromyalgia were reviewed, and patients were classified as having reactive fibromyalgia if a specific event prior to the onset of illness could be identified. Outcome features, including employment status and disability compensation, were compared in patients with reactive fibromyalgia versus those with primary fibromyalgia. Results. Twenty‐nine of 127 patients (23%) with a primary rheumatologic diagnosis of fibromyalgia reported having trauma, surgery, or a medical illness before the onset of fibromyalgia, and were classified as having reactive fibromyalgia. Patients in this group were more disabled than those with primary fibromyalgia, resulting in loss of employment in 70%, disability compensation in 34%, and reduced physical activity in 45% Conclusion. The development of fibromyalgia after a precipitating event may represent the onset of a prolonged and disabling pain syndrome with considerable social and economic implications.
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Position paper
Fibromyalgia syndrome
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This journal recently published a paper by Sleurs et al., entitled ‘Comorbidities of self-reported fibromyalgia in United States adults: A cross-sectional study from The National Epidemiological Survey on Alcohol and Related Conditions (NESARC-III). (Sleurs, Tebaka, Scognamiglio, Dubertret, & lLe strat, 2020)’. While its primary message is that persons reporting a physician diagnosis of fibromyalgia have very high rates of physical and mental comorbidities, this study provides other important information on the nature and validity of fibromyalgia and fibromyalgia diagnosis, as it is likely the most of the reported fibromyalgia patients in the study would not satisfy criteria for fibromyalgia. In the clinic, diagnosis of fibromyalgia is in ‘the eye of the beholder’. Close to 20 years ago George Ehrlich observed that ‘no one has FM until it is diagnosed’—that diagnosis is arbitrary. A striking result of the Sleurs et al. epidemiological study is the observation that 87.5% of those with reported fibromyalgia are women, confirming results from other population derived estimates of physician diagnosed fibromyalgia. In contrast, population-based studies applying current published criteria have found that around 60% or fewer fibromyalgia patients are women (Häuser, Brähler, Ablin, & Wolfe, 2020). In addition, we know from multiple studies that most clinically diagnosed patients do not satisfy criteria for fibromyalgia, and in a recent population study only 14.6% of persons who satisfied published criteria for fibromyalgia had received a clinical diagnosis of fibromyalgia (Häuser et al., 2020). Presumably, had such persons been interviewed in the Sleurs et al. study they would not have been included as fibromyalgia patients. Data such as these underscore problems of fibromyalgia definition and diagnosis. Fibromyalgia can be an arbitrary diagnosis. It appears to be diagnosed disproportionally in women and almost never thought of in men and, if multiple studies are correct, most community diagnosed fibromyalgia patients may not even satisfy fibromyalgia criteria. In studies where published criteria are applied, many patients diagnosed with one set of criteria will not be the same as those diagnosed with another set (Häuser et al., 2020)? Readers might reasonably ask, ‘What is fibromyalgia’? Do other characteristics, such as sex, mental symptoms and social factors influence the diagnosis and definition of fibromyalgia? This study throws light on another important issue. What are we to make of the extremely high rates of mental illness and physical comorbidity in those with fibromyalgia in this study? One hundred percent of reported fibromyalgia cases had at least one physical disorder, 68% had four or more disorders, 67% reported ‘arthritis’ and 80% were found to have a mental disorder. Some might try to separate these patients into primary of secondary fibromyalgia groupings, though it would seem clear that trying to guess the specific causal path would be hazardous. According to the authors, ‘The strengths of the relationships between mental disorders and self-reported fibromyalgia in our study support the hypothesis of central sensitization in fibromyalgia’. However, readers should be aware that current knowledge does not allow for the fibromyalgia sensitization hypothesis to be falsified, and mental and physical illness could be the cause or result (or some mixture) of fibromyalgia—a disorder that has no gold standard and whose definition has changed repeated over the last 60 years. We recently reported a similar study of self-reported physical and mental comorbidities in 12,215 patients in a research databank (Wolfe, Ablin, Guymer, Littlejohn, & Rasker, 2020), and obtained results similar to those of this study. Using a criteria-based definition of fibromyalgia as well as the quantitative measure of fibromyalgia severity, the polysymptomatic distress (PSD) scale, we found that criteria-based fibromyalgia as well as PSD were associated with an increase in the number of comorbidities. In addition, we found the association of PSD was present above and below the fibromyalgia diagnostic cut point. That is the degree of fibromyalgia-like symptom severity is more important than the presence or absence of fibromyalgia. Readers should also know that patients with fibromyalgia in this study are likely to satisfy diagnoses that fall under the rubric of bodily distress and other functional somatic syndromes. The main difference between these syndromes and fibromyalgia is the organizational beliefs and medical specialties of those making diagnoses and performing research. Considering fibromyalgia symptoms quantitatively with the PSD avoids the problems inherent with diagnostic and selection bias. In addition, it sidesteps the issue of central sensitivity attributions associated with diagnosis since if applies to the entire spectrum of patient symptom severity. No one argues about fibromyalgia symptoms. Instead the controversy regarding fibromyalgia is how to classify and understand the symptoms and their social meaning. It is unfortunate that the authors of this very important current study were unable to administer the PSD, as it would have further defined the nature of comorbidity in symptomatic patients. We advise that this simple scale—which also provides a fibromyalgia diagnosis for those who require it—be used in future similar studies. None declared. None declared.
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Fibromyalgia has previously been categorized as primary, secondary, and juvenile fibromyalgia. However, these definitions do not adequately explain the etiopathology of disease, nor do they help direct new specific therapies. Herein, we review the previously known categorizations of fibromyalgia. Based on common patient characteristics and previously studied pathophysiologies, we propose new subcategorizations of fibromyalgia that we have self-narrated, including hormonal fibromyalgia, neuroendocrine fibromyalgia, psychologic fibromyalgia, inflammatory fibromyalgia, and lastly, neuropathic fibromyalgia. Future research needs to be done to verify, add to, and fully describe these self-narrated categories of fibromyalgia that we have proposed.
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Objectives: Although there are studies in the literature about how Behçet's disease is affected in the presence of fibromyalgia, there is no information about how the severity of fibromyalgia is in the presence of Behçet's disease. This study aims to evaluate the severity of fibromyalgia by comparing the impact of fibromyalgia and pain thresholds between fibromyalgia patients with and without Behçet's disease. Methods: Twenty-five fibromyalgia patients with Behçet's disease and 34 primary fibromyalgia patients were included in this cross-sectional study. All participants completed the fibromyalgia impact questionnaire, and pain thresholds were measured at 18 tender points using algometry. Results: The mean fibromyalgia impact questionnaire scores in fibromyalgia patients with and without Behçet's disease were 66.6 ± 18.4 and 60.4 ± 14.5, respectively (p = 0.157). Pain thresholds were not different between the groups in 15 of the 18 tender points (TP). In fibromyalgia patients with Behçet's disease, pain thresholds in TP-15, TP-16 and TP-17 were 11.44 ± 4.84, 11.92 ± 5.00 and 15.16 ± 4.89 pounds, respectively, while in primary fibromyalgia patients those were 8.41 ± 2.68, 8.14 ± 2.76 and 12.14 ± 4.06 pounds respectively. Pain thresholds in TP-15, TP-16 and TP-17 were significantly different between the groups (p = 0.003, p = 0.003, p = 0.014, respectively). Conclusions: According to the literature data, although fibromyalgia has an effect on Behçet's disease, especially in cases associated with central sensitization syndromes, the severity of fibromyalgia was not found to be different in fibromyalgia patients with and without Behçet's disease in this study. There may be a relationship between Behçet's disease and fibromyalgia due to non-inflammatory causes such as central sensitization.
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Fibromyalgia is a common chronic syndrome defined by core symptoms of widespread pain, fatigue, and sleep disturbance. Other common symptoms include cognitive difficulty, headache, paresthesia, and morning stiffness. Fibromyalgia is increasingly understood as 1 of several disorders that are referred to as central sensitivity syndromes; these disorders share underlying causes and clinical features. Tender points are often detected in patients with fibromyalgia and were formerly required for diagnosis. Newly proposed criteria, however, rely on patients' reports of widespread pain and other somatic symptoms to establish the diagnosis of fibromyalgia. The management of fibromyalgia requires a multidimensional approach including patient education, cognitive behavioral therapy, exercise, and pharmacologic therapy. The present review provides an update on these various aspects of treating a patient with fibromyalgia.
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Dr. Mary-Ann Fitzcharles from McGill University Health Center moderated the topic Fibromyalgia: New Clinical Concepts with Drs. Frederick Wolfe from the University of Kansas School of Medicine, Winfried Hauser from Technische Universitat Munchen, and Brian Walitt from the Georgetown University Medical Center participating The discussion focused primarily on: The evolution and changing concepts of fibromyalgia; the criteria for diagnosis of fibromyalgia emphasizing the subjective nature of symptoms; the great variation in symptomatology among fibromyalgia patients; pharmacological and nonpharmacological treatment for fibromyalgia and the importance of the latter; the long-term outcomes for fibromyalgia patients; the appropriate goals and expectations of fibromyalgia treatment; and the societal and legal implications of the diagnosis of fibromyalgia. Med Roundtable Gen Med Ed. 2013;2(1):e26–e33.
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