Objective: Illness perceptions, i.e. how patients think about their illness in terms of identity, cause and consequences, are important, as negative illness perceptions are associated with maladaptive illness behavior, more dysfunctioning, poor treatment adherence and treatment outcome. As illness perceptions are influenced by cultural background, former experiences and provided information, the aim of this study was to compare illness perceptions of patients with fibromyalgia syndrome [FMS] living in different countries.Methods: Dutch speaking participants from two countries were recruited in this international comparative study. In total, 114 Belgian [Flemish] and 283 Dutch FMS patients completed the Illness Perception Questionnaire for Fibromyalgia-Dutch Language version [IPQ-R FM-Dlv]. The Mann-Whitney U test for non-parametric data was used to compare data between the patient groups. Pearson's chi-squared test was used to compare proportions.Results: Significant differences in illness perceptions were observed. Belgian patients reported a higher variety of symptoms and believed more strongly that these symptoms are related with their illness. They had more negative beliefs concerning the consequences of their illness and reported more external attributed factors to be the cause of their illness. Dutch patients demonstrated a better understanding and controllability. They indicated more internal attributed factors as a cause.Conclusions: These findings suggest that illness perceptions in patients with FMS are prone to local influences, including small differences in the health care system. Future studies are advised to measure mood, psychopathology, medical co-morbidity and socio-demographic factors and include them in a multivariate analysis.
Objectives: The need for the development of better therapies for fibromyalgia is urgent due to the distress experienced by patients with this disorder and the escalating health care costs. A variety of animal models of fibromyalgia, including the reserpine-induced myalgia model, repeated acidic saline injection model and subchronic swim stress model, have been developed to study this disorder. This review highlights the advancements in the understanding of the characteristic comorbidities of fibromyalgia and the pathophysiology of hyperalgesia at the peripheral, spinal and supraspinal levels from studies of these models.Findings: Recent studies have described comorbidities, such as fatigue and anxiety, which are characteristic of patients with fibromyalgia. The pathophysiologies underlying these comorbidities are beginning to be explored. In addition, the pathophysiology underlying the hyperalgesia observed in animal models of fibromyalgia might include increases in acid-sensing ion channels and macrophage-mediated signals at peripheral level, increased microglia-mediated immune responses at spinal level, and neuroplastic and neurochemical changes at supraspinal brain level.Conclusions: Animal models of fibromyalgia have resulted in valuable advancements in the understanding of the main comorbidities of fibromyalgia, such as fatigue and emotional disturbances. Investigations of the mechanisms underlying the comorbidities and the hyperalgesia of fibromyalgia are important for a comprehensive understanding of the pathophysiology of fibromyalgia. Although several significant advances in the understanding of fibromyalgia have recently been made, additional studies on the pathophysiology of hyperalgesia and the main comorbidities of fibromyalgia are warranted to better understand this complex disorder and develop better therapies.
After this, the second issue of the journal that was previously known as the Journal of Musculoskeletal Pain, MYOPAIN, a journal of myofascial pain and fibromyalgia, will, like the JMP before it, go into hiatus or slumber. To signal the intensity of our focus, the editorial board and the International Myopain Society board of directors decided, with the change of the name of the journal, to limit the publication to topics related to muscle pain to the exclusion of rheumatologic disorders. We wanted to be the place where researchers and clinicians went to discuss muscle pain, which affects almost everyone and which attracts relatively little specific scientific interest. We were unable to sustain the volume of submissions and the recruitment of reviewers for those articles to publish the journal in the frequency needed to be the forum the topic deserved. It is a wonder to those who study and treat muscle pain why the topic does not attract more clinical and research attention. We know myofascial pain is a regional pain of muscles and tendons. Most people have had it. Although myofascial pain has a specific anatomy and physiology, it needs further exploration. The clinical evaluation of the patient with it is relatively simple. Actually examining muscles, is an event becoming rare in clinical medicine, to prove the patient has primary or secondary myofascial pain leads to effective treatment and fewer expensive misdiagnoses. Fibromyalgia pervades our society. It can be considered the muscular component of a widespread syndrome we are coming to term ‘‘chronic pain.’’ It is different from myofascial pain, but the two often inhabit the same patient. Fibromyalgia has a signature on functional MRI showing where and why patients are so prone to pain. There is no easy treatment for any of the chronic pain conditions. We need controlled research to identify the biologic basis of the muscle pain of fibromyalgia. The results should lead to inventive therapy. As we wait in our ignorance, fibromyalgia patients are at risk for medication abuse, as they drop out of productive life while their care givers watch in frustration and exhaustion. I thank associate editor Scott Mist (USA), and section editors Jacob Ablin (Israel), Robert Gerwin (USA), Carmen Gota (USA), Roberta Moreira (Brazil), and Matthew Robbins (USA) for their diligence and long hours of work on the journal. They and our reviewers have helped improve the quality of the submissions. I appreciate the efforts of various editors and assistant editors at Taylor & Francis, especially those of Lucy Francis, in helping with the publication process. Like Snow White, MYOPAIN will enter sleep from a potion of circumstances beyond its control. It will be served while in repose by acolytes, in this case the believers in the entities of myofascial pain and fibromyalgia: scientists, academicians, clinicians, patients. It will await rescue from a person or organization of nobility. Once restored, it will again serve the clinical and research communities to better understand and treat muscle pain.
Background: Myofascial trigger points (MTrP) are considered to be a common source of pain in people. Due to their presence in any skeletal muscle in the body, they can be relevant in the genesis of musculoskeletal disorders. Their preventive management could reduce its potential activation and impact over people's functioning.Objectives: The aim was to determine the immediate effect of combining myofascial release (MFR) with ice on a latent MTrP in the forearm of young adults.Materials and methods: Using a randomized repeated measures design, 30 young adults with one latent MTrP on the extensor muscles of the forearm were allocated into three groups; group I received ice massage, group II received MFR and group III received MFR with ice. The pressure pain threshold (PPT), pressure pain perception (PPP) and strength of the flexor and extensor muscles of the forearm were evaluated at baseline, immediately after treatment and at 30 min.Results: An immediate improvement in PPT (p<0.05) and PPP (p<0.0005) occurred in group III. Additionally, an increase in flexor muscle strength (p<0.05) is observed 30 min in this group. Group II increased its PPT immediately (p<0.005) and afterwards (p<0.05). Group I also changed its PPP immediately (p<0.005). No changes in extensor muscle strength were observed.Conclusions: The results demonstrate an immediate improvement in pain variables after the application of ice massage, MFR and MFR with ice in young adults with a latent MTrP.
Objectives: There is a need to develop efficient, cost-effective psychological interventions for chronic pain. Expressive writing has been found to produce beneficial psychological and physical outcomes for those with chronic medical conditions. Positive expressive writing may also be beneficial to those with musculoskeletal pain, but this type of writing has not been studied before with this population. The current study was a pilot to explore how chronic pain patients respond to two positive variations of the expressive writing paradigm.Methods: Ninety-three participants with chronic pain were recruited from chronic pain forums and completed the writing exercise. Participants were randomized to either self-compassion or self-efficacy writing and wrote for 20 min once a week for three consecutive weeks. Participants completed baseline and post-writing measures of pain severity, illness intrusiveness, pain acceptance, pain catastrophizing, depression symptoms, life satisfaction, self-compassion and chronic pain self-efficacy.Results: Overall, both types of writing helped participants, who reported that the exercise was a positive experience. Raters were able to accurately identify the writing group for the majority of participants, which indicates that most participants followed the writing instructions. Few differences were found between the two writing groups, though when participants in either group reported an increase in self-compassion or self-efficacy, they also reported better physical and psychological outcomes.Conclusions: Participants with chronic pain appear to be open to self-compassion and self-efficacy writing. Positive writing may be useful to the extent that it increases self-compassion and self-efficacy.
Objectives: Kinesiophobia is associated with pain disability across a number of physical conditions, particularly chronic low back pain [CLBP]. The Tampa Scale of Kinesiophobia [TSK] is the primary instrument for assessing kinesiophobia, and was originally developed in English. The objective of this study is to establish an Arabic version of TSK [TSK-AV] with subsequent validation in Arabic patients with CLBP.Methods: 101 CLBP patients completed the TSK-AV, demographic measures, and measures of pain severity and disability. Collected data were used for further psychometric analysis.Results: Explorative factor analysis showed that a three-factor model provided an acceptable fit to our data, explaining 45.2% of the variance. Factor 1 [labeled as "Activity Avoidance"] comprised items 1, 2, 4, 12, 14, 15 and 17. Factor 2 was labeled as "Experience with Pain/Bodily Injury" and comprised items 5, 6, 7, 8, 9 and 16. Factor 3 was labeled as "Somatic Focus" and comprised items 3, 10, 11 and 13. The TSK-AV and its subscales were all independent significant [p < 0.001] predictors of pain disability in Jordanian patients with CLBP after accounting for factors such as age, gender, pain duration and pain severity.Conclusion: The study provided the first translation of the TSK into Arabic. The TSK-AV and its subscales were each significant independent predictors of pain disability. The measure can therefore be recommended for clinical and research purposes with Arabic-speaking populations.
Objective: This study investigated potential associations of morning stiffness (MS) with rheumatoid arthritis (RA) disease activity and ultrasonography (US).Methods: We conducted a cross-sectional analysis of 100 consecutive patients with RA divided into MS-positive group (n = 38) and MS-negative group (n = 62). US findings, disease activity score in 28 joints (DAS28) and Clinical Disease Activity Index (CDAI) were compared.Results: DAS28, CDAI and the number of power Doppler (PD) signal-positive joints were significantly higher in the MS-positive group (p<0.01). The number of patients who did not achieve the DAS28 or CDAI remission criteria was significantly higher in the MS-positive group (p<0.01). When cut-off points were applied, MS duration of >= 10 min was associated with PD signal-positive joints, with a sensitivity of 47.5% and a specificity of 92.3% (area under curve = 0.7087, chi-square test: p<0.0001).Conclusion: This study showed that in patients with MS duration of >= 10 min, there was a high probability of PD-positive joints in the hand.
Lumbar disc herniation [LDH] is a common chronic orthopedic disease which often leads to severe pain and distress. Mechanical pressure and local chemical disturbance are the main factors that cause the pain in LDH. In recent years, many studies have confirmed that transient receptor potential channels [TRPs] are the main cell signaling pathways that regulate the mechanism of pain sensitivity. This study intends to explore the relationship between TRPs and the chronic pain sensitivity of LDH. Thirty SD rats were randomly divided into the normal group and the LDH group. The LDH group used autologous nucleus pulposus entrapment to manufacture LDH model and 2 weeks later, dorsal root ganglion tissue is dissected to detect the change of pain threshold, protein and gene expressions of TRPA1, TRPV4 and TRPM8. The results showed that in the LDH group, both cold and mechanical pain threshold were lower than the normal group, the protein and gene expressions of TRPA1 and TRPM8 were higher than that of the normal group, while the protein and gene expressions of TRPV4 were lower than the normal group. This study confirmed that the pain sensitivity mechanism of LDH may be probably related to the regulation of TRPs.
Aim: The aim of this study was to report a retrospective study on the profile of patients seen in the last 11 years [2004-2014], in a TMD clinic at the Federal University of the Jequitinhonha and Mucuri Valleys.Methods: All medical records were evaluated from January 2004 to December 2014. The following items of information were collected: gender, age, parafunctional habits, main complaints and treatment offered. The data collected were analyzed by using SPSS 22.0 software.Results: A total of 560 patient records related to 448 [80%] women and 112 [20%] men were evaluated. The age ranged from 10 to 93 years. Etiologic factors were reported in 374 [66.8%] records. There was an association between age and abuse [p = 0.003]. There was no significant association between treatment and gender [p = 0.361].Conclusion: The profile of TMD patients seen in the last decade [2004-2014] was characterized by the majority being female patients, mean age 34.94 years and having some parafunctional habit.
Objectives: Select biomarkers derived from such tissue damage have been proposed as a tool for predicting MSD risk. Factors beyond the exposure to biomechanical stress, although, may influence these biomarkers and thus should be quantified. The purpose of this exploratory study was to determine (1) whether diurnal variations exist for Cartilage Oligomeric Matrix Protein (COMP), Interleukin-6 (IL6), and Creatine Kinase (CK); and (2) if these diurnal variations are influenced by personal factors including age, obesity status, and gender.Methods: Twenty-seven participants were dichotomously classified by age (young = 24.7 [3.9], older = 55.2 [5.0]), body mass index (BMI) (not obese = 23.1 [2.2], obese = 34.1 [2.9]), and gender (males = 14, females = 13), and had blood samples drawn at six time points over a 24-hour period (22:00, 07:00, 10:00, 14:00, 18:00, and 22:00) during which any strenuous physical activity was restricted.Results: COMP levels were significantly higher for males, had significant diurnal variation (p < 0.01), and this diurnal variation differed between genders (p = 0.05). IL6 did not have any significant diurnal variation or differences related to age, obesity status, or gender. CK levels exhibited significant diurnal variation (p = 0.05), and levels were significantly influenced by age (p < 0.07) and an obesity status x gender interaction (p < 0.02). Reliability (between two samples at 22:00), measured by the intraclass correlation, was classified as "excellent'' for all biomarker levels.Conclusions: Diurnal changes in COMP and CK may reflect differences in body composition between groups. The present results may aid in future study interpretation or design utilizing these biomarkers in the occupational environment.
Background: Dry needling [DNHS (c) technique] is a promising treatment modality for patients with spasticity. However, little is known regarding the indirect effects of dry needling on regional brain activity. This study aimed to describe the electroencephalographic changes found after the application of DNHS (c) in two patients with stroke.Findings: Two patients with chronic stroke and spasticity received a single session of dry needling in spastic muscles selected after clinical evaluation. An improvement in the regional brain activity was observed after the application of DNHS (c) based on the measurement of quantitative electroencephalographic activity and electroencephalographic cordance.Conclusions: This study shows that the DNHS (c) technique, which is based on a peripheral application, has a positive effect on regional brain activity.
Objectives: To evaluate and compare the blood leukocytes and plasmatic levels of cytokines [IL-17, IL-23, MIP-1 alpha and MCP-1] found in patients with fibromyalgia [FM] and healthy controls.Methods: Forty-four women with FM and 28 healthy women matched by age and Body Mass Index [BMI] participated in this study. The white blood cell count was determined by the complete blood count [CBC]. The plasmatic levels of cytokines were determined by enzyme-linked immunosorbent assay [ELISA]. The statistical analysis was performed by means of the Kolmogorov-Smirnov test for data distribution, the Mann-Whitney test or independent t-test to test for intergroup differences, Spearman's correlation test for association between the variables and stepwise multiple regression to select the independent predictive variables. The tests were performed in SPSS v. 19 ( SPSS Inc., Chicago, IL), with significance level set to a = 0.05.Results: Patients with FM had significantly higher levels of global leukocytes, IL-17, IL-23, MIP-1 alpha and MCP-1 than healthy controls. The absolute number of global leukocytes is directly and positively correlated with plasmatic levels of IL-17 and IL-23 in FM patients. IL-17 was the only variable selected in the prediction model of leukocyte levels in FM patients.Conclusions: The higher levels of global leucocytes, IL-17, IL-23, MIP-1 alpha and MCP-1 showed by FM patients support the involvement of the immune system in the pathophysiology of this condition. The association between high levels of global leukocytes with high plasmatic levels of cytokines, mainly IL-17, in FM patients should be considered during the FM's diagnosis and clinical decision making.
Objectives: Temporomandibular disorders (TMD) may present with diverse symptoms and multiple signs. Thus, the use of indices allows reliable quantification of the signs and symptoms of the TMD based on signs and symptoms and standardized clinical examination. The purpose of this study was to compare the results obtained using the anamnestic and clinical dysfunction Helkimo indices and Fricton's Craniomandibular Index (CMI) in the same group of patients with TMD.Material and methods: Thirty patients (28 women and 2 men, mean age 34.0 years) with diagnosis of TMD according to the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) were evaluated to obtain the Helkimo indices and CMI. Statistical analyses were performed using the Statistical Package for Social Sciences (SPSS) version 19.0. The data were submitted to the Spearman correlation test.Results: There was a statistically significant correlation between the Helkimo anamnestic index and the CMI (p = 0.019) and between the Helkimo clinical dysfunction index and the CMI (p = 0.001). Comparing the component items of the Helkimo clinical dysfunction index and the CMI, there was a correlation in most crosses.Conclusions: It was concluded that there was a statistically significant correlation between the anamnestic and clinical dysfunction Helkimo indices and Fricton's CMI, with correlation in most of their subitems. Thus, both indices Helkimo or Fricton's - are suitable for the evaluation of a specific case of TMD. However, the CMI is more detailed in the composition of some of its subitems, which could lead to a more complete assessment.
Objective: To determine the variability in pain intensity experienced by children with Juvenile Primary Fibromyalgia Syndrome (JPFS) and to relate within-day patterns of pain to children's quality of life.Subjects and methods: Pain intensity was self-reported on a 0-10 cm visual analog scale by 46 young subjects with JPFS using a daily booklet chart three times a day for seven days. Forty-six healthy children and adolescents matched by age and sex were randomly recruited as controls from a pediatric clinic on a voluntary basis. Variability in pain during the day was investigated using a multidimensional pain survey that was completed three times daily in a printed booklet for one week and was related in the primary evaluation to scores for tender points and pediatric quality of life (PedsQL v 4.0).Results: Variations in pain intensity were observed during the day in patients with JPFS. The majority of JPFS patients (67%) had a high Average Absolute Change (AAC) in pain (>1 VAS unit), and a lower quality of life was associated with high pain variability.Conclusions: Pain intensity in JPFS varies throughout the day. Higher pain variability is usually associated with a lower quality of life. Psychological and functional aspects should be addressed with approaches that can support children with JPFS and their family members.
Fibromyalgia syndrome (FMS) is a widespread pain disorder of unknown etiology. It is characterized by tender points noted on physical examination and is often accompanied by a number of associated ...
Objectives: Heel pain secondary to plantar fasciitis [PF] is a common problem making up 11-15% of foot problems. Extracorporeal shock wave therapy [ESWT] is a relatively new approach that has evolved as a treatment option, but there are controversies about the applied parameters. The effects of ESWT have not been studied in an Iranian population, so the aim of our study was to investigate the effects of ESWT on patients with PF.Methods: A total of 168 patients [70 men and 98 women] with the mean age of 50 +/- 4.55 years were treated between March 2010 and 2013. Each patient was treated four times [once a week] and received a total of 8000 pulses. The parameters were set according to patients' perception of pain and increased gradually in accordance with patients' tolerance.Results: We evaluated the visual analog scale [VAS] of pain, TUG test, and activities of daily living [ADLs] in patients during the first session and immediately after the completion of the sessions. We also followed up the patients for a mean of 10.5 months. Both VAS and ADLs have demonstrated improvement immediately after the completion of treatment course and during the follow up period. TUG test showed significant statistical differences among the evaluations.Conclusions: ESWT is a safe and efficient treatment method for recalcitrant plantar fasciitis, especially, if prescribed dosage would be considered individually.
Objective: To evaluate the effects of a 16-week program of hydrotherapy on postural control and pain of women with fibromyalgia syndrome [FMS].Methods: Seventeen women with FMS performed three evaluation sessions, one before, one in the middle and one at the end of a 16-week hydrotherapy treatment program. The outcome measure was postural control of the body during quiet erect posture on upright stance [eyes opened and closed] and right and left tandem on a force platform. Pain was evaluated with the Visual Analogue Scale [VAS] and function with the Fibromyalgia Impact Questionnaire [FIQ]. Statistical analysis was performed with Friedman's ANOVA and Wilcoxon's matched pairs test. Effect sizes were measured with Cohen's d coefficient. For all variables, a level of 5% of significance was adopted.Results: Postural control showed decreased variables, especially for the right and left tandem positions with eyes closed and opened. Pain and function also showed improvement after 8 and 16 weeks of hydrotherapy treatment.Conclusions: Hydrotherapy was effective in improving postural control, pain and function in women with FMS.
Purpose: To determine the effectiveness of adding Ganoderma lucidum (GL) to standard care for patients with fibromyalgia (FM), and to examine the costs per quality-adjusted life year (QALY) gained from this nutritional supplementation. Materials and methods: This was a randomised controlled trial with a random allocation of participants to two groups; experimental group and active-placebo controlled group. A total of 26 women with FM participated in the experimental group. These participants were instructed to take 3 g of micromilled GL twice a day for six weeks. EQ-5D-5L was used to obtain the utilities and a non-parametric bootstrap was used to plot the acceptability curve. Results: Of the women initially recruited, over 81% completed the experimental treatment. The incremental QALY in the GL group was 0.177, and the incremental QALY in the active placebo group was 0.101. Therefore, the difference in terms of QALYs was 0.076 and the incremental cost-utility ratio was €1348.55/QALYs. The cost-utility acceptability curve showed 90% probability that the addition of GL to the standard care as a nutritional supplement is cost-effective. Conclusions: The GL as nutritional supplementation in patients with FM is cost-effective in women with FM. To authors’ knowledge, the current study reports the first cost-utility analysis of GL as a nutritional supplement.
Objective: To evaluate the function and health-related quality of life [QoL], and to determine the relationship between pain, function and QoL in patients with benign joint hypermobility syndrome [BJHS].Material and method: A total of 36 patients and 31 healthy controls were enrolled. Demographic characteristics were recorded and the patients were evaluated according to the Beighton score and Brighton criteria for BJHS. The assessment of pain was performed based on the visual analogue scale [VAS 0-10 cm]. Function and QoL were assessed using the Stanford Health Assessment Questionnaire [HAQ] and Nottingham Health Profile [NHP], respectively.Results: The mean age was 29.94 +/- 6.04 years in the patient group and 30.16 +/- 5.64 years in the control group. When the two groups were compared, there were significant differences in the HAQ scores. QoL was also significantly worse in the patient group in all dimensions of the NHP except for social isolation. There was a positive correlation between the Beighton score and the NHP-emotional reaction score. We have also observed a positive correlation between the HAQ scores and the pain [VAS], NHP-pain and NHP-Physical Mobility scores in the patient group. No correlation was observed among the other parameters.Conclusion: This study has demonstrated that function and QoL are significantly impaired in the patients with BJHS compared to healthy controls. Function and QoL as well as the pain should be assessed in the patients with BJHS. Also, the disease may not be benign as it is widely regarded.
