Fibromyalgia: An update and immunological aspects

This pilot study was designed to test the efficacy of a physical activity program for improving psychological variables and fibromyalgia syndrome (FMS) symptoms and to provide preliminary evidence regarding the effects on perceived cognitive symptoms and objectively measured cognitive performance by FMS patients. Sixteen women diagnosed with FMS were randomly assigned to an 18-week physical activity program or to a control condition. Psychological measures, FMS symptoms, perceived cognitive function, objective measures of cognition, and walking capacity were assessed at baseline and posttest. At posttest, there were significant differences in fatigue (effect size, ES=1.86), depression (ES=1.27), FMS symptoms (ES=1.56), self-reported cognitive symptoms (ES=1.19), and delayed recall performance (ES=1.16) between the physically active group and the control group, indicating that the FMS patients benefited from physical activity. Beneficial effects were also observed for 6 of the 7 objective measures of cognition and ranged from small to large (ESs=0.26 to 1.06). Given that all FMS patients do not respond well to conventional treatments, these beneficial effects of physical activity are important. Future studies with larger samples are warranted to test the reliability of the findings for the objective measures of cognition.

Heightened interoception in adults with fibromyalgia

We have studied the prevalence of fibromyalgia syndrome (FMS) in patients with type 1 and type 2 diabetes mellitus (DM). Relationship with disease control of DM and the presence of FMS was also evaluated. We have studied 93 consecutive patients with DM (85 with type 2 DM and 8 patients with type 1 DM) followed in Diabetes Center. Single researcher took the history and did physical examination including manual tender point examination according to Manual Tender Point Survey instructions. For the diagnosis of FMS, 1990 American College of Rheumatology Classification Criteria for FMS was used. We measured patients' fasting blood sugar levels and HbA1c levels around the same time period. Patients were excluded from the study if they had any other serious disease, and if there was any history of drug use that interferes with the symptoms of FMS. Patients with rheumatoid arthritis (RA) were accepted as controls. FMS was found in 18% of patients with DM type 2 (no patients with FMS in type 1 DM group), in 34% of patients with RA. Female patients with DM type 2 had significantly higher FMS rates. Mean fasting blood sugar levels and mean HbA1c levels were not significantly different between type 2 DM patients with FMS and DM patients without FMS. In RA group, in RA patients without FMS, the use of steroids was significantly higher. We have found an increased prevalence rate of FMS in patients with DM type 2 and RA. There was no correlation between the prevalence rate of FMS and good DM disease control.

Objectives: The aim of this study was to evaluate the association and prevalence of hypertension in patients with Fibromyalgia Syndrome (FMS). Methods: 100 consecutive patients with FMS were screened for hypertension and it was found in 61 patients. FMS was diagnosed according to the 1990 American College of Rheumatology criteria. The blood pressure was measured by using mercury splygnomanometer and according to WHO protocol. Symptoms of FMS were measured by FIQR. Counts of 18 tender points were performed by thumb palpation and levels of hormonal profiles (Cortisol, melatonin and serotonin) and were recorded in each patient. Results: The main outcome measure was the association of FMS with hypertension. Hypertension was diagnosed in 61 patients with FMS. Furthermore, a very significantly lower levels of cortisol was found in the morning hours and a significantly high levels of melatonin (P < 0.01) was found in the morning hours along with low levels of serotonin giving rise to pain, stiffness and morning fatigue among the hypertensive FMS patients; whereas a significantly lower levels of melatonin was found in the night time along with higher levels of Cortisol (P < 0.01) and no significant difference was observed in the levels of serotonin in the night time, giving rise to restlessness, impaired sleep and pain symptoms among hypertensive patients of FMS in comparison to the non-hypertensive population. Moreover, the number of tender points, and FIQR scores, were much higher in FMS with hypertensive group of patients than the other group. Conclusion: Hypertension is a very common finding in patients with FMS, and also its prevalence could be related to disease severity.

Fibromyalgia syndrome (FMS) is characterized by chronic widespread musculoskeletal pain, stiffness and tenderness at multiple points. Sleep disturbances are common in FMS and patients usually complain about nonrestorative sleep. Obstructive sleep apnea syndrome (OSAS) is characterized by repetitive pharyngeal collapse during sleep. Recurrent arousals from sleep occurs to restore pharyngeal patency in OSAS and this results in increased sympathetic activity and fragmentation of sleep. Sleep disturbances may lead to musculoskeletal pain and some studies suggest a relation between OSAS and FMS. Since OSAS is strongly associated with increased risk of myocardial infarction, cerebrovascular accidents and congestive heart failure, its diagnosis and treatment are of particular importance. Herein we present a female patient with diagnosis of FMS for 10 years who had complaints of morning fatigue, restless sleep, sleepiness during day and snoring besides musculoskeletal symptoms. Severe OSAS was diagnosed after polysomnographic analysis and FMS symptoms were totally improved with nasal continuous positive airway pressure treatment.

This study aims to assess the relationship between fibromyalgia syndrome (FMS) and vitiligo in Iraqi patients and evaluate the predictors of this relationship, if present. The case-control study included 100 Iraqi patients (46 males, 54 females; mean age 30.4±14 years; range 15 to 65 years) with vitiligo and 200 age- and sex-matched healthy controls (74 males, 126 females; mean age 30.3±9.4 years; range 15 to 62 years). Baseline characteristics of patients and controls were recorded. The 2012 Canadian Guidelines criteria were used for the diagnosis of FMS and applied to all patients and controls. Prevalence of FMS in vitiligo patients and controls was 12% and 7%, respectively (p=0.15, odds ratio=1.8, 95% confidence interval=0.8-4.08). FMS symptoms in vitiligo patients were fatigue (46%), diffuse body pain (34%), sleep disturbance (33%), cognitive dysfunction (30%), and mood disorders (23%), while visceral involvements were central nervous system (52%), skin (35%), gastrointestinal tract (32%), cardiovascular system- respiratory system (16%), genitourinary tract (8%), and ear nose throat (7%). Of vitiligo patients, FMS was significantly more common among females (22.2%) compared to none among males (0%) (p<0.05). Prevalence of FMS was restricted to female sex only and a significantly higher prevalence rate of FMS was found among female vitiligo patients (22.2%) compared to controls (9.5%). Receiving phototherapy significantly increased the risk of having FMS by 5 times compared to female patients not receiving phototherapy. Use of any steroid reduced the risk of having FMS by 2.5 times (inverse of odds ratio=0.4) among females patients (p>0/05). No significant association was found between FMS in vitiligo patients and age, disease duration, type of vitiligo, use of any immunosuppressant and body mass index (p>0.05). Fibromyalgia syndrome was more prevalent in vitiligo patients compared to controls, which was clinically important but statistically not significant. There was a significant association between FMS in vitiligo patients and female sex, severe form of vitiligo, and receiving phototherapy. This may suggest that early diagnosis of FMS in vitiligo patients may help in early treatment and subsequently improve patients' quality of life.

Background: Fibromyalgia syndrome (FS) is one of the most common causes of chronic generalised pain and often complicates the therapeutic management of inflammatory chronic arthritis (ICA), negatively impacting both the real assessment of disease activity and the perception of response. Our study aims to evaluate in a group of patients with ICA, multi-resistant to biologic/target synthetic disease-modifying antirheumatic drugs (b/ts-DMARDs), both the impact of FS on the possibility of achieving low disease activity (LDA) or remission (REM) and the possible improvement in the severity of FS symptoms, after starting b/ts-DMARDs with different a mechanism of action (MoA). Methods: A prospective study was conducted, from January 2023 to December 2024, on patients who fulfil the classification criteria for psoriatic arthritis (PsA) or fulfil the 2010 American College of Rheumatology criteria for RA. Results: Sixty-four Caucasian patients with ICA, of which 47 with FS, were enrolled in the study. At the baseline visit, FS patients had a significantly shorter ICA disease duration, worse fibromyalgia symptom-related indices (such as Fibromyalgia Severity Scale (FSS), Widespread Pain Index (WPI), and Symptom Severity Scale (SSS)) and functional and disability scores (such as health assessment questionnaire (HAQ) and Functional Assessment of Chronic Illness Therapy (FACIT)), and a higher basal value of Disease Activity in Psoriatic Arthritis (DAPSA) score compared to patients without FS. After 6 months of starting b/ts-DMARDs, no differences in severity of arthritis clinimetric indices (disease activity score (DAS) 28 (erythrocyte sedimentation (ESR)) and DAPSA) and Visual Analogue Scale (VAS) pain were found between the patients with FS compared to those without. At the follow-up visit, 36% of the whole group of patients were in LDA (36% ICA patients with FS vs. 35% of ICA patients without FS; p = 0.080), while 17% of patients reached REM (11% ICA with FS vs. 35% ICA without FS patients; p = 0.031). The FS presence appeared to be a factor associated with failure to reach REM (OR 4.5 (95%CI: 1.1-17.8), p = 0.028), but not for achieving LDA (OR 2.7 (95%CI: 0.8-8.9), p = 0.099). The overall retention rate at 6 months was 79%; in particular, 11 patients discontinued treatment with b/ts-DMARD, 69% of whom belonged to the FS group (p = 0.489). Among the group of patients with ICA and FS, patients in LDA/REM presented an important improvement in FSS, SSS, and VAS pain, with the best percentage variation from the baseline of these indices compared to patients who did not achieve the LDA/REM. Of note, sixteen patients with FS at the baseline no longer met the diagnostic criteria for FS after 6 months of follow-up. Conclusions: The presence of FS seems to negatively impact the achievement of REM, but not LDA, in both RA and PsA patients, even in b/ts-DMARDs patients with multi-failure of at least two different MOAs. Only a cluster of patients with FS, presumably those with FS triggered and/or amplified by the chronic joint inflammatory process, appear to improve their perception of FS severity by achieving ICA LDA/REM. However, these findings require further supporting data for more accurate validation.

Purpose: The aim was to investigate the skin findings in patients with Fibromyalgia Syndrome (FMS), and the relations of these findings with the clinical symptoms of the disease, quality of life and depression levels of the patient. Materials and Methods: A total of 77 patients with FMS were included in the study as the study group, 74 individuals were included as the control group. The pain levels were evaluated with Visual Analogue Scale (VAS). The short form-36 (SF-36) was used to evaluate the quality of life levels of the patients. The Beck Depression Scale (BDS) was used to evaluate the depression levels of the patients. All participants were evaluated by the same dermatology specialist. Results: Although 37.1% patients who had FMS had at least one cutaneous symptom, 19.9% of the control group had at least one cutaneous symptom (p<0.01). According to the BDS, significant increases were detected in FMS patients (p=0.001). Significant decreases were detected in terms of all SF-36 parameters in the FMS group (p=0.001). There was at least one dermatological disease in 43% of the patients, and in 20.5% of the controls. Although no significant differences were detected between BDS and VAS scores of the FMS patients with and without dermatological findings, SF-36 total score and physical role strength score were found to be significantly lower in the patients who had dermatological symptoms. Conclusions: It must be known that there may be dermatological symptoms in FMS, a more multidisciplinary approach must be used in treatment and follow-up.

Annotation. The research is devoted to the study of clinical signs of painful and nonspecific somatoform disorders in children of early and late adolescence, depending on sex, place of residence, and study. The study examined 56 adolescent children with pain and non-specific syndromes who were treated in the MNP “Khmelnytskyi Regional Children's Hospital” of the Khmelnytskyi Regional Council and in the MP “Khmelnytskyi City Children’s Hospital” of the Khmelnytsky City Council. The average age of the children was 14,0±4,53 years. Among them, children of early adolescence (10-14 years) accounted for 57.2%, and late adolescence (15 years 11 months 28 days) – 42.8%. The clinical signs of pain and nonspecific somatoform disorders in the children we examined were as follows: headache, thermoregulation disorder, fibromyalgia and arthralgia syndrome, nonspecific back pain, asthenic syndrome with decreased work capacity, increased meteorological sensitivity, and impaired concentration. Nonspecific persistent pain syndrome occurred in 56 children, in particular, cephalic pain – in 77.4 %, polyarthralgia – in 8.9%, fibromyalgia syndrome – in 8.5%, nonspecific back pain – in 13.4% of children; thermoregulatory disorders were identified in 42.7%, asthenic syndrome – in 35.3% of children. It shows that among pain somatoform disorders, headache, in particular, tension headache and migraine, occupies the first rank in children. Stress, tension, and sleep disturbances were predominant among the triggering factors. Therefore, among adolescent children with painful and non-specific somatoform disorders, cephalalgia, with a predominance of tension headaches, and long daytime low fevers are most often diagnosed, as a manifestation of autonomic somatoform dysfunctions with impaired thermoregulation. At the same time, migraine, episodic symptoms associated with migraine, as well as trigeminal variants of headache and long-term pain of other localization were found in isolated cases. The age dependence of primary headache has been revealed: tension headaches occur more often in children of early adolescence, and migraines in children of older adolescence, which is important to consider in the differential diagnosis of headaches, since the treatment and prevention of attacks of these forms of headache are completely different.

Objectives. Fibromyalgia (FM) and multiple sclerosis (MS) are known to cause disability and have an impact on physical functioning, social functioning, and emotional well-being of affected individuals. The aim of this study was to compare pressure pain threshold, health and functional status in females with FM and MS who were ambulatory. Methods. Control point scores (CPS), total myalgic scores (TMS; using an algometer), tender point (TP) counts, and chronic widespread pain were assessed in females with FM and MS and in healthy age-matched female controls. The Fibromyalgia Impact Questionnaire (FIQ), and the Nottingham Health Profile were performed. The Kurtzke Expanded Disability Status Scale (EDSS) was used to estimate the disability status of persons with MS. Results. Fibromyalgia patients have significantly lower CPS and TMS than MS patients and controls. Multiple sclerosis patients had similar CPS but significantly lower TMS compared to controls. Tender point counts were significantly higher in FM than MS patients and controls. Patients with MS had a higher numbers of TPs with respect to controls. Chronic widespread pain was reported by only three patients with MS and these patients did not meet FM criteria for tender point counts. Fibromyalgia patients had significantly lower FIQ-first item scores than MS patients. FM patients had higher NHP section scores in pain, social isolation, emotional reaction, sleep and energy, but similar physical mobility compared to MS patients. In MS patients energy and physical mobility dimension of NHP and FIQ-first item scores correlated with EDSS (r=0.42, P=0.047, r=0.83, P=0.001, and r=0.62, P=0.001, respectively). Conclusion. This cross-sectional study warrants further research comparing FM and MS, which share a lot of clinical and psychosocial features or may coexist. Chronic pain and related fatigue, social and emotional reactions and disability seem to be important components in FM, so taking care of these components, in other words a biopsychosocial model, may improve disease outcome and quality of life not only in FM but also in MS.

To determine the epidemiologic features and symptom characteristics of fibromyalgia (FM) in Japan, and compare them with those for other chronic pain (CP) diagnoses. An internet survey was conducted in June and July 2011. The questionnaire consisted of 111 questions, including assessments of the Japanese version of the 2010 American College of Rheumatology preliminary diagnostic criteria for FM, the Japanese Fibromyalgia Impact Questionnaire, and additional questions regarding pain and lifestyle. The questionnaire was completed by 20,407 male and female respondents in all prefectures of Japan. Of the survey population, 2,524 respondents (12.4%) reported symptoms consistent with CP; of these, 425 (2.1%) reported symptoms consistent with FM. Among respondents with FM and CP, 61% and 53%, respectively, were women. Pain severity and Widespread Pain Index scores were significantly higher in respondents meeting the diagnostic criteria for FM than in those meeting the criteria for CP. In terms of symptom severity scores, the proportions of respondents reporting the 3 major symptoms as "highly applicable" and greater numbers of 41 somatic symptoms were higher among respondents with FM than among those with CP. The incidence of FM in the present survey was similar to that reported (1.7%) in a study of FM in Japan in 2003, despite the use of the newer, easier to use 2010 diagnostic criteria. Because FM usually presents with more severe and more widely distributed pain, as well as more nonpainful symptoms than CP, our results suggest that FM is a different clinical phenotype of CP.

The fibromyalgia syndrome (FM) is a chronic rheumatic condition characterized by the presence of chronic and widespread pain and other symptoms, such as fatigue, sleep disturbances, anxiety, and depression. The pathophysiology of FM is not yet fully understood; however, neuroendocrine disorders, including those related to the production of melatonin by the pineal gland appear to exert strong influence on the genesis and evolution of this condition. The difficulty in understanding the pathophysiology of FM affects the development of effective therapeutic approaches. Currently, the most widely used drug classes for the treatment of FM are tricyclic antidepressants, analgesics, anti-inflammatory drugs, and modulators of sleep. However, the isolated use of these drugs does not cause the remission of all symptoms; besides, the association between these drugs for patients with FM finds no support in the literature. In this context, the therapeutic use of melatonin and or their agonists such as agomelatine and ramelteon have been tested as an alternative to the treatment of FM and are showing good results in relieving core symptoms of FM, and they have good safety and present few adverse effects. It is believed that the success of these drugs is due, at least in part, the chronotropic, analgesic, and anxiolytic antioxidants and melatonin.

Reply to "Pain neuroscience education for fibromyalgia syndrome".

BackgroundLittle is understood about the determinants of symptom expression in individuals with fibromyalgia syndrome (FMS). While individuals with FMS often report environmental influences, including weather events, on their symptom severity, a consistent effect of specific weather conditions on FMS symptoms has yet to be demonstrated. Content analysis of a large number of messages by individuals with FMS on Twitter can provide valuable insights into variation in the fibromyalgia experience from a first-person perspective.ObjectiveThe objective of our study was to use content analysis of tweets to investigate the association between weather conditions and fibromyalgia symptoms among individuals who tweet about fibromyalgia. Our second objective was to gain insight into how Twitter is used as a form of communication and expression by individuals with fibromyalgia and to explore and uncover thematic clusters and communities related to weather.MethodsComputerized sentiment analysis was performed to measure the association between negative sentiment scores (indicative of severe symptoms such as pain) and coincident environmental variables. Date, time, and location data for each individual tweet were used to identify corresponding climate data (such as temperature). We used graph analysis to investigate the frequency and distribution of domain-related terms exchanged in Twitter and their association strengths. A community detection algorithm was applied to partition the graph and detect different communities.ResultsWe analyzed 140,432 tweets related to fibromyalgia from 2008 to 2014. There was a very weak positive correlation between humidity and negative sentiment scores (r=.009, P=.001). There was no significant correlation between other environmental variables and negative sentiment scores. The graph analysis showed that “pain” and “chronicpain” were the most frequently used terms. The Louvain method identified 6 communities. Community 1 was related to feelings and symptoms at the time (subjective experience). It also included a list of weather-related terms such as “weather,” “cold,” and “rain.”ConclusionsAccording to our results, a uniform causal effect of weather variation on fibromyalgia symptoms at the group level remains unlikely. Any impact of weather on fibromyalgia symptoms may vary geographically or at an individual level. Future work will further explore geographic variation and interactions focusing on individual pain trajectories over time.

Background/Aims Sleep problems are common in fibromyalgia (FM) and chronic widespread pain (CWP), and may result in similar structural brain changes as those seen in chronic pain. However, the exact neural mechanisms are not fully understood. Studies to date are relatively small and yield conflicting results. The aim of this study is to investigate structural differences in brain regions of interest (ROI) in participants with FM or CWP from UK Biobank, a large-scale biomedical database, compared with healthy controls. We also explore the potential interaction of sleep on the volume of these ROIs, with the hypothesis that low sleep duration with chronic pain amplifies the atrophy seen. Methods Using T1 structural brain imaging data from UK Biobank, we defined cases as those experiencing CWP for 3+ months at the imaging visit or with a diagnosis of FM. Age- and sex-matched controls did not report any pain or chronic pain diagnoses at the imaging visit. Low sleep duration was defined as less than 7 hours of sleep in a 24-hour period in line with the recommended sleep duration of 7-9 hours. 22 brain ROIs were selected based on the existing literature. Pre-processed image-derived phenotype data for grey matter volumes were compared in brain ROIs using 2-way independent ANOVAs in SPSS. Results 429 cases and 429 controls were included: (n = 664/858 [77.4%] female; mean [SD] age 62.0 ± 7.4). The volume of the grey matter in the bilateral insular cortices and anterior parahippocampal gyri, and the volume of the right pallidum, were all significantly smaller in cases compared to controls, p &amp;lt; 0.05. In addition to the significant difference between the controls and cases in the right anterior parahippocampal gyrus, the interaction effect of sleep duration on pain was also significant, p &amp;lt; 0.05. Even though there were no significant differences between the controls and cases in the grey matter volumes of the left posterior division of the cingulate gyrus, bilateral superior frontal gyri, right middle frontal gyrus, left posterior division of the parahippocampal gyrus, right precuneus cortex and left inferior frontal gyrus, pars opercularis, and the volume of the right thalamus, there was a significant interaction effect of sleep duration and pain status on their volumes, p &amp;lt; 0.05. Conclusion This large-scale study confirms differences in grey matter volumes in key brain ROIs in those with chronic pain, highlighting neural changes in individuals suffering from CWP or FM, and a novel interaction of sleep on these areas. Perhaps these changes are due to neurotoxic effects of low sleep duration. Alternatively, low sleep duration and chronic pain may be caused by these structural differences. Evidently, further research is still needed to identify the directionality of these changes and their functional implications through longitudinal functional brain imaging studies, to identify the underlying cause of these structural differences. Disclosure N.W.I.L. Silva: None. A. Soni: None. V. Wanigasekera: None. S. Zhang: None. A.J.W. Wall: None. I. Tracey: None.