Correlational analysis and predictive validity of psychological constructs related with pain in fibromyalgia

Background  

Fibromyalgia (FM) is a prevalent and disabling disorder characterized by a history of widespread pain for at least three months. Pain is considered a complex experience in which affective and cognitive aspects are crucial for prognosis. The aim of this study is to assess the importance of pain-related psychological constructs on function and pain in patients with FM.     

Fibromyalgia: diagnosis, pathogenesis, and treatment

Fibromyalgia is characterized by chronic widespread pain and the presence of tender points, often accompanied by several non-specific symptoms, such as fatigue, depressive mood, and sleep disturbances. The apparent overlap between fibromyalgia and other syndromes, such as chronic fatigue and irritable bowel, is not sufficient cause to consider all these syndromes as manifestations of a single syndrome. Fibromyalgia is a multifaceted problem. Central afferent pain amplification and perhaps also impaired descending pain inhibition are supposed to underlie widespread pain. Neuroendocrine perturbations, sleep disturbances, health beliefs, mood disorder, and physical deconditioning play a role in the modulation and perseverance of pain and other symptoms. It is extremely difficult to mitigate chronic generalized pain and to deal with other symptoms in fibromyalgia. A uniform intervention strategy is missing. Essential in the tailored management of fibromyalgia are an enhancement of functional capacities and quality of life, and the symptomatic treatment of individual symptoms such as pain, distress, and sleep disturbances. Rather than analysing monotherapy per se, the objective in future evaluations should be to try to find the combined pharmacological or non-pharmacological treatment of choice for specific subgroups of patients.     

Stages of chronicity in fibromyalgia and pain catastrophising: a cross-sectional study

Background  

Fibromyalgia (FM) is a prevalent and disabling disorder characterised by widespread pain and other symptoms such as insomnia, fatigue and depression. Catastrophisation is considered to be a key clinical symptom in FM; however, few studies have investigated how contextual factors, such as catastrophisation, might contribute to the duration of the pain. The present research examined the relationship among pain, catastrophic thinking and FM impact, as a function of stage of chronicity.     

The development of occupational therapy-led groups for people with fibromyalgia

Fibromyalgia is a complex condition which can provide a challenge to healthcare professionals. Sufferers experience widespread body pain and debilitating fatigue in addition to cognitive difficulties and sleep disturbance. Group pain management programmes are an evidenced-based approach to providing pain management for people living with chronic pain. Occupational therapists are uniquely placed to provide a holistic approach to patients with chronic pain and a group programme specifically targeted at patients with fibromyalgia has been found to provide an additional benefit of meeting the wide range of challenges they experience. Patient education is an important part of the content of these groups. This article describes the background and development of the ‘Living Well with Fibromyalgia’ group programme.     

Economic implications of pain management

BACKGROUND: Economic issues in pain management affect the patient, the provider and society. This paper will review some of the data on the costs to society of chronic pain and its associated disability. It will also look at the costs to patient and provider of alternative economic models. Conceptual issues that underlie health care delivery and the attendant costs must be addressed if society is to gain control over runaway health care costs and reduce the economic burden of chronic pain and disability for the patient as well as the provider. METHODS: Literature review and synthesis. RESULTS: Chronic pain is the primary cause of health care consumption and disability in the working years. Multidisciplinary pain clinics have proven utility. Data on efficacy of most other kinds of care is lacking. Disability costs are related to conceptual inadequacies and the medicalization of post-industrial societies. CONCLUSION: To control inappropriate care and escalating costs, we must change concepts of pain and disability and the methods of funding both of these in relation to chronic pain. The outcome of the continuing struggle between the profession of medicine, the state and capitalists will determine how and whether pain management is a part of medical care.     

Trigeminal autonomic cephalalgias. Part 2: Paroxysmal hemicrania.

Paroxysmal hemicrania (PH) is characterized by severe, strictly unilateral pain attacks lasting 2 to 30 minutes localized to orbital, supraorbital, and temporal areas accompanied by ipsilateral autonomic features. It represents 1 of 3 primary headaches classified as trigeminal autonomic cephalalgias. Although PH is rare, patients may present to dental offices seeking relief for their pain. It is important for oral health care providers to recognize PH and render an accurate diagnosis. This will avoid the pitfall of implementing unnecessary and inappropriate traditional dental treatments in hopes of alleviating this neurovascular pain. This is part 2 of a review on trigeminal autonomic cephalalgias and focuses on PH. Aspects of PH including epidemiology, genetics, pathophysiology, clinical presentation, classification and variants, diagnosis, medical management, and dental considerations are discussed.     

Caracterização dos padrões de dor,sono e alexitimia em pacientes com fibromialgia atendidos em um centro terciário brasileiro

ObjectivesFibromyalgia (FM) is a complex syndrome that is characterized by lasting and diffuse chronic musculoskeletal pain, derived from non‐inflammatory causes and classically associated with the presence of specific tender points. However, studies have highlighted other important symptoms associated with a lower quality of life (QOL) in FM, such as sleep disturbances and alexithymia. This study aimed to investigate the pain, sleep and alexithymia patterns of FM patients treated in a Brazilian tertiary center.Methods20 patients with FM who were followed‐up in the Rheumatology outpatient clinic of a Brazilian tertiary center (Faculdade de Medicina de São José do Rio Preto – FAMERP, São Paulo, Brazil) and 20 patients without FM from other outpatient services of the FAMERP completed a clinical and socio‐demographic questionnaire, the Fibromyalgia Impact Questionnaire (FIQ), the Pittsburgh Sleep Quality Index (PSQI), the Toronto Alexithymia Scale (TAS‐20) and the SF‐36 (WHOQOL).ResultsThe patients with FM presented worse performances in all QOL dimensions of the SF‐36 and higher scores on the PSQI (p = 0.01), and the TAS‐20 (p = 0.02). Patients with FM also scored significantly higher in all specific domains of PSQI and TAS‐20.DiscussionThe present data were in accordance with literature, disclosing a worse performance of patients with FM on pain impact, sleep complains and more presence of alexithymia.ConclusionStudies have disclosed the presence of important and frequently underdiagnosed symptoms beyond pain complaints in FM, such as sleep complaints and alexithymia, and a better knowledge of such disturbances might improve FM patients’ approach and treatment.     

Trigeminal autonomic cephalalgias. Part 1: cluster headache.

Cluster headache is characterized by severe, strictly unilateral pain attacks lasting 15 to 180 minutes localized to orbital, temporal, and midface areas accompanied by ipsilateral autonomic features. It represents 1 of 3 primary headaches classified as trigeminal autonomic cephalalgias. While its prevalence is small, it is not uncommon for cluster headache patients to present at dental offices seeking relief for their pain. It is important for oral health care providers to recognize cluster headache and render an accurate diagnosis. This will avoid the pitfall of implementing unnecessary and inappropriate traditional dental treatments in hopes of alleviating this neurovascular pain. The following article is part 1 of a review on trigeminal autonomic cephalalgias and focuses on cluster headache. Aspects of cluster headache including its prevalence and incidence, genetics, pathophysiology, clinical presentation, classification and variants, diagnosis, medical management, and dental considerations are discussed.     

Trigeminal autonomic cephalalgias. Part 3: short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing.

Short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) is a syndrome characterized by severe, strictly unilateral short-lasting (between 5 and 240 seconds) pain localized to orbital, supraorbital, and temporal areas, accompanied by ipsilateral conjunctival injection and lacrimation. It represents 1 of 3 primary headaches classified as trigeminal autonomic cephalalgias (TACs). Although its prevalence is extremely small, SUNCT patients may present at dental offices seeking relief for their pain. It is important for oral health care providers to recognize SUNCT and render an accurate diagnosis. This will avoid the pitfall of implementing unnecessary and inappropriate traditional dental treatments in hopes of alleviating this neurovascular pain. The following article is part 3 of a review on TACs and focuses on SUNCT. Aspects of SUNCT, including epidemiology, genetics, pathophysiology, clinical presentation, classification and variants, diagnosis, medical management, and dental considerations are discussed.     

Correlação entre variáveis demográficas e clínicas,e a gravidade da fibromialgia

IntroductionFibromyalgia (FM) is a rheumatic condition characterized by a picture of gener- alized chronic pain, hyperalgesia and allodynia. Symptoms such as fatigue, sleep disorders, morning stiffness, headache and paresthesia can also be present. It is also associated with other comorbidities, such as depression, anxiety, irritable bowel syndrome, myofascial pain syndrome and nonspecific urethral syndrome. Few studies have addressed the evolution of FM, especially regarding medium and long-term evolution, such as why some patients do better than others, despite the fact of being submitted to the same treatment.ObjectiveTo determine whether there is a correlation between demographic and clinical variables and FM severity.Material and methodsSixty women who met the classification criteria for FM of the Ameri- can College of Rheumatology of 1990 were divided into three groups, according to the sever- ity established by the Fibromyalgia Impact Questionnaire (FIQ): severe (70-100), moderate (50 to 70) and mild (0 to 50).ResultsNine demographic and clinical variables were assessed, with a significant differ- ence (P <0.05) being observed only in the groups showing higher FIQ scores with the pres- ence of depression and workers’ compensation interests.ConclusionThe impact of FM measured by the FIQ is directly correlated with the severity of depression and the presence of workers’ compensation interests.     

Pathogenesis of fibromyalgia - a review

Fibromyalgia, a syndrome characterized by widespread pain and diffuse tenderness, is considered a multifactorial disorder. Central nervous system sensitization is a major pathophysiological aspect of fibromyalgia, while various external stimuli such as infection, trauma and stress may contribute to development of the syndrome. In addition, current evidence points towards the existence of a genetic basis for fibromyalgia and information has been accumulated regarding the role of a number of candidate genes in fibromyalgia pathogenesis. In the present review, we have summarized the clinical manifestations of fibromyalgia, as well as the necessary laboratory workup; subsequently we have attempted to cover various aspects of pathogenesis with special emphasis on the genetic aspects currently uncovered.     

Treating trauma more effectively: A review of psychosocial programming

ImportanceTraumatic events are the leading cause of life-altering disability in adults of working age. The management of patients with traumatic injury has substantially improved due to development of sophisticated trauma centers increasing survival after injury. Unlike the adoption of the trauma system framework, the same has not occurred with specialized trauma recovery services to include mental and social health needs. This literature review will discuss unique issues facing trauma survivors, some current recovery programs available, outcomes and benefits of these programs, and barriers that impair widespread incorporation.ObservationsStudies have shown that patients with traumatic injury experience reduction in quality of life and concurrent threats to mental health, including post-traumatic stress disorder (PTSD), alcohol use disorder, and recreational substance abuse. Patients with traumatic injury also have high recidivism rates, low pain management satisfaction, and poor engagement in care following injury. Screening efforts for PTSD, mental illness, and alcohol and substance abuse are more widely available interventions. Early coordinated efforts included dedicated multidisciplinary recovery teams. Recently, more methodical and organized programs, such as the Trauma Survivors Network, trauma collaborative care, Trauma Recovery Services, and Center of Trauma Survivorship, have been implemented.Conclusions and RelevanceThe enrollment of patients with traumatic injury in novel programs to enhance recovery has led to heightened self-efficacy, better coping mechanisms, and increased use of mental health services. Additionally, trauma recovery services have been shown to reduce recidivism and have generated cost savings for hospital systems. While positive outcomes have been demonstrated, they are not consistently predictable. Barriers for widespread implementation include limitations of time, funding, and institutional support. This article describes models of successful programs initiated within some trauma centers, which may be duplicated to serve future trauma survivors.     

Pain in Chronic Kidney Disease: A Scoping Review

There is increasing international attention in efforts to integrate palliative care principles, including pain and symptom management, into the care of patients with advanced chronic kidney disease (CKD). The purpose of this scoping review was to determine the extent, range, and nature of research activity around pain in CKD with the goal of (i) identifying gaps in current research knowledge; (ii) guiding future research; and (iii) creating a rich database of literature to serve as a foundation of more detailed reviews in areas where the data are sufficient. This review will specifically address the epidemiology of pain in CKD, analgesic use, pharmacokinetic data of analgesics, and the management of pain in CKD. It will also capture the aspects that pertain to specific pain syndromes in CKD such as peripheral neuropathy, carpal tunnel syndrome, joint pain, and autosomal dominant polycystic kidney disease.     

Chronic pain in end-stage renal disease

A growing body of literature has shown that chronic pain is common for patients with end-stage renal disease (ESRD), is typically moderate or severe, and impacts virtually every aspect of health-related quality of life. Unfortunately, there is a lack of clinical and research focus in this area in nephrology, and pain in ESRD is undertreated. This article will review the epidemiology of chronic pain in ESRD, discuss basic principles of pain assessment and management, and highlight some of the challenges in pain management in ESRD with the hope of guiding health professionals in the effective management of pain in patients with ESRD.     

Central motor control failure in fibromyalgia: a surface electromyography study

Background  

Fibromyalgia (FM) is characterised by diffuse musculoskeletal pain and stiffness at multiple sites, tender points in characteristic locations, and the frequent presence of symptoms such as fatigue. The aim of this study was to assess whether the myoelectrical manifestations of fatigue in patients affected by FM are central or peripheral in origin.     

Total knee arthroplasty in patients with fibromyalgia

Fibromyalgia has recently emerged as a diagnosis of exclusion for patients with chronic, widespread pain. We investigated the influence of this comorbidity on outcomes of total knee arthroplasty (TKA). We matched 59 patients (90 knees) who underwent primary TKA with a diagnosis of fibromyalgia to control patients who underwent the same surgery. Postoperative satisfaction and functional outcomes were assessed using a Likert scale and the SF-36 survey, respectively. At 3.4 years' follow-up, fibromyalgia patients were less satisfied with TKA than control patients, and had lower preoperative and postoperative SF-36 scores. They demonstrated improvement comparable to that of controls following TKA, however. Fibromyalgia patients appear to show improvement comparable to that of controls following surgery. This syndrome should not be considered a contraindication for surgery.     

Fibromyalgia: mechanisms and potential impact of the ACR 2010 classification criteria

Fibromyalgia is a disorder characterized by chronic widespread pain in the presence of widespread tenderness, and multiple somatic symptoms. Since the publication of the American College of Rheumatology (ACR) 1990 classification criteria for fibromyalgia, research has proliferated and, in a relatively short period, investigators have begun to unravel the etiology and long-term impact of this complex condition. Although the ACR 1990 criteria have been central to fibromyalgia research during the past two decades, a number of practical and philosophical objections have been raised in relation to them. Principally these objections have centered on the use (or lack thereof) of the tender point examination, the lack of consideration of associated symptoms, and the observation that fibromyalgia might represent the extreme end of a pain continuum. In developing the ACR 2010 criteria, experts have sought to address these issues and to simplify clinical diagnosis. An implicit aim was to facilitate more rigorous study of etiology. The purpose of this Review is to summarize research to date that has described the epidemiology, pathology and clinical course of fibromyalgia, and to assess the probable impact of the ACR 2010 criteria on future research efforts.     

The future role of the anaesthesiologist in pain management

Background: Relieving pain during and after surgery and trauma has always been a basic duty of anaesthesiologists. With their skills and expertise in regional analgesia and pharmacological analgesia, anaesthesiologists have improved management of severe cancer pain. Will there be a place for anaesthesiologists in multidisciplinary pain clinics managing chronic non‐cancer pain patients in the future? Methods: This is a personal review of the development of pain management as a growing part of the responsibilities of anaesthesiologists during the past three decades and the importance of continued involvement of anaesthesiologists in this interesting and challenging aspect of clinical medicine. Results and conclusions: Optimal management of pain during and after surgery is a prerequisite for successful short‐ and long‐term rehabilitation after surgery. After surgery, reducing dynamic pain with prolonged optimal epidural analgesia and regional blocks facilitates mobilization and reduces chronic pain. The expertise of well‐trained anaesthesiologists in skilfully using regional analgesia and pharmacological pain relief continues to be in demand in palliative care. Some interventional techniques are useful in relieving chronic non‐cancer pain in selected patients. Well‐trained anaesthesiologist‐pain clinicians can perform interventional treatments safely. No doubt, anaesthesiologists will continue to have important roles in pain management in the future.     

Not small adults: the emerging role of pediatric pain services

Purpose

This review article explores the need for specialized pain care for children and adolescents and provides some historical context for our current knowledge base and clinical practice.

Principal findings

Pediatric patients have specialized needs with respect to assessment and management of pain. Acute pain care is modified by developmental considerations in both these areas; chronic pain encompasses a wide range of complex developmental, social, and psychological factors requiring the skills of different health disciplines to provide the best care.

Conclusions

Awareness of children’s pain has increased dramatically over the past three decades, and Canadians have performed a leadership role in much of the research. Specific multidisciplinary teams are a more recent phenomenon, but they are shown to be more effective and probably more cost effective than traditional treatment models. Important gaps in availability of resources to manage these patients remain.     

Accountable disease management of spine pain

The health care landscape has changed with new legislation addressing the unsustainable rise in costs in the US system. Low-value service lines caring for expensive chronic conditions have been targeted for reform; for better or worse, the treatment of spine pain has been recognized as a representative example. Examining the Patient Protection and Affordable Care Act and existing pilot studies can offer a preview of how chronic care of spine pain will be sustained. Accountable care in an organization capable of collecting, analyzing, and reporting clinical data and operational compliance is forthcoming. Interdisciplinary spine pain centers integrating surgical and medical management, behavioral medicine, physical reconditioning, and societal reintegration represent the model of high-value care for patients with chronic spine pain.