Treatment of fibromyalgia with cyclobenzaprine: A meta‐analysis

Objective

To systematically review the effectiveness of cyclobenzaprine in the treatment of fibromyalgia.

Methods

Articles describing randomized, placebo‐controlled trials of cyclobenzaprine in people with fibromyalgia were obtained from Medline, EMBase, Psyclit, the Cochrane Library, and Federal Research in Progress Database. Unpublished literature and bibliographies were also reviewed. Outcomes, including global improvement, treatment effects on pain, fatigue, sleep, and tender points over time, were abstracted.

Results

Five randomized, placebo‐controlled trials were identified. The odds ratio for global improvement with therapy was 3.0 (95% confidence interval [95% CI] 1.6–5.6) with a pooled risk difference of 0.21 (95% CI 0.09–0.34), which calculates to 4.8 (95% CI 3.0–11) individuals needing treatment for 1 patient to experience symptom improvement. Pain improved early on, but there was no improvement in fatigue or tender points at any time.

Conclusion

Cyclobenzaprine‐treated patients were 3 times as likely to report overall improvement and to report moderate reductions in individual symptoms, particularly sleep.

     

Effects of Stanger bath therapy on fibromyalgia

The purpose of this study was to assess the effectiveness of Stanger bath on the treatment of fibromyalgia (FM). Fifty women with FM were randomly divided into two groups. The first group (n=25) was treated with amitriptyline, 10 mg/day for 8 weeks, and Stanger bath, 20 min daily for ten sessions. The second group (n=25) only had amitriptyline, 10 mg/day for 8 weeks. In the first group the assessment parameters were measured before (t1), at the end (t2), and 2 months after the hydrotherapy (t3). In the second group these parameters were examined before (T1) and 2 months after the treatment (T2). Patients were evaluated by number of tender points and Fibromyalgia Impact Questionnaire (FIQ) scores. There was significant improvement in number of tender points between t1 and t2 (P<0.01) and t1 and t3 (P<0.001) in the Stanger bath group. In addition, there was significant improvement in FIQ scores between t1 and t2 (P<0.001) and t1 and t3 (P<0.01) in the Stanger bath group. In the second group we observed significant improvement in FIQ scores and tender point numbers between T1 and T2 (P=0.00). We did not find any difference between groups in tender point number percent change (p=0.074). However, we observed statistically significant improvement in percent change of FIQ scores in Stanger bath group (−30±16.7) when compared to group 2 (−19.3±13) (p=0.016). We conclude that Stanger bath therapy when combined with amitriptyline has a long lasting effect and better outcome in FM patients.     

Factors predisposing to the resort of complementary therapies in patients with fibromyalgia

Summary This study examined the factors influencing the use of complementary therapies in patients with fibromyalgia. A postal questionnaire was sent to 90 patients who had attended a rheumatology out-patient clinic in West Yorkshire for their diagnosis or treatment of fibromyalgia. Seventy-one per cent of fibromyalgia patients had used or were using complementary therapies. Patients who were using complementary therapies were of a higher socio-economic group (p<0.001). The most popular therapy was oral supplementation. The duration of complementary therapies ranged from 3 months to 26 years (median=3). The number of therapies used by each patient ranged from 1 to 10 (median=3). The duration of fibromyalgia was associated with both the duration of complementary therapies (p<0.001) and the number of therapies used (p<0.05). The most popular source of advice for the decision to use complementary therapies was from a magazine (40%). Patients using complementary therapies were less likely to be satisfied with their current hospital treatment and turned to complementary therapies in the chance of relief from their fibromyalgia. The relatively high cost and lack of information on complementary therapies appeared to dissuade those patients who chose not to use it.     

Treatment of fibromyalgia (Fibrositis syndrome): A parallel double blind trial with carisoprodol,paracetamol and caffeïne (Somadril comp®) versus placebo

Summary Forty-three of fifty-eight (74.1%) female patients with fibromyalgia completed an eight-week treatment period testing the combination of carisoprodol, paracetamol (acetaminophen) and caffeine versus placebo. Twenty-three patients received placebo and twenty active medication. In the placebo group 56.5% of the patients used additional analgesics or nonsteroidal anti-inflammatory drugs compared to only 20% in the active treatment group (p=0.015). Forty-three percent of the patients in the placebo group and none of the patients in the active treatment group used tricyclic antidepressants, anxiolytics or sedatives (p=0.0008). Active treatment gave statistically significant improvement after treatment for pain (p<0.01), for sleep quality (p<0.01) and for the general feeling of sickness (p<0.05). In the active treatment group increased pressure pain threshold after eight weeks was found at 70% of the sites measured, while the pressure pain threshold was increased at only 30% of the sites in the placebo group. In the placebo group improvement was found for the pain and sleep quality (p<0.05). This improvement may in part be due to the large amounts of extra medication in this group. Thus, the combination of carisoprodol and paracetamol (acetaminophen) and caffeine are effective in the treatment of fibromyalgia.     

Effectiveness of aquatic therapy in the treatment of fibromyalgia syndrome: a randomized controlled open study

The aim of this study was to investigate the efficacy of aquatic exercises in fibromyalgia syndrome (FMS). A total of 63 patients were included and allocated to two groups. Group I (n = 33) received an aquatic exercise program and Group II (n = 30) received a home-based exercise program for 60 min, 3× a week, over 5 weeks. Patients were evaluated for pain (visual analogue scale, VAS), number of tender points (NTP), Beck depression inventory (BDI), and functional capacity (fibromyalgia impact questionnaire, FIQ). All assessment parameters were measured at baseline, and at weeks 4, 12, and 24. There were statistically significant differences in FIQ and NTP in both groups at the end and during follow-up (P < 0.05). Group I showed a statistically significant decrease in BDI scores after 4 and 12 weeks (P < 0.05) that remained after 24 weeks (P < 0.001). In Group II, a significant decrease in BDI scores was observed at the end and during follow-up (P < 0.001). Also, a significant improvement was found in VAS at weeks 4 and 12 in both groups (P < 0.001). The average of reduction in pain scores was 40% in Group1 and 21% in Group II. However, this was still significant at week 24 only in the aquatic therapy group. A comparison of the two groups showed no statistically significant difference for FIQ, NTP, and BDI scores except VAS (P < 0.001) Our results showed that both aquatic therapy and home-based exercise programs have beneficial effects on FIQ, BDI, and NTP. In pain management, only aquatic therapy seems to have long-term effects.     

Opioid use, misuse, and abuse in patients labeled as fibromyalgia

Background

As pain is the cardinal symptom of fibromyalgia, it is logical that treatments directed toward pain relief will be commonly used. Analgesic drug therapy remains the traditional treatment intervention for most chronic pain conditions, with a progressive increased use of opioids in the past 20 years. Concerns about efficacy, risk-benefit ratio, and possible long-term effects of chronic opioid therapy have been raised. There is limited information about opioid treatment in fibromyalgia, with all current guidelines discouraging opioid use.

Methods

A chart review of all patients referred to a tertiary care pain center clinic with a referring diagnosis of fibromyalgia was conducted to evaluate use of opioid medications.

Results

We have recorded opioid use by 32% of 457 patients referred to a multidisciplinary fibromyalgia clinic, with over two thirds using strong opioids. Opioid use was more commonly associated with lower education, unemployment, disability payments, current unstable psychiatric disorder, a history of substance abuse, and previous suicide attempts.

Conclusion

We have observed negative health and psychosocial status in patients using opioids and labeled as fibromyalgia. Prolonged use of opioids in fibromyalgia requires evaluation.     

Effect of a randomized,controlled trial of exercise on mood and physical function in individuals with fibromyalgia

Objective

To evaluate the effect of exercise on mood and physical function in individuals with fibromyalgia.

Methods

Subjects were randomly assigned to an exercise (EX) or control (CTL) group. EX subjects participated in 3 30‐minute exercise classes per week for 23 weeks. Subjects were tested at entry and at 6, 12, and 23 weeks. Tests included the Beck Depression Inventory (BDI), 6‐minute walk, State‐Trait Anxiety Inventory (STAI), Mental Health Inventory (MHI), Fibromyalgia Impact Questionnaire (FIQ), Arthritis Self‐Efficacy Scale (ASES), and a measure of tender points and knee strength.

Results

Fifty subjects (27 EX, 23 CTL) completed the study, and 31 (15 EX, 16 CTL) met criteria for efficacy analyses. In efficacy analyses, significant improvements were seen for EX subjects in 6‐minute walk distances, BDI (total, cognitive/affective), STAI, FIQ, ASES, and MHI (3 of 5 subscales) scores. These effects were reduced but remained during intent‐to‐treat analyses.

Conclusion

Exercise can improve the mood and physical function of individuals with fibromyalgia.

     

SPA therapy in fibromyalgia: a randomised controlled clinic study

Objective: The aim of the present study is to evaluate the effectiveness of spa therapy in the management of fibromyalgia. Methods: Thirty women with fibromyalgia were randomly assigned to either a spa therapy group or a control group. The spa therapy group (n = 16) had spa treatment for 2 weeks in addition to their medical treatment. The control group (n = 14) continued to have their medical treatment and/or daily exercises. An investigator who was blinded for the intervention assessed all the patients for 9 months. Improvements in Fibromyalgia Impact Questionnaire (FIQ), pain and number of tender points were primary outcomes. Secondary outcome measures were improvement in sleep disturbance, fatigue, gastrointestinal symptoms, anxiety, Beck Depression Inventory and patients global evaluation. Results: the spa group was found to be superior to the control group at the end of intervention in terms of FIQ, pain, tender point count, fatigue and patients global assessment. This superiority remained for 6 months in FIQ, 1 month in pain and tender point count. Conclusion: It was concluded that the addition of spa therapy to medical therapy has both short- and long-term beneficial effects in female patients with fibromyalgia.     

Muscle performance in fibromyalgia syndrome

The objective of the study was to examine the muscle performance, isokinetic muscle strength, muscle endurance ratio, and submaximal aerobic performance in fibromyalgia syndrome (FMS) patients, to evaluate the relation between muscle performance, pain severity, clinical findings, and physical activity level, and to compare the results with healthy control subjects. Twenty-four FMS patients and 15 control subjects participated in this study. Data were obtained about the symptoms, location and onset of pain, treatment, and associated symptoms. Patients and controls underwent an examination of isokinetic muscle strength of right quadriceps on a Cybex dynamometer, and submaximal aerobic performance tests (PWC-170) were done for all subjects. Maximal voluntary muscle strength of the quadriceps was significantly lower in patients compared with the control group. Endurance ratios showing the work capacity were not statistically different between two groups. Submaximal aerobic performance scores were higher in the control group. There was not a relation between the decreased muscle performance and clinical findings, including pain severity, number of tender points, and duration of the symptoms of FMS patients. We found a reduced quadriceps muscle strength and submaximal aerobic performance in patients with FMS, indicating that patients have impaired muscle function. Received: 17 March 1999 / Accepted: 29 July 1999     

Serum lipid profile in fibromyalgia women

The etiology and pathogenic mechanisms of fibromyalgia (FM) syndrome are unknown. A number of studies have shown that there is an association between some of the musculoskeletal system diseases and hyperlipidemia. The aims of this study were (1) to compare the serum lipid profile among FM and healthy women and (2) to investigate the relationship between serum lipid levels and FM findings. One hundred sixty-four women (82 women with FM as study group and 82 healthy women as control group) were enrolled in the study. The mean serum total cholesterol and low-density lipoprotein cholesterol (LDL-c) were found significantly higher in the FM group than that in the control group (p<0.05). However, There was no statistically significant difference in the mean serum triglyceride, high-density lipoprotein cholesterol (HDL-c), and very low-density lipoprotein cholesterol (VLDL-c) values between the two groups (p>0.05). In the FM group, we could not find a significant correlation between the serum lipid profile values and the FM parameters (p>0.05).     

The effects of multidisciplinary therapy on positron emission tomography of the brain in fibromyalgia: a pilot study

Aberrant central neurological functioning is believed to contribute to the abnormal sensations of fibromyalgia (FM). This pilot study sought to determine if alterations in regional brain metabolism from baseline occur in FM after undergoing a multidisciplinary therapeutic regimen. Regional brain metabolic activity was estimated using ¹⁸F-fluorodeoxyglucose positron emission tomography (¹⁸FDG PET). Nine participants with FM received an 8-week comprehensive treatment program. Serial testing with ¹⁸FDG PET and the Fibromyalgia Impact Questionnaire were performed. Statistical analysis was performed using repeated Wilcoxon signed rank tests. A clinical improvement (FIQ median change 20.68, P = 0.005) was noted with treatment. With treatment, increases in brain metabolism were noted in various components of the limbic system (P = 0.004–0.1). An increase in limbic metabolism was noted with concomitant symptomatic improvement, suggesting that the limbic system attenuates FM symptoms.     

Primary fibromyalgia and allergy

Summary Primary fibromyalgia (PF) has attracted much interest since the 80's. There are many controversies as to whether it is a true disease or not and many studies are carried on. In this study 32 patients which were accepted as PF were examined for some frequent symptoms and allergy and compared with controls. Migraine, irritable bowel syndrome, sleep disturbance and morning stiffness were investigated and found to be 40.6%, 12.5%, 71.9%, 68.8% respectively. Sleep disturbance and morning stiffness showed a positive correlation. Allergy background of PF patients was found frequently when compared with an age and sex matched control group. Though serum IgE levels were found elevated in PF group, they were not statistically significant. Allergic skin tests which could not be performed in the control group, were positive in 10 of 15 PF patients.     

Alternative medicine use in fibromyalgia syndrome

Objective . To record the prevalence, extent, cost, and satisfaction with use of alternative medicine practices by patients with fibromyalgia syndrome (FMS), compared to control rheumatology patients. Methods . An interviewer-based questionnaire was administered to 221 consecutive rheumatology patients and 80 FMS patients. Results . Alternative medicine interventions were currently being used extensively by rheumatology patients overall, and by FMS patients in particular. All categories of alternative practices were used more often by FMS patients, compared to controls, including overall use 91% versus 63% (P = 0.0001), over-the-counter products 70% versus 54% (NS), spiritual practices 48% versus 37% (NS), and alternative practitioners 26% versus 12% (P = 0.003), respectively. Two-thirds of patients using alternative medicine practices were concurrently using multiple interventions. Patient satisfaction ratings were highest for spiritual interventions. Conclusions . Alternative medicine practices were currently being used by almost all FMS patients. This observation might indicate that traditional medical therapies are inadequate in providing symptomatic relief to FMS patients.     

Antipolymer antibody is not associated with fibromyalgia in Korean female patients

To examine the levels of antipolymer antibody (APA) in Korean female patients with fibromyalgia (FM) and to determine whether the levels of APA correlate with FM severity. Serum samples from patients with FM (n = 69), patients with rheumatoid arthritis (RA) (n = 71), and controls (n = 75) were assayed for APA. All of the subjects were female, and the controls were age-matched healthy volunteers. FM tender point counts and scores were examined, and FM patients were asked to complete a Korean version of the Fibromyalgia Impact Questionnaire (FIQ), the State-Trait Anxiety Inventory (STAI), and the Beck Depression Inventory (BDI). APA-positive samples were detected in five (7.2%) of the 69 FM patients, seven (9.9%) of the 71 RA patients, and four (5.3%) of the 75 controls. The prevalence of seropositivity and the level of APA in FM patients did not differ from those in RA patients and controls. The proportion positive for APA was not higher for FM patients with severe symptoms than for FM patients with mild symptoms. There was a negative association between the APA level and age. The APA level in FM patients was not correlated with age at diagnosis, age at symptom onset, disease duration, education, tender point counts and scores, FIQ, STAI, or BDI. The prevalence of APA in Korean FM patients was quite low. Owing to the low prevalence of APA in this study, the APA assay did not distinguish FM patients with severe symptoms from those with mild symptoms.     

Self-efficacy predicting outcome among fibromyalgia subjects

Objectives . This study examined whether pretreatment self-efficacy and pre- to post-treatment changes in self-efficacy predict post-treatment tender point index, disease severity, pain, and physical activity. Methods . One hundred nine subjects with fibromyalgia were assessed before and after a 6-week training intervention. Measures included tender point index, physician ratings of disease severity, the visual analog scale for pain, the Physical Activities subscale of the Arthritis Impact Measurement Scales, and the Arthritis Self-Efficacy Scale. Results . Pretreatment self-efficacy significantly predicted post-treatment physical activity, with higher selfefficacy associated with better physical activity outcome. Changes in self-efficacy significantly predicted post-treatment tender point index, disease severity, and pain; improvements in self-efficacy were associated with better outcomes on each measure. Conclusions . Higher levels of self-efficacy are associated with better outcome, and may mediate the effectiveness of rehabilitation-based treatment programs for fibromyalgia.     

Counter irritation test in primary fibromyalgia

Summary In primary fibromyalgia the main symptom is diffuse pain predominating at tender points which are sensitive to palpation. The aim of this study was to compare the effects on the amplitude of the nociceptive flexion reflex of the lower limb (RIII reflex) of applying painful pressure to the tender points with the effects of the same pressure applied to other points of the body or to the same part of the body in control subjects. This method was chosen because previous studies have shown that it was possible to activate the diffuse noxious inhibitory system using a counter-irritation stimulation.Our study was carried out on 18 fibromyalgic patients and on 12 control subjects. During the counter-irritation procedure, consisting of applying pressure with a mechanical dolorimeter to tender points, a clear cut and significant decrease in the amplitude of the RIII response was observed in 6 patients.In conclusion, in view of the subjective nature of the criteria used at present to diagnose primary fibromyalgia, we would like to suggest that a positive counter-irritation test be adopted as a further obligatory criterion, since it has been clearly established that the diffuse noxious inhibitory control responsible for the decrease in the RIII amplitude can be activated only when the subjects undergo intense nociceptive stimulation.