Exercise in waist‐high warm water decreases pain and improves health‐related quality of life and strength in the lower extremities in women with fibromyalgia

Objective

To evaluate the short‐ and long‐term efficacy of exercise therapy in a warm, waist‐high pool in women with fibromyalgia.

Methods

Thirty‐four women (mean ± SD tender points 17 ± 1) were randomly assigned to either an exercise group (n = 17) to perform 3 weekly sessions of training including aerobic, proprioceptive, and strengthening exercises during 12 weeks, or to a control group (n = 17). Maximal unilateral isokinetic strength was measured in the knee extensors and flexors in concentric and eccentric actions at 60°/second and 210°/second, and in the shoulder abductors and adductors in concentric contractions. Health‐related quality of life (HRQOL) was assessed using the EQ‐5D questionnaire; pain was assessed on a visual analog scale. All were measured at baseline, posttreatment, and after 6 months.

Results

The strength of the knee extensors in concentric actions increased by 20% in both limbs after the training period, and these improvements were maintained after the de‐training period in the exercise group. The strength of other muscle actions measured did not change. HRQOL improved by 93% (P = 0.007) and pain was reduced by 29% (P = 0.012) in the exercise group during the training, but pain returned close to the pretraining level during the subsequent de‐training. However, there were no changes in the control group during the entire period.

Conclusion

The therapy relieved pain and improved HRQOL and muscle strength in the lower limbs at low velocity in patients with initial low muscle strength and high number of tender points. Most of these improvements were maintained long term.

     

Attentional functioning in fibromyalgia,rheumatoid arthritis,and musculoskeletal pain patients

Objectives

To investigate whether chronic pain patients have deficits in attentional functioning compared with pain‐free controls, and whether fibromyalgia patients have larger deficits in attentional functioning compared with rheumatoid arthritis and musculoskeletal pain patients.

Methods

Sixty patients (20 in each of 3 patient groups) and 20 pain‐free controls completed measures assessing pain intensity, mood, pain‐related disability, somatic awareness, and catastrophic thinking about pain. Attentional functioning was assessed using an age‐standardized, ecologically valid test battery. Analyses were made of between‐group differences.

Results

Sixty percent of patients had at least one score in the clinical range of neuropsychological impairment, independent of demography and mood. Fibromyalgia patients were more anxious and somatically aware than rheumatoid arthritis or musculoskeletal pain patients, but did not show larger attentional deficits than other patient groups.

Conclusion

All 3 groups of chronic pain patients, regardless of diagnosis, had impaired cognitive functioning on an ecologically sensitive neuropsychological test of everyday attention.

     

Comparisons of spontaneous pain and tenderness in patients with primary fibromyalgia

Summary Pain was assessed in 47 patients with fibromyalgia in the University Rheumatology Clinic in Basle with the aid of three different techniques. First, a simple visual analog scale was used, later a body diagram on which patients could indicate pain separately in different regions of the body (pain score) and, finally, dolorimetric measurements at 56 typical PFS tender points. After four weeks of therapy, pain was again scored by patients using these techniques. The changes in assessment were compared with the aid of Spearman correlation. Data recorded with the aid of the body diagram correlated better with dolorimetric findings than did the results obtained from a simple visual analog scale. The severity of the disease can be more objectively assessed using these three techniques than it can using only the visual analog scale. In particular, the pain score and dolorimetry make possible a clear assessment of the value of therapeutic regimens.With the support of the Deutscher Akademischer Austauschdienst e.V., D-5300 Bonn-Bad Godesberg.     

Physical performance characteristics of women with fibromyalgia

Objective. The aim of this study was to examine physical performance in women with fibromyalgia (FM) using methods that are easy to use in clinical settings and to compare our findings with published norms or a healthy comparison group. Methods. Measures of shoulder pain and range-of-motion, isometric shoulder endurance, neck rotation, leg strength, hand grip strength, back flexibility, 6-minute walk distance, and symptom duration were completed on 97 subjects with FM. The comparison group was 30 age-matched healthy women. Results. The FM group had significantly lower physical functioning scores on all variables when compared to the healthy group or published norms. When pain at rest was controlled, pain on motion was the most significant predictor of variance in shoulder range of motion, whereas range of motion was the most significant predictor of right shoulder endurance and grip strength of both hands. Conclusions. Women with FM are markedly below average in physical performance abilities when measured by clinical tests.     

Effect of body weight on pain,sleep quality,and depression in patients with primary fibromyalgia syndrome

Aim of the workObesity and fibromyalgia syndrome (FMS) are two diseases, which are becoming more common and have an impact on social life. This study aimed to evaluate the effect of body weight on pain, sleep quality, and depression in patients with primary FMS and to assess its impact on the functional status.Patients and methodsThe study included 234 patients with primary FMS. The body mass index (BMI) was determined. The visual analog scale (VAS), Beck depression inventory (BDI), and the Pittsburgh sleep quality index (PSQI) were used for evaluating the patients. The Fibromyalgia impact questionnaire (FIQ) was assessed. The patients were divided into 3 groups: normal weight, overweight and obese.ResultsThe mean age of the patients was 40.3 ± 11.01 years (19–65 years); 206 (88%) were female, and 28 (22%) were males. The mean BMI was 28.8 ± 7.1 (17.7–49.1): 80 (34.2%) had a normal weight (24.4 ± 1.8), 76 (32.5%) were overweight (26.4 ± 1.6), and 78 (33.3%) were obese (37.9 ± 5.9) (p < 0.001). The FIQ, BDI, and PSQI were significantly higher in the obese patients compared to the normal and overweight (p < 0.001). The BMI, VAS, BDI, and FIQ were comparable between females and males while only the PSQI was significantly reduced in males (p = 0.004). A significant correlation was found between BMI with the PSQI, BDI, and FIQ (r = 0.11, p = 0.009; r = 0.41, p < 0.001 and r = 0.35p < 0.001 respectively).ConclusionObesity in primary FMS patients was significantly related to pain, sleep disorders, and depression. The importance of movement and weight control in FMS is emphasized.     

Isometric and isokinetic quadriceps strength in gonarthrosis; Inter-relations between quadriceps strength,walking ability,radiology, subchondral bone density and pain

Summary Patients with osteoarthrosis suffer from disability and pain. We measured isokinetic and isometric peak torque in 20 women with gonarthrosis (GA) and in 26 healthy controls. Relationships between muscle strength, walking and stair climbing time, pain level and pain disability scores as assessed by the patients using an extensive questionnaire, radiological changes and subchondral sclerosis expressed as bone mineral density (BMD, g/cm²) of the proximal tibia were studied.Precision errors of the torque measurements in both GA patients and controls were approximately 6%. In the GA patients, isokinetic and isometric quadriceps strength was reduced by 40 and 15% (p<0.01) respectively, and walking and stair climbing time was increased by 30% (p<0.005). Isokinetic strength was a better predictor of pain level and pain disability scores than isometric strength and radiological stage. Walking time and stair climbing time were not associated with quadriceps strength, pain level, pain disability scores or radiological changes. Subchondral BMD was not predictive of pain.The study suggests that quadriceps strength assessed by isokinetic dynamometry in GA is a reliable measurement. Isokinetic strength was pronouncedly reduced compared to isometric strength and was a more important predictor of pain and pain disability than isometric strength. These findings should be taken into consideration when planning exercise studies and programmes in GA.     

Tender points, depressive and functional symptoms: Comparison between fibromyalgia and major depression

Summary The degree of symptomatic overlap between fibromyalgia and major depression should be estimated by assessing the amount of local tenderness and the frequency and severity of depressive and functional symptoms. Tender points were assessed by palpation and symptoms by psychometric scales in 30 patients with fibromyalgia and 26 patients with major depression. The patients with fibromyalgia had markedly more tender points (16.5) than the depressive patients (1.3). In contrast, depressive and functional symptoms were present in both groups of patients, and some depressive patients (26%) also suffered from clinical pain. An increased sensitivity to pressure pain clearly distinguishes fibromyalgia from depression even if there is an overlap of other symptoms.     

The relationship between balance and vitamin 25(OH)D in fibromyalgia patients

Introduction: Fibromyalgia syndrome (FMS) is a chronic disease characterized by diffuse pain of unknown cause, fatigue, sleep disorders, cognitive dysfunction, and sensitivity. Fibromyalgia was shown to be associated with balance problems and increased incidence of falls. There are many theoretical mechanisms related to the impact of vitamin D on postural control. The aim of the current study was to investigate the relationship between vitamin 25(OH)D levels and pain, balance and daily activities in patients with FMS.

Method: Patients aged 35–65 years who were diagnosed with FMS according to 1990 ACR diagnostic criteria were screened. Seventy patients diagnosed with FMS and 60 healthy controls with comparable age and gender were included in the study. Fibromyalgia impact scale (FIQ), Berg Balance Scale (BBS), the Nottingham Health Profile (NHP), and visual analog scale (VAS) were applied to the subjects. The subjects were divided into two groups by vitamin 25(OH)D level being above or below 30?ng/ml.

Results: A statistically significant difference was established between VAS, BBS value and all NHP subscale and NHP total values of FMS patients and those of healthy control group. The relationship between BBS and the level of vitamin 25(OH)D of all participants was investigated, a positive statistically significant relationship was found with Vit-D at r?=?0.481 level (p?Conclusion:: It was observed that low vitamin D levels affected balance in both FMS group and healthy control group. It should be kept in mind that vitamin D level is likely to negatively affect balance and VAS values in FMS.     

Lack of correlation between the mean tender point score and self-reported pain in fibromyalgia

Objectives . To study the validity and nature of self-assessed symptoms among patients with fibromyalgia syndrome (FMS) and to compare our data with findings reported in the US. To determine whether tender point scores correlate with self-reported pain and other symptoms and to study the influence of disease duration. Methods . Tender point scores were assessed in 113 consecutive patients with FMS. All patients completed 2 self-assessment questionnaires (an extended Campbell list, the Enschede Fibromyalgia Questionnaire, and the Dutch Arthritis Impact Measurement Scales). Results . The self-assessed symptoms of the Dutch FMS patients seem to be valid and are comparable with those of American patients. No association between disease duration and number of self-reported symptoms was found. An association between self-reported pain and mean tender point score was lacking for patients with disease of shorter duration and was weak for patients with disease of longer duration. Conclusions . The use of a self-report questionnaire for patients with FMS is feasible and appears to be valid. Tender point scores and self-reported pain represent very different aspects of pain in FMS.     

Dimensions of psychological dysfunction in patients with fibromyalgia: development of an Italian questionnaire

Our objective was to observe whether dysfunctional psychological dimensions of pain could be detected in fibromyalgia patients through the development of a new questionnaire. An original questionnaire composed of 51 items was given to 250 patients (185 females and 65 males, mean age 55±12.8 years) suffering from chronic fibromyalgia according to the criteria of the Multicenter Criteria Committee of the American College of Rheumatology. A Varimax computerized program of factorial analysis with orthogonal and oblique rotation of the axes was used to analyze the data. Five strong independent factors were identified: 1) catastrophizing and 2) external control beliefs (cognitive); 3) alexithymia (emotional); 4) restless behavior (behavioral); and 5) need for support (relational). Our questionnaire is a preliminary development of an Italian language psychological characterization of FM patients which may be a relevant and useful tool for the evaluation of the outcome of clinical/psychological treatment of FM.Abbreviations FM Fibromyalgia     

Fibromyalgia - the effect of relaxation and hydrogalvanic bath therapy on the subjective pain experience

Summary In the present study, two established non-medicinal treatment methods are compared with regard to their effect on various psychological pain parameters in patients with fibromyalgia. Twelve patients underwent hydrogalvanic baths, 13 patients the Jacobson relaxation training. Statistical evaluation showed only one significant difference in the different dimensions of pain measured at the beginning and end of the therapy. In comparison with patients receiving Jacobson-therapy, there is a significantly higher decrease in pain intensity in the period from breakfast till lunch in patients receiving bath-therapy. Apart from this, no differences between the two treatment groups could be found, either in the quality of pain, the psychological symptoms accompanying it, in sleep quality or in pain behaviour.     

Quantifying pain threshold and quality of life of fibromyalgia patients

The most typical symptom of fibromyalgia (FM) is diffuse pain, and pain at specific points—tender points—is crucial for its diagnosis. By comparing healthy individuals and FM patients, this study was aimed at assessing pain and quality of life of Brazilian females with FM, while seeking for a correlation between pain threshold and quality of life. A total of 178 women were evaluated: 124 were FM patients and 54 were healthy women. Pain threshold at tender points was quantified by dolorimetry, and diffuse pain by means of the visual analogue scale (VAS); the Fibromyalgia Impact Questionnaire (FIQ) was used to evaluate quality of life. Statistical treatment of the data allowed for proposing two indexes: a pain threshold index (PT) and a quality of life one (QOL). PT is the lowest value among all pain thresholds measured at the 18 tender points; QOL is the mean of responses to the FIQ and VAS. Both indexes were tested and showed significant differences between the test and control groups. By pairing pain threshold values of each tender point in the test and control groups, it was found that the most sensitive points matched between the two groups, that is, the most sensitive anatomic spots in a healthy individual are also likely to be the most sensitive points in a person with FM. This suggests that a stimulus that provokes slight discomfort to a healthy person may produce more pain in FM patients—which may bear implications for FM clinical treatment. In this sample of Brazilian women, FM patients had both lower pain threshold and worse quality of life than healthy women.     

Impact of electromagnetic field exposure on pain,severity, functional status and depression in patients with primary fibromyalgia syndrome

IntroductionFibromyalgia syndrome (FMS) is a chronic condition characterized by generalized body pain, and mood disturbances of unknown etiology. Electromagnetic hypersensitivity (EHS), where patients report “hypersensitivity” to electro-magnetic fields (EMF). They wonder whether aches and pains, headaches, depression, sleeping disorders, could be associated with EMF exposure.Aim of the workIs to investigate if fibromyalgia symptoms and scores are affected by the exposure to EMF.Patients and methodsThis study included 80 FMS patients. The numerical pain rating scale (NPRS), Montgomery-Asberg Depression Rating Scale (MADRS) and the revised fibromyalgia impact questionnaire (FIQR) were used. A patient self-reporting questionnaire invented by the authors in Arabic for the frequency and intensity of EMF exposure was validated and used.ResultsThe mean age of the patients was 38.7 ± 11 years and mean disease duration 4.5 ± 2.4 years. The male to female ratio was 1:2.8. A near-by cellular phone or electric tower did not significantly affect disease scores (p > 0.05), Microwave users appeared to have higher wide spread pain index (WPI) and system severity (SS) scores than non-users, but the difference was not statistically significant (p = 0.08 and 0.06) respectively. FMS scores significantly increased with higher TV watching duration, while MADRS score significantly decreased with higher cellular phone use indices. MADRS depression score was increased with shorter distance from electric tower, though not statistically significant (p = 0.76)ConclusionThis study highlights a possible pathological link between fibromyalgia and exposure to electromagnetic radiation. Excess exposure to electromagnetic devices could be one of the underlying or at least augmenting factors of fibromyalgia symptoms.     

Effects of strength training and detraining on knee extensor strength,muscle volume and muscle quality in elderly women

Strength training seems to be an interesting approach to counteract decreases that affect knee extensor strength, muscle mass and muscle quality (force per unit of muscle mass) associated with ageing. However, there is no consensus regarding the changes in muscle mass and their contribution to strength during periods of training and detraining in the elderly. Therefore, this study aimed at verifying the behaviour of knee extensor muscle strength, muscle volume and muscle quality in elderly women in response to a 12-week strength training programme followed by a similar period of detraining. Statistical analysis showed no effect of time on muscle quality. However, strength and muscle volume increased from baseline to post-training (33 and 26 %, respectively). After detraining, the knee extensor strength remained 12 % superior to the baseline values, while the gains in muscle mass were almost completely lost. In conclusion, strength gains and losses due to strength training and detraining, respectively, could not be exclusively associated with muscle mass increases. Training-induced strength gains were partially maintained after 3 months of detraining in elderly subjects.     

Effects of pool‐based and land‐based aerobic exercise on women with fibromyalgia/chronic widespread muscle pain

Objective

To examine the effects of pool‐based (PE) and land‐based (LE) exercise programs on patients with fibromyalgia.

Methods

The outcomes were assessed by the Fibromyalgia Impact Questionnaire, the Arthritis Self‐Efficacy Scale, and tests of physical capacity.

Results

Eighteen subjects in the PE group and 16 in the LE group performed a structured exercise program. After 20 weeks, greater improvement in grip strength was seen in the LE group compared with the PE group (P < 0.05). Statistically significant improvements were seen in both groups in cardiovascular capacity, walking time, and daytime fatigue. In the PE group improvements were also found in number of days of feeling good, self‐reported physical impairment, pain, anxiety, and depression. The results were mainly unchanged at 6 months followup.

Conclusion

Physical capacity can be increased by exercise, even when the exercise is performed in a warm‐water pool. PE programs may have some additional effects on symptoms. Arthritis Care Res 45:42–47, 2001. © 2001 by the American College of Rheumatology.

     

Impact of fibromyalgia pain on health‐related quality of life before and after treatment with tramadol/acetaminophen

Objective

To assess health‐related quality of life (HRQOL) in patients with moderate‐to‐severe fibromyalgia pain compared with the general population, and to assess the relationship between pain severity and HRQOL before and after treatment with an analgesic.

Methods

Data were obtained from a randomized, double‐blind study of patients with moderate‐to‐severe fibromyalgia pain. Patients received either tramadol/acetaminophen or placebo 4 times/day as needed for 91 days. HRQOL was measured with the Short Form 36 Health Survey (SF‐36) and the Fibromyalgia Impact Questionnaire (FIQ). Baseline HRQOL scores were compared with a national sample of noninstitutionalized adults and a sample of patients with impaired HRQOL due to congestive heart failure. Patients with fibromyalgia were divided into tertiles by change in pain severity, and SF‐36 scores were compared across the tertiles. Mean changes in SF‐36 and FIQ scores were compared between treatment groups.

Results

Patients with fibromyalgia scored lower than the US norm on all SF‐36 scales (P < 0.0001) and lower than patients with congestive heart failure on most scales. More severe pain was associated with greater impairment of HRQOL compared with less severe pain (P < 0.0001). Patients in the highest tertile for improved pain severity had greater improvement in HRQOL scores than patients in the lower tertiles. Compared with patients who received placebo (n = 157), patients treated with tramadol/acetaminophen (n = 156) showed greater improvement on SF‐36 physical functioning, role physical, bodily pain, and physical summary scales, as well as FIQ scales for ability to do job, pain, and stiffness (P < 0.01).

Conclusion

Moderate‐to‐severe fibromyalgia pain significantly impairs HRQOL, and effective pain relief in these patients significantly increases HRQOL.

     

Hypermobility in women with fibromyalgia syndrome

The purpose of this study was to evaluate the relationship between hypermobility and fibromyalgia syndrome (FS) in women. Ninety-three women with FS who met the American College of Rheumatology criteria for FS and 58 healthy women without FS were included in this study. All women were examined for hypermobility by blinded observers using the Beighton criteria. The mean age was 43.5±9.9 (21–68) and 40.2±11.1 (21–63) years in the FS and control groups, respectively, and the two groups were statistically similar (p>0.05). The mean Beighton total score was 4.7±2.1 and 2.9±2.4 in the FS and control groups, respectively (p<0.0001). The frequency of joint hypermobility was 64.2% in the FS group and 22% in the control group. In accordance with the Beighton criteria (p<0.05), we found that the joint hypermobility ratio was significantly higher in patients with FS than in subjects without FS. Additionally, we evaluated the correlation between the total Beighton score and the age and number of trigger points. There were negative correlations between the total Beighton score and the age (r=−0.42, p<0.001) and number of trigger points (r=−0.24, p=0.03) in all patients. Hypermobility syndrome is more common in women with FS than in those in the control group. Therefore, the relationship between hypermobility and FS should be taken into consideration in the diagnosis and follow-up of women, especially those with widespread pain.     

Cold-induced vasospasm in patients with fibromyalgia and chronic low back pain in comparison to healthy subjects

Summary Using capillary videomicroscopy of the nail fold, the frequency of cold-induced vasospasm and capillary hemodynamic parameters were studied after application of cold in 50 patients with primary fibromyalgia, 50 patients with chronic low back pain, and 50 healthy controls. Cold-induced vasospasm was detected in 38% of the patients with fibromyalgia. In this group it was significantly more frequent than in the patients with chronic low back pain (20%, p<0.05) and healthy subjects (8%, p<0.001). In the fibromyalgia group, the magnitude of vasospasm as measured by the capillary blood flow deceleration after cold application correlated negatively with the pain intensity as measured by pain score (r=–0.3839, p<0.01). No differences in clinical appearance were found between patients with and without cold-induced vasospasm in both the fibromyalgia and low back pain group.