RESUMEN
OBJECTIVES: Fibromyalgia is a chronic debilitating pain syndrome. There has been growing interest in the development of non-pharmacological therapies. Ba-Duan-Jin is an ancient Chinese exercise for health promotion, yet easy to learn. The purpose of this study is to evaluate the effectiveness of Ba-Duan-Jin in managing fibromyalgia symptoms experienced by Chinese patients. METHODS: In this randomised, usual therapy-controlled study, patients with fibromyalgia practiced Ba-Duan-Jin for one hour, twice a week for 12 weeks. The primary outcome measure was change in the Visual Analogue Scale for pain (pain VAS). Secondary outcomes included the Fibromyalgia Impact Questionnaire (FIQ), the Multidimensional Assessment of Fatigue (MAF), the Pittsburgh Sleep Quality Index (PSQI), the Beck Depression Inventory (BDI), the Perceived Stress Scale (PSS), and the Tender Point Count (TPC). These measures were assessed at baseline and after 4, 8, and 12 weeks. The Patient Global Impression of Change (PGIC) was collected at week 12. The Mann-Whitney U-test was performed using the intention-to-treat population. RESULTS: A total of 62 fibromyalgia patients were randomised to the Ba-Duan-Jin or the control groups. For the Ba-Duan-Jin group, significant improvement in pain VAS, FIQ, MAF, PSQI, and TPC were documented at weeks 4 (p≤0.046) and continued at week 8 (p≤0.003). At week 12, all of the outcome measures including BDI and PSS exhibited significant improvement (p≤0.004), and PGIC ratings were significantly better (p<0.001). No significant changes in the control group were observed. CONCLUSIONS: This study suggests that Ba-Duan-Jin exercise has the potential to be a valuable non-pharmacological intervention among Chinese fibromyalgia patients.
Asunto(s)
Fibromialgia , Dolor Musculoesquelético , Qigong/métodos , Fibromialgia/terapia , Humanos , Dolor Musculoesquelético/terapia , Dimensión del Dolor , Encuestas y Cuestionarios , Resultado del TratamientoRESUMEN
Fibromyalgia syndrome (FMS) is a chronic, idiopathic condition of widespread musculoskeletal pain affecting more women than men. Even though clinical studies have provided evidence of altered central pain pathways, the lack of definitive pathogenesis or reliable objective markers has hampered development of effective treatments. Here we report that the neuropeptides corticotropin-releasing hormone (CRH), substance P (SP), and SP-structurally-related hemokinin-1 (HK-1) were significantly (P = 0.026, P < 0.0001, and P = 0.002, respectively) elevated (0.82 ± 0.57 ng/ml, 0.39 ± 0.18 ng/ml, and 7.98 ± 3.12 ng/ml, respectively) in the serum of patients with FMS compared with healthy controls (0.49 ± 0.26 ng/ml, 0.12 ± 0.1 ng/ml, and 5.71 ± 1.08 ng/ml, respectively). Moreover, SP and HK-1 levels were positively correlated (Pearson r = 0.45, P = 0.002) in FMS. The serum concentrations of the inflammatory cytokines interleukin (IL)-6 and tumor necrosis factor (TNF) were also significantly (P = 0.029 and P = 0.006, respectively) higher (2.97 ± 2.35 pg/ml and 0.92 ± 0.31 pg/ml, respectively) in the FMS group compared with healthy subjects (1.79 ± 0.62 pg/ml and 0.69 ± 0.16 pg/ml, respectively). In contrast, serum IL-31 and IL-33 levels were significantly lower (P = 0.0001 and P = 0.044, respectively) in the FMS patients (849.5 ± 1005 pg/ml and 923.2 ± 1284 pg/ml, respectively) in comparison with healthy controls (1281 ± 806.4 pg/ml and 3149 ± 4073 pg/ml, respectively). FMS serum levels of neurotensin were not different from controls. We had previously shown that CRH and SP stimulate IL-6 and TNF release from mast cells (MCs). Our current results indicate that neuropeptides could stimulate MCs to secrete inflammatory cytokines that contribute importantly to the symptoms of FMS. Treatment directed at preventing the secretion or antagonizing these elevated neuroimmune markers, both centrally and peripherally, may prove to be useful in the management of FMS.
Asunto(s)
Hormona Liberadora de Corticotropina/sangre , Fibromialgia/sangre , Interleucina-6/sangre , Mastocitos/metabolismo , Sustancia P/sangre , Taquicininas/sangre , Factor de Necrosis Tumoral alfa/sangre , Adulto , Anciano , Biomarcadores/sangre , Citocinas/sangre , Femenino , Fibromialgia/diagnóstico , Humanos , Mediadores de Inflamación/sangre , Masculino , Persona de Mediana EdadRESUMEN
Fibromyalgia syndrome (FMS) is a chronic, idiopathic condition of widespread musculoskeletal pain, affecting primarily women. It is clinically characterized by chronic, nonarticular pain and a heightened response to pressure along with sleep disturbances, fatigue, bowel and bladder abnormalities, and cognitive dysfunction. The diagnostic criteria have changed repeatedly, and there is neither a definitive pathogenesis nor reliable diagnostic or prognostic biomarkers. Clinical and laboratory studies have provided evidence of altered central pain pathways. Recent evidence suggests the involvement of neuroinflammation with stress peptides triggering the release of neurosenzitizing mediators. The management of FMS requires a multidimensional approach including patient education, behavioral therapy, exercise, and pain management. Here we review recent data on the pathogenesis and propose new directions for research and treatment.
Asunto(s)
Fibromialgia/terapia , Anticonvulsivantes/uso terapéutico , Antidepresivos/uso terapéutico , Terapia Cognitivo-Conductual , Suplementos Dietéticos , Fibromialgia/diagnóstico , Fibromialgia/etiología , Humanos , Fármacos Neuromusculares/uso terapéutico , Educación del Paciente como Asunto , SíndromeRESUMEN
INTRODUCTION: This study tested the hypothesis that baseline ratings of fatigue/tiredness would be negatively associated with the efficacy of duloxetine on measures of pain and functional ability in patients with fibromyalgia. METHODS: A post hoc analysis of pooled data from 4 double-blind, placebo-controlled studies of duloxetine in fibromyalgia was performed. The fibromyalgia impact questionnaire (FIQ) tiredness item score (0 to 10 scale) was used to define tiredness subgroups. Patients were stratified into 3 subgroups: mild (0 to 3), moderate (4 to 6), and severe (7 to 10) tiredness. Analysis of covariance models and logistic regressions were used to test treatment-by-tiredness subgroup interactions. RESULTS: Data from the first 3 months are included in this post hoc analysis (duloxetine N = 797, placebo N = 535). At baseline, the distribution of tiredness severity in the duloxetine and placebo groups respectively was 3.64% and 3.75% mild, 16.71% and 15.57% moderate, and 79.65% and 80.68% severe. Rates of clinically significant (≥30% and ≥50%) improvement in brief pain inventory (BPI) average pain were similar across the tiredness subgroups. Tiredness severity at baseline was not negatively associated with the effects of duloxetine on patients' reports of functional ability using the FIQ total score, FIQ measures of physical impairment, interference with work, pain, stiffness, and depression and the medical outcomes study short form-36 (SF-36). CONCLUSIONS: Studies of duloxetine in fibromyalgia have demonstrated clinically significant improvements in pain and functional ability (FIQ, SF-36). This post hoc analysis of data shows that the efficacy of duloxetine among patients with fibromyalgia does not vary as a function of baseline ratings of fatigue/tiredness.