RESUMEN
OBJECTIVE: To analyze the knowledge about fibromyalgia of people with this diagnosis and its repercussions in coping with the disease. METHOD: Qualitative research, based on the Social Representation Theory framework. Thirty people over 18 years old and from the state of Rio de Janeiro, Brazil, participated. Snowball sampling was applied to recruit participants and a semi-structured interview was used to produce data, between April 2020 and January 2021. Statistical and lexicographic analysis was performed using Alceste. RESULTS: Most participants were women (93%); aged 41 to 60 years old (67%); of whom 63% were married; had been diagnosed 10 years ago or more (40%); and 40% participated in support groups. They did not know the name of the disease and its causes, but they mentioned its symptoms, mainly pain. Objectification of fibromyalgia occurs in painful symptoms and the lack of signs in the body generates misunderstanding among the people they live with. They share experiences in support groups to cope with the disease. CONCLUSION: The subjective phenomenon of pain generates distrust about the disease. Diagnosis difficulties delay treatment and insufficient information generates judgments and stereotypes for patients. Prejudices and rejections have repercussions on coping with the disease.
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Adaptación Psicológica , Fibromialgia , Conocimientos, Actitudes y Práctica en Salud , Investigación Cualitativa , Fibromialgia/psicología , Humanos , Femenino , Persona de Mediana Edad , Adulto , Masculino , Brasil , Anciano , Grupos de AutoayudaRESUMEN
Though the mechanisms are not fully understood, tryptophan (Trp) and physical exercise seem to regulate mechanical hypersensitivity in fibromyalgia. Here, we tested the impact of Trp supplementation and continuous low-intensity aerobic exercise on the modulation of mechanical hypersensitivity in a fibromyalgia-like model induced by acid saline in female rats. Twelve-month-old female Wistar rats were randomly divided into groups: [control (n = 6); acid saline (n = 6); acid saline + exercise (n = 6); acid saline + Trp (n = 6); and acid saline + exercise + Trp (n = 6)]. Hypersensitivity was caused using two intramuscular jabs of acid saline (20 µL; pH 4.0; right gastrocnemius), 3 days apart. The tryptophan-supplemented diet contained 7.6 g/hg of Trp. The three-week exercise consisted of progressive (30-45 min) treadmill running at 50 to 60% intensity, five times (Monday to Friday) per week. We found that acid saline induced contralateral mechanical hypersensitivity without changing the levels of Trp, serotonin (5-HT), and kynurenine (KYN) in the brain. Hypersensitivity was reduced by exercise (~150%), Trp (~67%), and its combination (~160%). The Trp supplementation increased the levels of Trp and KYN in the brain, and the activity of indoleamine 2,3-dioxygenase (IDO), and decreased the ratio 5-HT:KYN. Exercise did not impact the assessed metabolites. Combining the treatments reduced neither hypersensitivity nor the levels of serotonin and Trp in the brain. In conclusion, mechanical hypersensitivity induced by acid saline in a fibromyalgia-like model in female rats is modulated by Trp supplementation, which increases IDO activity and leads to improved Trp metabolism via the KYN pathway. In contrast, physical exercise does not affect mechanical hypersensitivity through brain Trp metabolism via either the KYN or serotonin pathways. Because this is a short study, generalizing its findings warrants caution.
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Modelos Animales de Enfermedad , Fibromialgia , Condicionamiento Físico Animal , Ratas Wistar , Serotonina , Triptófano , Animales , Triptófano/metabolismo , Triptófano/farmacología , Fibromialgia/metabolismo , Femenino , Ratas , Serotonina/metabolismo , Quinurenina/metabolismo , Indolamina-Pirrol 2,3,-Dioxigenasa/metabolismo , Hiperalgesia/metabolismo , Encéfalo/metabolismo , Encéfalo/efectos de los fármacos , Encéfalo/patología , Suplementos DietéticosRESUMEN
The definition of quaternary prevention as the set of interventions that avoids or mitigates the consequences of unnecessary or excessive activity of medical interventionism and the health system. The definition of a new disease is a complex process that involves the identification, characterization and description of a medical condition that has not been previously recognized or documented. Since mid-2020, the term chronic COVID/long COVID has been used to describe the presence of signs and symptoms after an acute SARS-CoV-2 infection, with multiple terminologies and definitions in international literature. Post-infectious syndromes, myalgia encephalomyelitis and fibromyalgia, are some of the diseases that have similarities with chronic COVID. This article presents an analysis relating the concepts of new disease and quaternary prevention with chronic COVID and other diseases described in the literature.
Se define prevención cuaternaria como el conjunto de intervenciones que evita o atenúa las consecuencias de la actividad innecesaria o excesiva del intervencionismo médico y del sistema sanitario. La definición de una nueva enfermedad es un proceso complejo que involucra la identificación, caracterización y descripción de un cuadro clínico que no ha sido previamente reconocida o documentada. Desde mediados del año 2020 se utiliza el término COVID crónico/long COVID para describir la presencia de signos y síntomas luego de una infección aguda por SARS-CoV-2, con múltiples terminologías y definiciones en la literatura internacional. Los síndromes posinfecciosos, la encefalomielitis mialgia y la fibromialgia, son algunas de las enfermedades que tienen similitudes con el COVID crónico. En este artículo se presenta un análisis relacionando los conceptos de nueva enfermedad y prevención cuaternaria con el COVID crónico y otras enfermedades descritas en la literatura.
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COVID-19 , Síndrome Post Agudo de COVID-19 , Humanos , COVID-19/complicaciones , COVID-19/prevención & control , SARS-CoV-2 , Enfermedad Crónica , FibromialgiaRESUMEN
BACKGROUND: Electroencephalography (EEG) is a promising tool for identifying the physiological biomarkers of fibromyalgia (FM). Evidence suggests differences in power band and density between individuals with FM and healthy controls. EEG changes appear to be associated with pain intensity; however, their relationship with the quality of pain has not been examined. We aimed to investigate whether abnormal EEG in the frontal and central points of the 10-20 EEG system in individuals with FM is associated with pain's sensory-discriminative and affective-motivational dimensions. The association between EEG and the two dimensions of emotional disorders (depression and anxiety) was also investigated. METHODS: In this cross-sectional pilot study, pain experience (pain rating index [PRI]) and two dimensions of emotional disorders (depression and anxiety) were assessed using the McGill Pain Questionnaire (PRI-sensory and PRI-affective) and Hospital Anxiety and Depression Scale (HADS), respectively. In quantitative EEG analysis, the relative spectral power of each frequency band (delta, theta, alpha, and beta) was identified in the frontal and central points during rest. RESULTS: A negative correlation was found between the relative spectral power for the delta bands in the frontal (r= -0.656; p = 0.028) and central points (r= -0.624; p = 0.040) and the PRI-affective scores. A positive correlation was found between the alpha bands in the frontal (r = 0.642; p = 0.033) and central points (r = 0.642; p = 0.033) and the PRI-affective scores. A negative correlation between the delta bands in the central points and the anxiety subscale of the HADS (r = -0.648; p = 0.031) was detected. CONCLUSION: The affective-motivational dimension of pain and mood disorders may be related to abnormal patterns of electrical activity in patients with FM. TRIAL REGISTRATION: Retrospectively registered on ClinicalTrials.gov (NCT05962658).
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Ansiedad , Electroencefalografía , Fibromialgia , Dimensión del Dolor , Humanos , Fibromialgia/fisiopatología , Fibromialgia/diagnóstico , Fibromialgia/psicología , Fibromialgia/complicaciones , Proyectos Piloto , Femenino , Electroencefalografía/métodos , Estudios Transversales , Persona de Mediana Edad , Adulto , Dimensión del Dolor/métodos , Masculino , Ansiedad/diagnóstico , Ansiedad/psicología , Depresión/diagnóstico , Depresión/psicología , Dolor/diagnóstico , Dolor/fisiopatología , Dolor/psicologíaRESUMEN
BACKGROUND: Fibromyalgia (FM) is a chronic condition characterized by widespread pain that is associated with sleep, emotional, and cognitive disturbances, including in executive functions (EFs). OBJECTIVE: To investigate the relationship between EFs and functionality in women with FM. METHODS: The study included 17 women with FM, aged between 30 and 59 years, with no history of neurological disease. The EFs were assessed using the Digit Span Subtest (DS), Five Digit Test, Trail Making Test (TMT), Corsi Block-Tapping Task, Hayling Test (HT), and Verbal Fluency Task. Functionality was evaluated through the Fibromyalgia Impact Questionnaire. The Beck Depression Inventory, Hamilton Anxiety Rating Scale, and Brief Pain Inventory were used to measure depression, anxiety, and pain, which were controlled in the statistical analyses. RESULTS: The FM patients showed longer response latency on the HT and TMT. They made fewer errors on part B of the HT, and they performed worse on the DS backward and on the Corsi Block-Tapping Task forward and backward. There were moderate correlations in the expected direction between performance on the Corsi Block-Tapping Task backward and interference at work, as well as between the time to complete part B of the Trail Making Test - B (TMT-B) and fatigue. An unexpected relationship was found between errors on part B of the HT and interference at work. CONCLUSION: The results suggest lower efficiency in processes such as inhibitory control and cognitive flexibility, difficulties in working memory and non-executive processes such as processing speed. Even with pain, anxiety, and depression controlled, some relationships between EFs and functionality were observed, indicating that these symptoms do not fully explain this relationship. We suggest that cognition, particularly EFs, and broader measures of functionality be considered in the evaluation of FM.
ANTECEDENTES: A fibromialgia (FM) é uma condição crônica caracterizada por dor generalizada, associada a distúrbios do sono, emocionais e cognitivos, entre os quais os das funções executivas (FEs). OBJETIVO: Investigar a relação entre FEs e funcionalidade em mulheres com FM. MéTODOS: O estudo incluiu 17 mulheres com FM, com idades entre 30 e 59 anos, sem histórico de doença neurológica. Para a avaliação das FEs, utilizou-se Subteste de Span de Dígitos (SD), o Teste dos Cinco dígitos, o Teste de Trilhas (TT), Tarefa dos Cubos de Corsi, O Teste de Hayling (TH), e a Tarefa de Fluência Verbal. A funcionalidade foi avaliada pelo Questionário de Impacto da Fibromialgia. O Inventário de Depressão de Beck, a Escala de Ansiedade Hamilton e o Inventário Breve de Dor foram usados para mensurar depressão, ansiedade e dor, que foram controladas nas análises estatísticas. RESULTADOS: Pacientes com FM apresentaram maior latência de resposta na TH e no TT. Elas cometeram menos erros na parte B da TH, e tiveram pior desempenho no SD em ordem inversa e na Tarefa dos Cubos de Corsi nas ordens direta e inversa. Houve relações moderadas, na direção esperada, entre a Tarefa dos Cubos de Corsi na ordem inversa e interferência no trabalho, assim como entre tempo até completar a parte B do Teste de Trilhas (TT) e fadiga. Encontrou-se uma relação inesperada entre erros na parte B da TH e interferência no trabalho. CONCLUSãO: Os resultados sugerem menor eficiência em processos como controle inibitório e flexibilidade cognitiva, dificuldades na memória de trabalho e em processos não executivos, como velocidade de processamento. Mesmo com controle da dor, da ansiedade e da depressão, houve algumas relações entre FEs e funcionalidade, o que indica que esses sintomas não explicam completamente essa relação. Sugere-se considerar a cognição, particularmente as FEs, e medidas mais abrangentes de funcionalidade na avaliação da FM.
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Función Ejecutiva , Fibromialgia , Pruebas Neuropsicológicas , Humanos , Fibromialgia/psicología , Fibromialgia/fisiopatología , Femenino , Función Ejecutiva/fisiología , Adulto , Persona de Mediana Edad , Encuestas y Cuestionarios , Dimensión del Dolor , Depresión/fisiopatología , Depresión/psicología , Ansiedad/fisiopatología , Ansiedad/psicología , Escalas de Valoración PsiquiátricaRESUMEN
Chronic fatigue syndrome (CFS), fibromyalgia (FM), silicone breast implants (SBI), Coronavirus-19 infectious disease (COVID), COVID-19 vaccination (post-COVIDvac-syndrome), Long-COVID syndrome (PCS), sick-building syndrome (SBS), post-orthostatic tachycardia syndrome (PoTS), and autoimmune/ inflammatory syndrome induced by adjuvants (ASIA) are a cluster of poorly understood medical conditions that have in common a group of ill-defined symptoms and dysautonomic features. Most of the clinical findings of this group of diseases are unspecific, such as fatigue, diffuse pain, cognitive impairment, paresthesia, tachycardia, anxiety, and depression. Hearing disturbances and vertigo have also been described in this context, the underlying pathophysiologic process for these conditions might rely on autonomic autoimmune dysbalance. The authors procced a literature review regarding to hearing and labyrinthic disturbances in CSF, FM, SBI, COVID, post-COVIDvac-syndrome, PCS, SBS, POTS, and ASIA. The PRISMA guidelines were followed, and the literature reviewed encompassed papers from January 1990 to January 2024. After the initial evaluation of the articles found in the search through Pubmed, Scielo and Embase, a total of 172 articles were read and included in this review. The prevalence of hearing loss, dizziness, vertigo and tinnitus was described and correlated with the diseases investigated in this study. There are great variability in the frequencies of symptoms found, but cochlear complaints are the most frequent in most studies. Vestibular symptoms are less reported. The main pathophysiological mechanisms are discussed. Direct effects of the virus in the inner ear or nervous pathways, impaired vascular perfusion, cross-reaction or autoimmune immunoreactivity, oxidative stress, DNA methylation, epigenetic modifications and gene activation were implicated in the generation of the investigated symptoms. In clinical practice, all patients with these autoimmune conditions who have any audiological complaint an ENT consultation followed by an audiometry are needed.
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COVID-19 , Síndrome de Fatiga Crónica , Fibromialgia , Síndrome de Taquicardia Postural Ortostática , Humanos , Enfermedades Autoinmunes/etiología , COVID-19/complicaciones , COVID-19/prevención & control , Vacunas contra la COVID-19/efectos adversos , Síndrome de Fatiga Crónica/complicaciones , Fibromialgia/complicaciones , Síndrome Post Agudo de COVID-19/complicaciones , Síndrome de Taquicardia Postural Ortostática/complicaciones , SARS-CoV-2RESUMEN
To evaluate the effectiveness of photobiomodulation (PBM) in conjunction with an aerobic exercise program (AEP) on the level of pain and quality of life of women with fibromyalgia (FM). METHODS: A double-blinded randomized controlled trial in which 51 participants with FM were allocated into 4 groups: control group (CG) (n = 12); active PBM group (APG) (n = 12); AEP and placebo PBM group (EPPG) (n = 13); AEP and active PBM group (EAPG) (n = 14). AEP was performed on an ergometric bicycle; and a PBM (with an increase dosage regime) [20 J, 32 J and 40 J] was applied using a cluster device. Both interventions were performed twice a week for 12 weeks. A mixed generalized model analysis was performed, evaluating the time (initial and final) and group (EAPG, EPPG, APG and CG) interaction. All analyses were based on intent-to-treat for a significance level of p ≤ 0.05. RESULTS: The intra-group analysis demonstrated that all treated groups presented a significant improvement in the level of pain and quality of life comparing the initial and final evaluation (p < 0.05). Values for SF-36 and 6-minute walk test increased significant in intragroup analysis for EPPG comparing the initial and final evaluation. No intergroup differences were observed. CONCLUSIONS: Both exercised and PBM irradiated volunteers present improvements in the variables analyzed. However, further studies should be performed, with other PBM parameters to determine the best regime of irradiation to optimize the positive effects of physical exercises in FM patients.
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Ejercicio Físico , Fibromialgia , Terapia por Luz de Baja Intensidad , Calidad de Vida , Humanos , Femenino , Fibromialgia/radioterapia , Fibromialgia/terapia , Fibromialgia/psicología , Fibromialgia/fisiopatología , Terapia por Luz de Baja Intensidad/métodos , Método Doble Ciego , Adulto , Persona de Mediana Edad , Ejercicio Físico/fisiología , Terapia por Ejercicio/métodos , Dimensión del Dolor , Resultado del Tratamiento , Dolor/radioterapia , Dolor/etiologíaAsunto(s)
Fibromialgia , Naltrexona , Antagonistas de Narcóticos , Humanos , Naltrexona/administración & dosificación , Fibromialgia/tratamiento farmacológico , Antagonistas de Narcóticos/administración & dosificación , Femenino , Persona de Mediana Edad , Adulto , Resultado del Tratamiento , Masculino , Relación Dosis-Respuesta a DrogaRESUMEN
OBJECTIVE: Fibromyalgia (FM) subjects are treated with antidepressant agents; in most cases, these drugs lose efficacy or have adverse effects. Ketamine is an anesthetic drug used in FM in some studies. This article aims to systematically review the safety and efficacy of ketamine in fibromyalgia (FM) patients. MATERIALS AND METHODS: We systematically searched articles on FM and ketamine published at Pubmed from 1966 to 2021. This study was registered at PROSPERO. RESULTS: There were only 6 articles published in this field, with a total of 115 patients. The female sex was predominant (88 to 100%). The age varied from 23 to 53 years old. Disease duration ranged from 1 month to 28 years. The dosage of ketamine changed from 0.1 mg/kg-0.3-0.5 mg/kg in intravenous infusion (4/5) and subcutaneous application (1/5). Regarding outcomes, the Visual analog scale (VAS) before ketamine was from 59 to 100 mm and after treatment from 2 to 95 mm. Most short-term studies had a good response. Only the study with 8 weeks of follow-up did not observe a good response. Side effects were common; all appeared during the infusion and disappeared after a few minutes of the ketamine injection. CONCLUSIONS: The present study demonstrates the effectiveness and safety of ketamine in FM patients in the short term. Although, more studies, including long-term follow-up studies, are still needed.
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Fibromialgia , Ketamina , Ketamina/uso terapéutico , Ketamina/administración & dosificación , Ketamina/efectos adversos , Fibromialgia/tratamiento farmacológico , Humanos , Analgésicos/uso terapéutico , Analgésicos/efectos adversos , Analgésicos/administración & dosificación , Femenino , Masculino , Adulto , Persona de Mediana Edad , Antidepresivos/uso terapéutico , Antidepresivos/efectos adversos , Dimensión del Dolor , Infusiones Intravenosas , Resultado del TratamientoRESUMEN
OBJECTIVE: To analyze the social representations of fibromyalgia based on its symptoms and their influences on diagnosis and therapy. METHODS: Qualitative research with the application of the Theory of Social Representations and snowball sampling method. Semi-structured interviews were conducted with 30 adults diagnosed with fibromyalgia in the city of Rio de Janeiro, Brazil, between April 2020 and January 2021. Statistical and lexicographical analysis was performed using Alceste software. RESULTS: Pain, as a subjective phenomenon, complicates its legitimacy, diagnosis, and therapy, enhancing suffering. Insufficient information generates judgments, stereotypes, and prejudices. FINAL CONSIDERATIONS: Stigmas, prejudices, the variety and invisibility of symptoms make it difficult to objectify the disease within the Cartesian-biomedical frameworks, generating diagnostic pilgrimage, mistakes, and challenges in treatment. Such representations hinder relationships and the management of the disease. Deconstructing them is a way to better care for those with fibromyalgia. Raising awareness and spreading qualified information are important allies.
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Fibromialgia , Investigación Cualitativa , Fibromialgia/terapia , Fibromialgia/diagnóstico , Fibromialgia/psicología , Humanos , Femenino , Brasil , Adulto , Masculino , Persona de Mediana Edad , Entrevistas como Asunto/métodosRESUMEN
BACKGROUND AND PURPOSE: Fibromyalgia is a complex clinical disorder with an unknown aetiology, characterized by generalized pain and co-morbid symptoms such as anxiety and depression. An imbalance of oxidants and antioxidants is proposed to play a pivotal role in the pathogenesis of fibromyalgia symptoms. However, the precise mechanisms by which oxidative stress contributes to fibromyalgia-induced pain remain unclear. The transient receptor potential ankyrin 1 (TRPA1) channel, known as both a pain sensor and an oxidative stress sensor, has been implicated in various painful conditions. EXPERIMENTAL APPROACH: The feed-forward mechanism that implicates reactive oxygen species (ROS) driven by TRPA1 was investigated in a reserpine-induced fibromyalgia model in C57BL/6J mice employing pharmacological interventions and genetic approaches. KEY RESULTS: Reserpine-treated mice developed pain-like behaviours (mechanical/cold hypersensitivity) and early anxiety-depressive-like disorders, accompanied by increased levels of oxidative stress markers in the sciatic nerve tissues. These effects were not observed upon pharmacological blockade or global genetic deletion of the TRPA1 channel and macrophage depletion. Furthermore, we demonstrated that selective silencing of TRPA1 in Schwann cells reduced reserpine-induced neuroinflammation (NADPH oxidase 1-dependent ROS generation and macrophage increase in the sciatic nerve) and attenuated fibromyalgia-like behaviours. CONCLUSION AND IMPLICATIONS: Activated Schwann cells expressing TRPA1 promote an intracellular pathway culminating in the release of ROS and recruitment of macrophages in the mouse sciatic nerve. These cellular and molecular events sustain mechanical and cold hypersensitivity in the reserpine-evoked fibromyalgia model. Targeting TRPA1 channels on Schwann cells could offer a novel therapeutic approach for managing fibromyalgia-related behaviours.
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Fibromialgia , Ratones Endogámicos C57BL , Estrés Oxidativo , Especies Reactivas de Oxígeno , Reserpina , Células de Schwann , Canal Catiónico TRPA1 , Animales , Reserpina/farmacología , Fibromialgia/inducido químicamente , Fibromialgia/metabolismo , Canal Catiónico TRPA1/metabolismo , Canal Catiónico TRPA1/antagonistas & inhibidores , Canal Catiónico TRPA1/genética , Estrés Oxidativo/efectos de los fármacos , Células de Schwann/metabolismo , Células de Schwann/efectos de los fármacos , Masculino , Ratones , Especies Reactivas de Oxígeno/metabolismo , Dolor/metabolismo , Dolor/inducido químicamente , Nervio Ciático/metabolismo , Modelos Animales de Enfermedad , Ratones Noqueados , Canales de Potencial de Receptor Transitorio/metabolismo , Canales de Potencial de Receptor Transitorio/antagonistas & inhibidores , Canales de Potencial de Receptor Transitorio/genéticaRESUMEN
Fibromyalgia (FM) is characterized by chronic widespread musculoskeletal pain accompanied by fatigue and muscle atrophy. Although its etiology is not known, studies have shown that FM patients exhibit altered function of the sympathetic nervous system (SNS), which regulates nociception and muscle plasticity. Nevertheless, the precise SNS-mediated mechanisms governing hyperalgesia and skeletal muscle atrophy in FM remain unclear. Thus, we employed two distinct FM-like pain models, involving intramuscular injections of acidic saline (pH 4.0) or carrageenan in prepubertal female rats, and evaluated the catecholamine content, adrenergic signaling and overall muscle proteolysis. Subsequently, we assessed the contribution of the SNS to the development of hyperalgesia and muscle atrophy in acidic saline-injected rats treated with clenbuterol (a selective ß2-adrenergic receptor agonist) and in animals maintained under baseline conditions and subjected to epinephrine depletion through adrenodemedullation (ADM). Seven days after inducing an FM-like model with acidic saline or carrageenan, we observed widespread mechanical hyperalgesia along with loss of strength and/or muscle mass. These changes were associated with reduced catecholamine content, suggesting a common underlying mechanism. Notably, treatment with a ß2-agonist alleviated hyperalgesia and prevented muscle atrophy in acidic saline-induced FM-like pain, while epinephrine depletion induced mechanical hyperalgesia and increased muscle proteolysis in animals under baseline conditions. Together, the results suggest that reduced sympathetic activity is involved in the development of pain and muscle atrophy in the murine model of FM analyzed.
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Clenbuterol , Modelos Animales de Enfermedad , Fibromialgia , Hiperalgesia , Atrofia Muscular , Sistema Nervioso Simpático , Animales , Femenino , Fibromialgia/patología , Fibromialgia/fisiopatología , Atrofia Muscular/patología , Atrofia Muscular/fisiopatología , Hiperalgesia/fisiopatología , Hiperalgesia/patología , Sistema Nervioso Simpático/fisiopatología , Sistema Nervioso Simpático/efectos de los fármacos , Sistema Nervioso Simpático/patología , Clenbuterol/farmacología , Ratas , Carragenina/toxicidad , Ratas Sprague-Dawley , Dolor/patología , Dolor/fisiopatología , Epinefrina , Músculo Esquelético/patología , Músculo Esquelético/efectos de los fármacos , Músculo Esquelético/fisiopatología , Catecolaminas/metabolismo , Agonistas Adrenérgicos beta/farmacologíaRESUMEN
BACKGROUND: The multifaceted nature of Fibromyalgia syndrome (FM) symptoms has been explored through clusters analysis. OBJECTIVE: To synthesize the cluster research on FM (variables, methods, patient subgroups, and evaluation metrics). METHODS: We performed a systematic review following the PRISMA recommendations. Independent searches were performed on PubMed, Embase, Web of Science, and Cochrane Central, employing the terms "fibromyalgia" and "cluster analysis". We included studies dated to January 2024, using the cluster analysis to assess any physical, psychological, clinical, or biomedical variables in FM subjects, and descriptively synthesized the studies in terms of design, cluster method, and resulting patient profiles. RESULTS: We included 39 studies. Most with a cross-sectional design aiming to classify subsets based on the severity, adjustment, symptomatic manifestations, psychological profiles, and response to treatment, based on demographic and clinical variables. Two to four different profiles were found according to the levels of severity and adjustment to FMS. According to symptom manifestation, two to three clusters described the predominance of pain versus fatigue, and thermal pain sensitivity (less versus more sensitive). Other clusters revealed profiles of personality (pathological versus non-pathological) and psychological vulnerability (suicidal ideation). Additionally, studies identified different responses to treatment (pharmacological and multimodal). CONCLUSION: Several profiles exist within FMS population, which point out to the need for specific treatment options given the different profiles and an efficient allocation of healthcare resources. We notice a need towards more objective measures, and the validation of the cluster results. Further research might investigate some of the assumptions of these findings, which are further discussed in this paper.
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Fibromialgia , Fibromialgia/psicología , Fibromialgia/diagnóstico , Humanos , Análisis por Conglomerados , Fatiga/etiología , Índice de Severidad de la Enfermedad , FemeninoRESUMEN
OBJECTIVES: Despite the fact that fibromyalgia, a widespread disease of the musculoskeletal system, has no specific treatment, patients have shown improvement after pharmacological intervention. Pregabalin has demonstrated efficacy; however, its adverse effects may reduce treatment adherence. In this context, neuromodulatory techniques such as transcranial direct current stimulation (tDCS) may be employed as a complementary pain-relieving method. Consequently, the purpose of this study was to evaluate the effect of pregabalin and tDCS treatments on the behavioral and biomarker parameters of rats submitted to a fibromyalgia-like model. METHODS: Forty adult male Wistar rats were divided into two groups: control and reserpine. Five days after the end of the administration of reserpine (1 mg/kg/3 days) to induce a fibromyalgia-like model, rats were randomly assigned to receive either vehicle or pregabalin (30 mg/kg) along with sham or active- tDCS treatments. The evaluated behavioral parameters included mechanical allodynia by von Frey test and anxiety-like behaviors by elevated plus-maze test (time spent in opened and closed arms, number of entries in opened and closed arms, protected head-dipping, unprotected head-dipping [NPHD], grooming, rearing, fecal boluses). The biomarker analysis (brain-derived neurotrophic factor [BDNF] and tumor necrosis factor-α [TNF-α]) was performed in brainstem and cerebral cortex and in serum. RESULTS: tDCS reversed the reduction in the mechanical nociceptive threshold and the decrease in the serum BDNF levels induced by the model of fibromyalgia; however, there was no effect of pregabalin in the mechanical threshold. There were no effects of pregabalin or tDCS found in TNF-α levels. The pain model induced an increase in grooming time and a decrease in NPHD and rearing; while tDCS reversed the increase in grooming, pregabalin reversed the decrease in NPHD. CONCLUSIONS: tDCS was more effective than pregabalin in controlling nociception and anxiety-like behavior in a rat model-like fibromyalgia. Considering the translational aspect, our findings suggest that tDCS could be a potential non-pharmacological treatment for fibromyalgia.
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Fibromialgia , Estimulación Transcraneal de Corriente Directa , Humanos , Adulto , Ratas , Masculino , Animales , Estimulación Transcraneal de Corriente Directa/métodos , Fibromialgia/tratamiento farmacológico , Pregabalina/farmacología , Factor Neurotrófico Derivado del Encéfalo , Ratas Wistar , Factor de Necrosis Tumoral alfa , Nocicepción/fisiología , Reserpina , Dolor , Ansiedad/tratamiento farmacológico , BiomarcadoresRESUMEN
Fibromyalgia (FM) is a painful chronic condition that significantly impacts the quality of life, posing challenges for clinical management. Given the difficulty of understanding the pathophysiology and finding new therapeutics, this study explored the effects of a medicinal plant, E. brasiliensis, in an FM model induced by reserpine in Swiss mice. Animals were treated with saline 0.9% (vehicle), duloxetine 10 mg/kg (positive control), or hydroalcoholic extract of E. brasiliensis leaves 300 mg/kg (HEEb). Nociceptive parameters, as well as locomotion, motor coordination, strength, anxiety, and depressive-like behaviors, were evaluated for 10 days. After that, the brain and blood were collected for further analysis of cytokines (interleukin 1? and interleukin 6), brain-derived neurotrophic factor (BDNF), and the immunocontents of total and phosphorylated Tropomyosin receptor kinase B (TrkB). The results demonstrated that the acute and prolonged treatment with HEEb was able to reduce both mechanical and thermal nociception. It was also possible to observe an increase in the strength, without changing locomotion and motor coordination parameters. Interestingly, treatment with HEEb reduces anxious and depressive-like behaviors. Finally, we observed a reduction in inflammatory cytokines in the hippocampus of animals treated with HEEb, while an increase in BDNF was observed in the prefrontal cortex (PFC). However, no alterations related to total and phosphorylated TrkB receptor expression were found. Our study demonstrated the antinociceptive and emotional effects of HEEb in mice, possibly acting on neuroinflammatory and neurotrophic mechanisms. These data provide initial evidence about the E. brasiliensis potential for treating chronic pain.
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Analgésicos , Antiinflamatorios , Factor Neurotrófico Derivado del Encéfalo , Modelos Animales de Enfermedad , Fibromialgia , Extractos Vegetales , Hojas de la Planta , Reserpina , Animales , Analgésicos/farmacología , Analgésicos/uso terapéutico , Ratones , Extractos Vegetales/farmacología , Extractos Vegetales/uso terapéutico , Hojas de la Planta/química , Fibromialgia/tratamiento farmacológico , Fibromialgia/inducido químicamente , Factor Neurotrófico Derivado del Encéfalo/metabolismo , Antiinflamatorios/farmacología , Antiinflamatorios/uso terapéutico , Masculino , Receptor trkB/metabolismo , Emociones/efectos de los fármacos , Citocinas/metabolismo , Depresión/tratamiento farmacológico , Depresión/inducido químicamente , Ansiedad/tratamiento farmacológico , Ansiedad/inducido químicamente , Conducta Animal/efectos de los fármacosRESUMEN
Fibromyalgia is a potentially disabling idiopathic disease characterized by widespread chronic pain associated with comorbidities such as fatigue, anxiety, and depression. Current therapeutic approaches present adverse effects that limit adherence to therapy. Diosmetin, an aglycone of the flavonoid glycoside diosmin found in citrus fruits and the leaves of Olea europaea L., has antinociceptive, anti-inflammatory, and antioxidant properties. Here, we investigated the effect of diosmetin on nociceptive behaviors and comorbidities in an experimental fibromyalgia model induced by reserpine in mice. To induce the experimental fibromyalgia model, a protocol of subcutaneous injections of reserpine (1 mg/kg) was used once a day for three consecutive days in adult male Swiss mice. Mice received oral diosmetin on the fourth day after the first reserpine injection. Nociceptive (mechanical allodynia, muscle strength, and thermal hyperalgesia) and comorbid (depressive-like and anxiety behavior) parameters were evaluated. Potential adverse effects associated with diosmetin plus reserpine (locomotor alteration, cataleptic behavior, and body weight and temperature changes) were also evaluated. Oral diosmetin (0.015-1.5 mg/kg) reduced the mechanical allodynia, thermal hyperalgesia, and loss of muscle strength induced by reserpine. Diosmetin (0.15 mg/kg) also attenuated depressive-like and anxiety behaviors without causing locomotor alteration, cataleptic behavior, and alteration in weight and body temperature of mice. Overall, diosmetin can be an effective and safe therapeutic alternative to treat fibromyalgia symptoms, such as pain, depression and anxiety.
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Modelos Animales de Enfermedad , Fibromialgia , Flavonoides , Hiperalgesia , Reserpina , Animales , Reserpina/farmacología , Fibromialgia/tratamiento farmacológico , Fibromialgia/inducido químicamente , Ratones , Masculino , Flavonoides/farmacología , Hiperalgesia/tratamiento farmacológico , Analgésicos/farmacología , Ansiedad/tratamiento farmacológico , Depresión/tratamiento farmacológico , Depresión/inducido químicamente , Conducta Animal/efectos de los fármacosRESUMEN
Although it is well established that fibromyalgia (FM) syndrome is characterized by chronic diffuse musculoskeletal hyperalgesia, very little is known about the effect of this pathology on muscle tissue plasticity. Therefore, the present study aimed to characterize the putative alterations in skeletal muscle mass in female rats subjected to a FM model by inducing chronic diffuse hyperalgesia (CDH) through double injections of acidic saline (pH 4.0) into the left gastrocnemius muscle at 5-day intervals. To determine protein turnover, the total proteolysis, proteolytic system activities and protein synthesis were evaluated in oxidative soleus muscles of pH 7.2 (control) and pH 4.0 groups at 7 days after CDH induction. All animals underwent behavioural analyses of mechanical hyperalgesia, strength and motor performance. Our results demonstrated that, in addition to hyperalgesia, rats injected with acidic saline exhibited skeletal muscle loss, as evidenced by a decrease in the soleus fibre cross-sectional area. This muscle loss was associated with increased proteasomal proteolysis and expression of the atrophy-related gene (muscle RING-finger protein-1), as well as reduced protein synthesis and decreased protein kinase B/S6 pathway activity. Although the plasma corticosterone concentration did not differ between the control and pH 4.0 groups, the removal of the adrenal glands attenuated hyperalgesia, but it did not prevent the increase in muscle protein loss in acidic saline-injected animals. The data suggests that the stress-related hypothalamic-pituitary-adrenal axis is involved in the development of hyperalgesia, but is not responsible for muscle atrophy observed in the FM model induced by intramuscular administration of acidic saline. Although the mechanisms involved in the attenuation of hyperalgesia in rats injected with acidic saline and subjected to adrenalectomy still need to be elucidated, the results found in this study suggest that glucocorticoids may not represent an effective therapeutic approach to alleviate FM symptoms.
Asunto(s)
Fibromialgia , Hiperalgesia , Ratas , Femenino , Animales , Hiperalgesia/tratamiento farmacológico , Fibromialgia/complicaciones , Fibromialgia/tratamiento farmacológico , Fibromialgia/patología , Adrenalectomía , Sistema Hipotálamo-Hipofisario/metabolismo , Sistema Hipotálamo-Hipofisario/patología , Sistema Hipófiso-Suprarrenal/metabolismo , Sistema Hipófiso-Suprarrenal/patología , Músculo Esquelético/metabolismo , Atrofia Muscular/patología , Solución Salina/farmacologíaRESUMEN
BACKGROUND: Multiple-session home-based self-applied transcranial direct current stimulation (M-HB-self-applied-tDCS) has previously been found to effectively reduce chronic pain and enhance cognitive function. However, the effectiveness of this method for disordered eating behavior still needs to be studied. OBJECTIVE: This study aimed to assess whether 20 sessions of M-HB-self-applied-tDCS, administered over four weeks to either the left dorsolateral prefrontal cortex (L-DLPFC) or primary motor cortex (M1), could improve various aspects of eating behavior, anthropometric measures, and adherence. METHODS: We randomly assigned 102 fibromyalgia patients between the ages of 30 and 65 to one of four tDCS groups: L-DLPFC (anodal-(a)-tDCS, n = 34; sham-(s)-tDCS, n = 17) or M1 (a-tDCS, n = 34; s-tDCS, n = 17). Patients self-administered 20-min tDCS sessions daily with 2 mA under remote supervision following in-person training. RESULTS: Generalized linear models revealed significant effects of M-HB-self-applied-tDCS compared to s-tDCS on uncontrolled eating (UE) (Wald χ2 = 5.62; df = 1; P = 0.018; effect size, ES = 0.55), and food craving (Wald χ2 = 5.62; df = 1; P = 0.018; ES = 0.57). Regarding fibromyalgia symptoms, we found a differentiated impact of a-tDCS on M1 compared to DLPFC in reducing food cravings. Additionally, M-HB-a-tDCS significantly reduced emotional eating and waist size. In contrast, M1 stimulation was more effective in improving fibromyalgia symptoms. The global adherence rate was high, at 88.94%. CONCLUSION: These findings demonstrate that M-HB-self-applied-tDCS is a suitable approach for reducing uncontrolled and emotional eating, with greater efficacy in L-DLPFC. Furthermore, these results revealed the influence of fibromyalgia symptoms on M-HB-self-applied-tDCS's, with M1 being particularly effective in mitigating food cravings and reducing fibromyalgia symptoms.