Fibromyalgia and Depression Gracely, Richard H.; Ceko, Marta; Bushnell, M. Catherine
Pain Research and Treatment,
01/2012, Letnik:
2012
Journal Article
Recenzirano
Odprti dostop
Fibromyalgia and depression might represent two manifestations of affective spectrum disorder. They share similar pathophysiology and are largely targeted by the same drugs with dual action on ...serotoninergic and noradrenergic systems. Here, we review evidence for genetic and environmental factors that predispose, precipitate, and perpetuate fibromyalgia and depression and include laboratory findings on the role of depression in fibromyalgia. Further, we comment on several aspects of fibromyalgia which support the development of reactive depression, substantially more so than in other chronic pain syndromes. However, while sharing many features with depression, fibromyalgia is associated with somatic comorbidities and absolutely defined by fluctuating spontaneous widespread pain. Fibromyalgia may, therefore, be more appropriately grouped together with other functional pain disorders, while psychologically distressed subgroups grouped additionally or solely with affective spectrum disorders.
Objective
To determine the incidence and worsening of lumbar spine structure and low back pain (LBP) and whether they are predicted by demographic characteristics or clinical characteristics or ...appendicular joint osteoarthritis (OA).
Methods
Paired baseline (2003–2004) and follow‐up (2006–2010) lumbar spine radiographs from the Johnston County Osteoarthritis Project were graded for osteophytes (OST), disc space narrowing (DSN), spondylolisthesis, and presence of facet joint OA (FOA). Spine OA was defined as at least mild OST and mild DSN at the same level for any level of the lumbar spine. LBP, comorbidities, and back injury were self‐reported. Weibull models were used to estimate hazard ratios (HRs) and 95% confidence intervals (95% CIs) of spine phenotypes accounting for potential predictors including demographic characteristics, clinical characteristics, comorbidities, obesity, and appendicular OA.
Results
Obesity was a consistent and strong predictor of incidence of DSN (HR 1.80 95% CI 1.09–2.98), spine OA (HR 1.56 95% CI 1.01–2.41), FOA (HR 4.99 95% CI 1.46–17.10), spondylolisthesis (HR 1.87 95% CI 1.02–3.43), and LBP (HR 1.75 95% CI 1.19–2.56), and worsening of DSN (HR 1.51 95% CI 1.09–2.09) and LBP (HR 1.51 95% CI 1.12–2.06). Knee OA was a predictor of incident FOA (HR 4.18 95% CI 1.44–12.2). Spine OA (HR 1.80 95% CI 1.24–2.63) and OST (HR 1.85 95% CI 1.02–3.36) were predictors of incidence of LBP. Hip OA (HR 1.39 95% CI 1.04–1.85) and OST (HR 1.58 95% CI 1.00–2.49) were predictors of LBP worsening.
Conclusion
Among the multiple predictors of spine phenotypes, obesity was a common predictor for both incidence and worsening of lumbar spine degeneration and LBP.
Neuroimaging of fibromyalgia Gracely, Richard H; Ambrose, Kirsten R
Best practice & research. Clinical rheumatology,
04/2011, Letnik:
25, Številka:
2
Journal Article
Recenzirano
The primary symptom of fibromyalgia is widespread pain. This symptom is accompanied by secondary symptoms, such as cognitive difficulties and sensitivity to painful stimulation, and by numerous ...co-morbidities. The first neuroimaging studies addressed the primary symptom by examining differences between patients and controls using single-photon-emission-computed tomography (SPECT). Subsequent studies focussed on the secondary symptom of increased sensitivity to painful stimulation. Functional MRI (fMRI) studies using the blood-oxygen-level-dependent (BOLD) method to assess brain activation demonstrated augmented sensitivity to painful pressure and the association of this augmentation with variables such as depression and catastrophising. These studies have also assessed brain processes associated with cognitive dysfunction. Neuroimaging studies of fibromyalgia have now come full circle, using new techniques to provide information about differences that may relate to underlying mechanisms and the primary symptom of widespread pain. Using a wide array of techniques, these studies have found differences in opioid receptor binding, concentration of metabolites associated with neural processing in pain-related regions and differences in functional brain networks and in regional brain volume and in white-matter tracks. This array of neuroimaging techniques continues to provide increasing information about supraspinal mechanisms associated with fibromyalgia that will aid in diagnosis, including identification of diagnostic subgroups, the development of new efficacious treatments that address both causes and symptoms and the matching of patients to treatments.
The study presents a novel approach of programing pain inhibition in chronic pain patients based on the hypothesis that pain perception is modulated by dysfunctional dorsal medial nucleus tractus ...solitarii (dmNTS) reflex arcs that produce diminished baroreflex sensitivity (BRS) resulting from a conditioned response. This study tested whether administration of noxious and non-noxious electrical stimuli synchronized with the cardiac cycle resets BRS, reestablishing pain inhibition. A total of 30 pain-free normotensives controls (NC) and 32 normotensives fibromyalgia (FM) patients received two, ≈8 min-epochs of cardiac-gated, peripheral electrical stimuli. Non-painful and painful electrical stimuli were synchronized to the cardiac cycle as the neuromodulation experimental protocol (EP) with two control conditions (CC1, CC2). BRS, heart-rate-variability (HRV), pain threshold and tolerance, and clinical pain intensity were assessed. Reduced BRS in FM at baseline increased by 41% during two, ≈8 min-epochs of stimulation. Thresholds in FM increased significantly during the experimental protocol (all Ps < 0.001) as did HRV. FM levels of clinical pain significantly decreased by 35.52% during the experimental protocol but not during control stimulations (p < 0.001). Baroreceptor training may reduce FM pain by BRS-mediated effects on intrinsic pain regulatory systems and autonomic responses.
More than two-thirds of patients with burning mouth syndrome (BMS) have altered taste sensation. The authors conducted a study to assess chorda tympani and trigeminal nerve function in these ...patients.
The study was composed of 48 patients; 22 were diagnosed as having BMS, 14 had burning symptoms related to other diseases and were diagnosed as having secondary burning mouth syndrome (SBMS), and 12 were healthy volunteers. The authors evaluated the electrical detection thresholds of the infraorbital and mental nerves and the electrical taste and electrical detection/tingling thresholds in the anterior two-thirds of the tongue for all patients. Electrical taste threshold is thought to be dictated by chorda tympani nerve function while electrical detection/tingling thresholds are regulated by trigeminal nerve function.
The mean electrical taste/tingling detection thresholds ratio and the taste detection thresholds were significantly higher in patients with BMS than in patients with SBMS and in control subjects, indicating chorda tympani nerve dysfunction. Eighteen (82 percent) of the 22 patients with BMS demonstrated chorda tympani dysfunction (13 unilateral and five bilateral).
Chorda tympani hypofunction may play an important role in BMS pathology. Unilateral hypofunction may be sufficient to produce generalized burning sensation exceeding the affected nerve area.
Elevated taste detection threshold levels determined via electrogustatory testing and an elevated taste/tingling detection thresholds ratio may assist clinicians in the diagnosis of BMS. More studies are needed to validate these findings.
This cross-sectional study compares prescribing patterns of opioid and nonopioid analgesics and patients’ dental pain outcomes before vs after implementation of an opioid reduction initiative at a ...single dental clinic.
To examine the relationship between current pain, distress, and ascending and random measures of tenderness.
Manual tender point counts and dolorimeter measures of the pressure pain threshold were ...determined in a sample of 47 women representative of the general population with respect to tenderness. In addition, discrete pressure stimuli of varying intensities to the left thumb were applied in random fashion. Distress was measured with the Brief Symptom Inventory and the Beck Depression Inventory, and pain was evaluated with the Short Form McGill Pain Questionnaire.
Only the random measure of tenderness was relatively independent of an individual's current psychological state. The respective correlation coefficients between measures of tenderness and psychological state were generally greatest for the manual tender point count and also significant for the dolorimeter measures. In contrast, all measures were highly correlated with ratings of spontaneous pain, again with the manual tender point count showing the strongest, and the random method the weakest, correlations. Linear regression analysis replicated the results of the correlational analysis.
As a measure of tenderness, the number of positive tender points is clearly influenced by an individual's distress. Other more sophisticated measures of tenderness that randomly present stimuli in an unpredictable fashion appear to be relatively immune to these biasing effects, although our results obtained in a research setting have yet to be replicated in clinical practice.
To assess both regional (vulvar) and overall (generalized) pain sensitivity in women with vulvodynia to determine whether both are increased, suggestive of altered central pain processing.
Seventeen ...patients (aged 18-60 years) with vulvodynia and 23 age-matched control subjects were included in this cross-sectional study. Pressure pain thresholds in the vulvar area were evaluated in 23 defined locations using a newly developed vulvodolorimeter. Peripheral pressure pain sensitivity was assessed by applying 1) continuously ascending pressures to 3 bilateral locations (thumb, deltoid, and shin), and 2) discrete pressure stimuli to the thumb using both an ascending and random sequence of varying pressures.
Pain thresholds at all vulvar locations were lower in the women with vulvodynia than in pain-free control subjects. Similarly, peripheral pain thresholds were lower at the thumb in women with vulvodynia when obtained by discrete ascending or random staircase paradigms, as well as at the thumb, deltoid, and shin when tested by dolorimeter (P <.05). Findings were similar in both those with generalized vulvar dysesthesia and those with localized vestibulodynia. The quantitative results obtained with the vulvodolorimeter and with the more subjective cotton-tipped swab testing routinely used in diagnosis were strongly correlated.
Women with vulvodynia displayed significantly increased pressure pain sensitivity in both the vulvar region and in peripheral body regions, suggesting a "central" component to the mechanisms mediating this disorder. Both the novel vulvodolorimeter and the thumb pressure stimulator may assist in future experimental tests of this and related hypotheses.
Fibromyalgia (FM) is characterized by widespread tenderness. Studies have also reported that persons with FM are sensitive to other stimuli, such as auditory tones. We hypothesized that subjects with ...FM would display greater sensitivity to both pressure and auditory tones and report greater sensitivity to sounds encountered in daily activities. FM subjects (n = 30) and healthy control subjects (n = 28) were administered auditory tones and pressure using the same psychophysical methods to deliver the stimuli and a common way of scaling responses. Subjects were also administered a self-report questionnaire regarding sensitivity to everyday sounds. Participants with FM displayed significantly greater sensitivity to all levels of auditory stimulation (Ps < .05). The magnitude of difference between FM patients' lowered auditory sensitivity (relative to control subjects) was similar to that seen with pressure, and pressure and auditory ratings were significantly correlated in both control subjects and subjects with FM. FM patients also were more sensitive to everyday sounds (t = 8.65, P < .001). These findings support that FM is associated with a global central nervous system augmentation in sensory processing. Further research is needed to examine the neural substrates associated with this abnormality and its role in the etiology and maintenance of FM.
Muscle tenderness is the hallmark of FM, but the findings of this study and others suggest that persons with FM display sensitivity to a number of sensory stimuli. These findings suggest that FM is associated with a global central nervous system augmentation of sensory information. These findings may also help to explain why persons with FM display a number of comorbid physical symptoms other than pain.
Exposure to acute 'stressors' (e.g. infections, pain, trauma) often results in altered sleep habits and reductions in routine activity. In some individuals, these behavioural responses to acute ...stressors may contribute to the development of chronic somatic symptoms such as widespread pain, fatigue, memory difficulties and mood disturbances, much like those associated with 'functional somatic syndromes' (FSS) such as fibromyalgia or chronic fatigue syndrome.
Eighty-seven healthy young adults who reported sleeping between 7 and 9 hours nightly and exercising regularly were randomised to one of four groups: exercise cessation, sleep restriction (6 hours nightly), both, or neither. Symptoms of pain, fatigue, cognitive dysfunction and negative mood were measured before and after the 10-day restriction period.
Sleep restriction was a potent contributor to the development of somatic symptoms. Exercise cessation was less influential leading only to fatigue. There were no significant interactions between exercise cessation and sleep restriction, except that males were much more likely to develop somatic symptoms when deprived of both sleep and exercise than one or the other. Women were generally much more likely to develop somatic symptoms than men.
This study supports previous research suggesting that both sleep and exercise are critical in 'preventing' somatic symptoms among some individuals. Furthermore, to our knowledge, this is the first time there is data to suggest that women are much more sensitive to decrements in routine sleep and exercise than are men.
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