Aim
The aim of this study was to investigate the effectiveness of pain neuroscience education (PNE) in addition to usual treatment in patients with fibromyalgia syndrome.
Methods
Forty patients were ...randomized into 2 groups. The experimental group underwent PNE sessions over 6 weeks in addition to pharmacological treatment, and the control group was given only pharmacological treatment. The primary outcome measure was functional status and the secondary outcome measures were widespread pain pressure threshold and kinesiophobia level. All assessments were conducted before the intervention and at the end of the 6th and 12th weeks by the same blinded researcher.
Results
The intervention group had significantly greater improvement than the control group in terms of the mean total scores in the Fibromyalgia Impact Questionnaire (P = .001) and the Tampa Scale of Kinesiophobia (P = .001) with large effect sizes. The intervention group also had significantly greater improvement in the pain pressure threshold values of the cervical (P = .040), thoracic (P = .001), lumbar (P < .001), elbow (P = .005) and calf (P = .006) regions with moderate‐to‐large effect sizes.
Conclusion
This study showed that the addition of 6‐week PNE sessions to pharmacological treatment was successful in improving functional status, widespread pain pressure threshold, and level of kinesiophobia in patients with fibromyalgia syndrome during a 12‐week follow‐up period.
This study was a prospective, randomized, controlled study.
To compare the effectiveness of aquatic exercise interventions with land-based exercises in the treatment of chronic low back pain (CLBP).
...Land-based exercise and physiotherapy are the main treatment tools used for CLBP. Clinical experience indicates that aquatic exercise may have advantages for patients with musculoskeletal disorders.
A total of 65 patients with CLBP were included in this study. Patients were randomly assigned to receive aquatic exercise or land-based exercise treatment protocol. Aquatic exercise program consisted of 20 sessions, 5 x per week for 4 weeks in a swimming pool at 33 degrees C. Land-based exercise (home-based exercise) program were demonstrated by a physiotherapist on one occasion and then they were given written advice The patients were assessed for spinal mobility, pain, disability, and quality of life. Evaluations were performed before treatment (week 0) and after treatment (week 4 and week 12).
In both groups, statistically significant improvements were detected in all outcome measures (except modified Schober test) compared with baseline. However, improvement in modified Oswestry Low Back Pain Disability questionnaire and physical function and role limitations due to physical functioning subpart of Short-Form 36 Health Survey were better in aquatic exercise group (P < 0.05).
It is concluded that a water-based exercises produced better improvement in disability and quality of life of the patients with CLBP than land-based exercise.
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.
Objective. To assess the prevalence of obstructive sleep apnoea syndrome (OSAS) in AS patients. Methods. Thirty-one patients with AS were included in the study. The demographic data, spinal mobility ...measures and Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) scores were recorded for each patient. All participants underwent one night of sleep recording, which was performed using a polysomnography (PSG). Pulmonary function test (PFT) was performed for all subjects and symptoms of OSAS were questioned. Results. Seven (22.6%) of 31 AS patients had OSAS according to PSG assessments. The mean BMI, disease duration, BASDAI score, neck circumference and occiput–wall distance were higher in patients with OSAS, but the differences were not significant. The mean ages of patients with OSAS were significantly higher than the patients without OSAS. The prevalence of OSAS in patients under the age of 35 years was found to be 6.3%, whereas the prevalence of OSAS in patients at the age of 35 years or over was 40.0% (P = 0.037). The prevalence of OSAS in AS patients with a disease duration <5 years was 11.8% and its prevalence in AS patients with a disease duration of ⩾5 years was 35.7% (P = 0.198). PFT was restrictive in 16 (53.3%) patients and obstructive in none. Conclusions. The prevalence of OSAS in AS patients is higher than reported in the general population. The diagnosis of OSAS should be kept in mind and OSAS symptoms should be considered especially in AS patients at the age of ⩾35 years and in AS patients with a disease duration of ⩾5 years.
This prospective, randomized, placebo-controlled trial aimed to investigate the efficacy of laser therapy in the treatment of carpal tunnel syndrome (CTS).
Low-level laser therapy (LLLT) has been ...found to have positive effects in the treatment of CTS and various musculoskeletal conditions.
A total of 81 patients were included in this study. Diagnosis of CTS was based on both clinical examination and electromyographic (EMG) study. Patients were randomly assigned into two groups. Group 1 (n = 41) underwent laser therapy (7 joules/2 min) over the carpal tunnel area. Group 2 (n = 40) received placebo laser therapy. All patients received therapy five times per week, for a total of 10 sessions. Patients also used a wrist splint each night. Patients were assessed according to pain, hand-pinch grip strength, and functional capacity. Pain was evaluated by Visual Analog Scale (VAS; day-night). Hand grip was measured by Jamar dynometer, and pinch grip was measured by pinchmeter. Functional capacity was assessed by a self-administered questionnaire for severity of symptoms.
The mean age of the patients (70 women, 11 Men) was 49.3 +/- 11.0 (range, 26-78). After therapy there were statistically significant improvements in VAS, pinch grip, and functional capacity measurement in both groups (p < 0.001). Hand grip was found to have been improved in the laser group. In EMG, there were statistically improvements in sensory nerve velocity, and sensory and motor distal latancies in the laser group (p < 0.001). Only sensory nerve velocity was meaningful in the placebo group.
In using LLLT, (1) there was no difference relative to pain relief and functional capacity during the follow-up in CTS patients; (2) there were positive effects on hand and pinch grip strengths.
There is much evidence suggesting that the decline in ovarian function after menopause is associated with spontaneous increases in proinflammatory cytokines. Treatment with risedronate is accompanied ...by significant changes in bone turnover and bone mineral density. The objective of this study was to determine the effects of risedronate treatment on the level of serum cytokines including receptor activator of nuclear factor-κB ligand (RANKL) and osteoprotegerin among postmenopausal women with osteoporosis. The study group consisted of 61 postmenopausal women with osteoporosis. Patients were randomly divided in two groups: In group 1 (n = 41) postmenopausal women received oral risedronate (35 mg/week), calcium (1,000 mg/day), and vitamin D (400 IU/day) for 12 months. In group 2 (control group; n = 20) patients received only oral calcium (1,000 mg/day) and vitamin D (400 IU/day). Bone mineral density (BMD) of lumbar spine (L1-L4) and proximal femur were determined using dual X-ray absorptiometry at baseline and after one year. Venous blood samples were obtained for determination of serum cytokines including interleukin-1β (IL-1β), tumor necrosis factor-α (TNF-α), RANKL, osteoprotegerin, and markers of bone formation and resorption. Levels of serum cytokines were measured before therapy and after three and 6 months. Markers of bone metabolism were studied before therapy and after 6 months. In group 1 (risedronate plus calcium/vitamin D-treated patients), serum levels of RANKL and IL-1β significantly decreased and the level of osteoprotegerin significantly increased after three and 6 months, but no significant difference was found in TNF-α level. In group 2, however, the level of serum cytokines did not change after three and 6 months. In cases of bone turnover, both markers of bone resorption and formation significantly decreased after 6 months in group 1. In conclusion risedronate could improve osteoporosis by increasing osteoprotegerin and reducing RANKL and IL-1β.
Familial Mediterranean fever (FMF) has episodic or subclinical inflammation that may lead to a decrease in bone mineral density (BMD). The aim of this study was to evaluate the effect of FMF on bone ...metabolism and to investigate the factors that can influence bone metabolism, such as body mass index (BMI), mutations in Mediterranean fever (MEFV) gene, osteoprotegerin (OPG), leptin and inflammatory cytokines, including interleukin (IL)-1β, IL-6 and tumor necrosis factor-alpha (TNF-α). OPG, a soluble protein produced by osteoblasts, favors increased bone mass. Leptin may influence bone metabolism by acting on differentiated osteoblasts, having anabolic effects on bone. Thirty-one FMF patients in attack-free period (12 females and 19 males; mean age 31.4 ± 9.3 years) and 18 healthy controls (11 females and 7 males; mean age 34.6 ± 9.5 years) were compared according to the above parameters. BMD (g/cm2) and standard deviation scores (Z-score) were measured at the lumbar spine L1-L4 (BMD-L1-4) and proximal femur by dual X-ray absorptiometry. Osteopenia is defined as a Z-score between −1 and −2.5 and osteoporosis is equal or below −2.5. FMF patients showed statistically significant reduction in BMD-L1-4 and Z-score-L1-4. Moreover, serum OPG concentration was significantly elevated in FMF patiens. In contrast, MEFV gene mutations, leptin and the inflammatory cytokines did not differ between the patient and control groups. In conclusion, BMD was decreased and OPG was increased in our FMF patients. The high OPG levels may reflect a preventive mechanism against bone loss; namely, OPG might protect the FMF patients from excessive osteoporosis.
Osteoporosis is a common complication of chronic liver diseases. However, there is limited information about autoimmune liver diseases as a factor of secondary osteoporosis. Therefore, we aimed to ...investigate the autoantibodies of autoimmune liver diseases in patients with osteoporosis.
One hundred fifty female patients with postmenopausal osteoporosis were included. Bone mineral density was measured by dual energy X-ray absorptiometry. We analysized autoantibodies including antinuclear antibodies, liver membrane antibodies, anti-liver/kidney microsomal autoantibodies1, liver-specific protein, anti-smooth muscle antibodies, and anti-mitochondrial antibodies by indirect immunofluorescence. Serum was assayed for the levels of aminotransferases.
The mean age of the patients was 63,13±8,6 years. The mean values of L1-L4 T-scores and femur total T-scores were -3,08±0,58 and -1,53±0,81, respectively. Among the 150 patients with osteoporosis, 14 (9.3%) were antinuclear antibodies, four (2.7%) were liver membrane antibodies, three (2.0%) were anti-liver/kidney microsomal autoantibodies1, and two (1.3%) were liver-specific protein positive. None of the patients had anti-mitochondrial antibodies or smooth muscle antibodies positivity. The mean values of levels of aminotransferases were within normal range.
The presence of liver membrane antibodies, liver-specific protein, and anti-liver/kidney microsomal autoantibodies1 has permitted us to see that there may be some suspicious clues of autoimmune liver diseases in patients with osteoporosis as a secondary risk factor. On the other hand, there is a need for comprehensive studies with a larger sample size and studies designed to compare the results with a normal population to understand the clinical importance of our findings.
Objective: Rheumatoid Arthritis (RA) is a chronic destructive inflammatory disorder. This study is aimed to investigate the effects of balneotherapy and aquatherapy in the treatment of RA patients. ...Materials and Methods: A total of 59 patients who fulfilled the American College of Rheumatology diagnostic criteria for RA were included this study. Patients were randomly assigned into three groups. Group 1 (n=20) received balneotherapy, group 2 (n=20) received an aquatic exercise program and group 3 (n=19) was accepted as control group. These programs were applied five times a week, over three weeks (15 sessions). Patients were evaluated for clinical and laboratory parameters. Clinical parameters included pain,duration of morning stiffness, number of swollen and tender joints, disease activity score (DAS28), Modified health assessment questionnaire (mHAQ), physician’s and patient’s global assessment and hand grip strength. Laboratory evaluation included erythrocyte sedimentation rate(ESR) and C-reactive protein (CRP). The assessment parameters were measured before, at the end of and after 3 months of the therapy. Results: The mean age of the patients was 54±10.7 (25-75) years and the mean disease duration was 122.3±98.1 (1-424) months. In aquatic exercise group we observed an improvement in DAS28 scores (p<0.001), in the number of tender joints (p<0.005), in VAS scores (p<0.005), mHAQ (p<0.05), physician’s and patient’s global assessments (p<0.05). Also there was a statistically significant decrease in ESR results in aquatherapy group compared to other groups (p<0.05). However no statistically significant difference was obtained between three groups (p>0.05). Conclusion: This study shows that aquatic exercise program is beneficial in the management of DAS28, pain, HAQ parameters and should be taken in to consideration in planning exercise therapy for RA patients. (Turkish Journal of Osteoporosis 2014;20: 10-5)
Objective: Osteoporosis a progressive bone disease that is characterized by a decrease in bone mass which can lead to an increased risk of fracture. Osteoporosis is still a global public health ...problem. In recent years, many new osteoporosis drugs have become available but none of them is totally curative. The aim of the present study was to evaluate and compare the effects of risedronate and raloxifene on bone mineral density (BMD) and bone turnover markers. Materials and Methods: A total of ninety patients with postmenopausal osteoporosis were randomly divided into three groups receiving calcium-vitamin D plus raloxifene, calcium-vitamin D plus risedronate, and only calcium-vitamin D (control group). Serum osteocalcin and collagen type 1 cross-linked C-telopeptide (CTX) were measured before treatment and after 3, 6, 9 and 12 months of treatment. BMD was measured by Dual-Energy X-Ray absorptiometry (DEXA) before treatment and after 12 months of treatment. Results: Serum CTX levels were decreased significantly (p<0.001) in all groups from baseline to post therapy of 3 months and this decrease continued to the end of the study. Serum osteocalcin levels were decreased significantly (p<0.001) in treatment groups compared to control group. L1-L4 and femur total BMD was statistically lower in treatment groups compared to control group after 12 months of the therapy (p<0.001 and p<0.05, respectively). Conclusion: The results of the present study showed us that risedronate and raloxifene were both effective on bone mineral density and the effect of both of them to do not differ not from each other in the treatment of osteoporosis. (Turkish Journal of Osteoporosis 2014;20: 110-6)
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