RESUMO
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.
Assuntos
Exercício Físico , Fibromialgia , Terapia com Luz de Baixa Intensidade , Qualidade de Vida , Humanos , Feminino , Fibromialgia/radioterapia , Fibromialgia/terapia , Fibromialgia/psicologia , Fibromialgia/fisiopatologia , Terapia com Luz de Baixa Intensidade/métodos , Método Duplo-Cego , Adulto , Pessoa de Meia-Idade , Exercício Físico/fisiologia , Terapia por Exercício/métodos , Medição da Dor , Resultado do Tratamento , Dor/radioterapia , Dor/etiologiaRESUMO
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.
Assuntos
Clembuterol , Modelos Animais de Doenças , Fibromialgia , Hiperalgesia , Atrofia Muscular , Sistema Nervoso Simpático , Animais , Feminino , Fibromialgia/patologia , Fibromialgia/fisiopatologia , Atrofia Muscular/patologia , Atrofia Muscular/fisiopatologia , Hiperalgesia/fisiopatologia , Hiperalgesia/patologia , Sistema Nervoso Simpático/fisiopatologia , Sistema Nervoso Simpático/efeitos dos fármacos , Sistema Nervoso Simpático/patologia , Clembuterol/farmacologia , Ratos , Carragenina/toxicidade , Ratos Sprague-Dawley , Dor/patologia , Dor/fisiopatologia , Epinefrina , Músculo Esquelético/patologia , Músculo Esquelético/efeitos dos fármacos , Músculo Esquelético/fisiopatologia , Catecolaminas/metabolismo , Agonistas Adrenérgicos beta/farmacologiaRESUMO
Spectral power density (SPD) indexed by electroencephalogram (EEG) recordings has recently gained attention in elucidating neural mechanisms of chronic pain syndromes and medication use. We compared SPD variations between 15 fibromyalgia (FM) women in use of opioid in the last three months (73.33% used tramadol) with 32 non-users. EEG data were obtained with Eyes Open (EO) and Eyes Closed (EC) resting state. SPD peak amplitudes between EO-EC were smaller in opioid users in central theta, central beta, and parietal beta, and at parietal delta. However, these variations were positive for opioid users. Multivariate analyses of variance (ANOVAs) revealed that EO-EC variations in parietal delta were negatively correlated with the disability due to pain, and central and parietal beta activity variations were positively correlated with worse sleep quality. These clinical variables explained from 12.5 to 17.2% of SPD variance. In addition, central beta showed 67% sensitivity / 72% specificity and parietal beta showed 73% sensitivity/62% specificity in discriminating opioid users from non-users. These findings suggest oscillations in EEG might be a sensitive surrogate marker to screen FM opioid users and a promising tool to understand the effects of opioid use and how these effects relate to functional and sleep-related symptoms.
Assuntos
Analgésicos Opioides/uso terapêutico , Mapeamento Encefálico , Ondas Encefálicas/efeitos dos fármacos , Encéfalo/efeitos dos fármacos , Eletroencefalografia , Fibromialgia/tratamento farmacológico , Descanso , Adulto , Encéfalo/fisiopatologia , Estudos Transversais , Feminino , Fibromialgia/diagnóstico , Fibromialgia/fisiopatologia , Humanos , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Processamento de Sinais Assistido por Computador , Fatores de TempoRESUMO
BACKGROUND: Fibromyalgia syndrome (FMS) is both a challenging and disabling condition. The International Association for the Study of Pain (IASP) classifies FMS as chronic primary pain, and it can negatively impact individuals' functioning including social, psychological, physical and work-related factors. Notably, while guidelines recommend a biopsychosocial approach for managing chronic pain conditions, FMS assessment remains clinical. The WHODAS 2.0 is a unified scale to measure disability in the light of the International Classification of Functioning, Disability and Health. Thus, this study aimed to evaluate the reliability and validity of the Brazilian version of WHODAS 2.0 for use in individuals with FMS. METHODS: Methodological study of the validity and reliability of the Brazilian version of the 36-item WHODAS 2.0 with 110 individuals with FMS. The instrument gives a score from 0 to 100, the higher the value, the worse the level of functioning. We assessed participants with Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) (0-100), Fibromyalgia Impact Questionnaire (FIQ) (0-10) and Beck Depression Inventory instrument (BDI) (0-63). The construct validity, internal consistency, and test-retest stability. We used SF-36, FIQ and BDI to study construct validity analysis. For statistical analysis, we performed the intraclass correlation (ICC), Spearman correlation, and Cronbach's alpha, with a statistical level of 5%. RESULTS: Most participants were female (92.27%), aged 45 (± 15) years. The test-retest reliability analysis (n = 50) showed stability of the instrument (ICC = 0.54; ρ = 0.84, p < 0.05). The test-retest correlation between the domains was moderate to strong (ρ > 0.58 and < 0.90). Internal consistency was satisfactory for total WHODAS 2.0 (0.91) and also for domains, ranging from 0.44 to 0.81. The construct validity showed satisfactory values with all moderately correlated with WHODAS 2.0 instruments (> 0.46 and < 0.64; p < 0.05). WHODAS 2.0 evaluates the functioning encompassing components of health-related quality of life, functional impact, and depressive symptoms in those with FMS. CONCLUSIONS: WHODAS 2.0 is a reliable and valid instrument to evaluate functioning of Brazilians with FMS. It provides reliable information on individuals' health through of a multidimensional perspective, that allows for individual-centered care.
Assuntos
Fibromialgia , Desempenho Físico Funcional , Inquéritos e Questionários , Adulto , Feminino , Fibromialgia/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos TestesRESUMO
Objective: To analyze the effect of the exergaming on muscular activity at rest and on maximum voluntary isometric contraction by electromyography (EMG) at peak torque, widespread pressure hyperalgesia identified using a tender point count, and static balance in fibromyalgia. Materials and Methods: Thirty-five women were divided into two groups: Wii™ (virtual rehabilitation, n = 16) and control (stretching exercises, n = 19), through simple randomization. The volunteers were evaluated by means of EMG, dynamometry by load cell, baropodometry, and algometry before interventions and reevaluated after the 10th and 20th sessions. The subjects participated fully in three 1-hour treatment sessions per week of 20 sessions. Results: The Wii group showed significant benefits for the peak torque of dorsiflexion movement after 20 sessions and for movement plantarflexion after 10 sessions. The control group showed bilateral improvement in muscular activity in the tibialis anterior muscle after 20 sessions. Both groups showed a significant decrease in tender point count, suggesting improved hyperalgesia after 10 sessions and 20 sessions. No significant improvement was found in static baropodometry in the two evaluated groups. Conclusion: Exergaming have the potential to increase the peak torque for dorsiflexion and plantarflexion movement in women with fibromyalgia. It also produces a decrease in tender point count equal to that with flexibility exercises and does not produce changes in the static balance.
Assuntos
Fibromialgia/fisiopatologia , Extremidade Inferior/fisiopatologia , Músculos/fisiopatologia , Equilíbrio Postural/fisiologia , Torque , Idoso , Análise de Variância , Eletromiografia/instrumentação , Eletromiografia/métodos , Feminino , Fibromialgia/complicações , Humanos , Extremidade Inferior/fisiologia , Pessoa de Meia-IdadeRESUMO
This exploratory retrospective study aims to investigate the thermal changes in the thyroid gland region of patients with hypothyroidism and fibromyalgia by analyzing the temperature of the brown adipose tissue (BAT). A total of 166 individuals from 1000 thermographic electronic medical records were classified into four groups: Group HP + FM-50 individuals with hypothyroidism and fibromyalgia; Group FM-56 individuals with fibromyalgia only; Group HP-30 individuals with hypothyroidism only, and Group Control-30 healthy individuals. The thermal images from the electronic medical records were acquired by a FLIR T650SC infrared camera (used for thermometry) and the temperature data for each group were statistically analyzed. Group HP + FM showed r = 0, meaning that the average temperatures of the thyroid and BAT are independent of each other. Groups FM, HP and Control showed r = 1, meaning that the average temperatures of the thyroid and BAT were directly related. Our findings showed that the average temperatures of the thyroid and BAT regions are similar. Also, there was no correlation between thyroid gland temperature and the presence of hypothyroidism or fibromyalgia using thermometry.
Assuntos
Tecido Adiposo Marrom/fisiologia , Fibromialgia/fisiopatologia , Hipotireoidismo/fisiopatologia , Glândula Tireoide/fisiopatologia , Tecido Adiposo Marrom/diagnóstico por imagem , Adolescente , Adulto , Registros Eletrônicos de Saúde , Feminino , Fibromialgia/diagnóstico por imagem , Voluntários Saudáveis , Humanos , Hipotireoidismo/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Temperatura , Termografia/métodos , Glândula Tireoide/diagnóstico por imagem , Adulto JovemRESUMO
Fibromyalgia is a potentially disabling chronic disease, characterized by widespread pain and a range of comorbidities such as hypertension. Among the mechanisms involved in fibromyalgia-like pain symptoms are kinins and their B1 and B2 receptors. Moreover, angiotensin I converting enzyme (ACE) inhibitors, commonly used as antihypertensive drugs, can enhance pain by blocking the degradation of peptides such as substance P and bradykinin, besides enhancing kinin receptors signalling. We investigated the effect of ACE inhibitors on reserpine-induced fibromyalgia-like pain symptoms and the involvement of kinins in this effect in mice. Nociceptive parameters (mechanical and cold allodynia and overt nociception) were evaluated after ACE inhibitors administration in mice previously treated with reserpine. The role of kinin B1 and B2 receptors was investigated using pharmacological antagonism. Additionally, bradykinin levels, as well as the activity of ACE and kininase I, were measured in the sciatic nerve, spinal cord and cerebral cortex of the mice. The ACE inhibitors enalapril and captopril enhanced reserpine-induced mechanical allodynia, and this increase was prevented by kinin B1 and B2 receptor antagonists. Substance P and bradykinin caused overt nociception and increased mechanical allodynia in animals treated with reserpine. Reserpine plus ACE inhibitors increased bradykinin-related peptide levels and inhibited ACE activity in pain modulation structures. Since hypertension is a frequent comorbidity affecting fibromyalgia patients, hypertension treatment with ACE inhibitors in these patients should be reviewed once this could enhance fibromyalgia-like pain symptoms. Thus, the treatment of hypertensive patients with fibromyalgia could include other classes of antihypertensive drugs, different from ACE inhibitors.
Assuntos
Inibidores da Enzima Conversora de Angiotensina/toxicidade , Fibromialgia/induzido quimicamente , Sistema Nervoso/efeitos dos fármacos , Dor Nociceptiva/induzido quimicamente , Limiar da Dor/efeitos dos fármacos , Peptidil Dipeptidase A/metabolismo , Receptores da Bradicinina/metabolismo , Animais , Comportamento Animal/efeitos dos fármacos , Captopril/toxicidade , Modelos Animais de Doenças , Enalapril/toxicidade , Fibromialgia/enzimologia , Fibromialgia/fisiopatologia , Masculino , Camundongos , Sistema Nervoso/enzimologia , Sistema Nervoso/fisiopatologia , Dor Nociceptiva/enzimologia , Dor Nociceptiva/fisiopatologia , Reserpina , Transdução de SinaisRESUMO
OBJECTIVE: The aim was to analyze the effect of one session and three sessions of strength training (ST) on pain in women with fibromyalgia (FM). METHOD: Twenty-three women with FM performed three sessions of ST for a week. Each training session worked the main muscle groups and lasted 60 min. Three sets of 12 repetitions were performed with 1 min intervals in between. The load was increased based on the perception of subjective effort of each patient. Pain intensity was evaluated immediately after the first and third sessions using a Fischer digital algometer. RESULTS: After the first ST session, pain reduction was observed. No significant differences were found in pain thresholds on the baseline versus the third session. The analysis of MBI demonstrated that the ST does not worsen patients' pain, indicating a 52.2% trivial effect and a 39.1% beneficial effect. CONCLUSION: Our results suggest that there is no harmful effect on the pain of women with FM after an acute session of ST. We emphasize that despite the promising results, more studies on the subject are needed to help understand pain in patients with FM.
Assuntos
Fibromialgia/terapia , Manejo da Dor/métodos , Dor/fisiopatologia , Treinamento Resistido/métodos , Feminino , Fibromialgia/fisiopatologia , Humanos , Pessoa de Meia-Idade , Medição da Dor , Limiar da Dor/fisiologia , Resultado do TratamentoRESUMO
OBJECTIVE: To analyze the measurement properties of the Brazilian-Portuguese version of the Tampa Scale for Kinesiophobia-11 in patients with fibromyalgia. METHODS: Assessment was made at three time points: baseline (n=130) and 15 days (n=54) and eight weeks after baseline (n=51). Data collected at baseline were used to assess internal consistency, criterion and construct validity, and ceiling and floor effects. Data collected at baseline and 15 days after baseline were used to assess reliability and measurement error, and data collected before and after an eight-week exercise-based physical therapy intervention were used to assess interpretability of change scores. RESULTS: The Tampa Scale for Kinesiophobia-11 showed adequate internal consistency (Cronbach's alpha=0.77; alpha if item deleted: 0.74-0.77), substantial reliability (intraclass correlation coefficient2,1=0.85; 95% confidence interval: 0.75, 0.90), good measurement error (standard error of measurement: 2.65 points), and a minimal detectable change (90% confidence) of 6.16 points. For validity, the Tampa Scale for Kinesiophobia-11 showed a positive and good correlation with the original Tampa Scale for Kinesiophobia (r=0.84, p<0.01), positive and moderate correlation with the Pain Catastrophizing Scale (r=0.55, p<0.01), positive and weak correlation with the Numerical Pain Rating Scale (r=0.25, p<0.01), positive and moderate correlation with the Beck Depression Inventory (r=0.39, p<0.01), and no correlation with the Patient-Specific Functional Scale (r=0.11, p=0.23). Kinesiophobia, pain, function, catastrophizing, and depression statistically improved after the eight-week intervention (p<0.01). CONCLUSION: The Tampa Scale for Kinesiophobia-11 is consistent, reliable, and appropriate to assess fear of movement in patients with fibromyalgia in the clinical context. Responsiveness of the Tampa Scale for Kinesiophobia-11 should be tested in future studies.
Assuntos
Fibromialgia/fisiopatologia , Movimento/fisiologia , Transtornos Fóbicos/psicologia , Brasil , Catastrofização/psicologia , Comparação Transcultural , Medo/psicologia , Humanos , Dor , Transtornos Fóbicos/diagnóstico , Transtornos Fóbicos/epidemiologia , Portugal , Psicometria/métodos , Reprodutibilidade dos Testes , Inquéritos e QuestionáriosRESUMO
BACKGROUND: Fibromyalgia (FM) is characterized by chronic and widespread pain, sleep disturbances, fatigue, psychological distress and morning stiffness. These patients also present symptoms such as depression, sexual dysfunctions and reproductive problems. Sexuality involves several aspects, including pelvic floor functionality, and one question is whether the sexual performance of women with fibromyalgia is associated with pelvic floor function or other characteristics of the disease. OBJECTIVE: The aim of this study was to gauge the association between perineal function and sexual performance in women with and without fibromyalgia. METHODS: We performed a cross-sectional study with 109 sexually active women from 19 to 65 years of age, either suffering from fibromyalgia (FM group, n = 51) or free from fibromyalgia (non-FM group, n = 58). Perineal function was measured with the use of perineometry and digital vaginal palpation (PERFECT Scheme), while sexual performance was assessed by the Sexual Quotient Female questionnaire (QS-F). RESULTS: Patients with fibromyalgia presented poor sexual performance compared to those without fibromyalgia (QS-F score 58 (32-66) vs. 66 (56-70); p = 0.002) as well as lower pelvic floor muscle strength measured by perineometry (32.5 (18.2-40.5) vs. 37.9 (23.4- 57.3); p = 0.03). Patients without fibromyalgia presented a positive correlation between perineometry and QS-F (r = 0.22; p = 0.038), while those with fibromyalgia presented no correlation between those two variables (r = 0.22; p = 0.12). The regression model showed an association between sexual performance and the presence of fibromyalgia, pelvic floor muscle strength (perineometry) and age, according to the following equation: sexual performance = 48.52 + (9.5 * non-FM group) + (0.23 * perineometry)-(0.4 * age), with adjusted R2 = 0.19. CONCLUSION: Women with FM present poor sexual performance and lower pelvic floor muscle strength compared to those without FM. However, the correlation between these variables among women without FM was not observed in women with FM. Sexual performance showed a positive association with absence of fibromyalgia and higher pelvic floor muscle strength, and a negative association with age.