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Masood R, LeRoy TE, Moverman MA, Feldman MW, Rogerson A, Salzler MJ. Functional Somatic Syndromes Are Associated With Varied Postoperative Outcomes and Increased Opioid Use After Spine Surgery: A Systematic Review. Global Spine J 2024; 14:1601-1608. [PMID: 38124313 DOI: 10.1177/21925682231217706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2023] Open
Abstract
STUDY DESIGN Systematic Review. OBJECTIVE To perform a systematic review assessing the relationship between functional somatic syndromes (FSSs) and clinical outcomes after spine surgery. METHODS A systematic review of online databases (PubMed and Web of Science) through December 2021 was conducted via PRISMA guidelines to identify all studies investigating the impact of at least one FSS (fibromyalgia, irritable bowel syndrome (IBS), chronic headaches/migraines, interstitial cystitis, chronic fatigue syndrome, multiple chemical sensitivity) on outcomes after spine surgery. Outcomes of interest included patient reported outcome measures (PROMs), postoperative opioid use, cost of care, complications, and readmission rates. RESULTS A total of 207 records were identified. Seven studies (n = 40,011 patients) met inclusion criteria with a mean MINORS score of 16.6 out of 24. Four studies (n = 21,086) reported postoperative opioid use; fibromyalgia was a strong risk factor for long-term opioid use after surgery whereas the association with chronic migraines remains unclear. Two studies (n = 233) reported postoperative patient reported outcome measures (PROMs) with mixed results suggesting a possible association between fibromyalgia and less favorable PROMs. One study (n = 18,692) reported higher postoperative complications in patients with fibromyalgia. CONCLUSION Patients with fibromyalgia and possibly migraines are at higher risk for prolonged postoperative opioid use and less favorable PROMs after spine surgery. There is limited research on the relationship between other Functional somatic syndromes (FSSs) and outcomes following spine surgery. Growing evidence suggests the variation in outcomes after spine procedures may be attributed to non-identifiable organic patient factors such as FSSs.
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Affiliation(s)
- Raisa Masood
- Department of Orthopaedic Surgery, Tufts Medical Center, Boston, MA, United States
| | - Taryn E LeRoy
- Department of Orthopaedic Surgery, Tufts Medical Center, Boston, MA, United States
| | - Michael A Moverman
- Department of Orthopaedic Surgery, Tufts Medical Center, Boston, MA, United States
| | | | - Ashley Rogerson
- Department of Orthopaedic Surgery, Tufts Medical Center, Boston, MA, United States
| | - Matthew J Salzler
- Department of Orthopaedic Surgery, Tufts Medical Center, Boston, MA, United States
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Sanchez JG, Rancu AL, Diatta FH, Jonnalagadda A, Dhodapkar MM, Knoedler L, Kauke-Navarro M, Grauer JN. Increased Risk of 90-Day Complications in Patients With Fibromyalgia Undergoing Total Shoulder Arthroplasty. J Am Acad Orthop Surg Glob Res Rev 2024; 8:01979360-202405000-00007. [PMID: 38722914 PMCID: PMC11081627 DOI: 10.5435/jaaosglobal-d-24-00102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Accepted: 03/25/2024] [Indexed: 05/13/2024]
Abstract
INTRODUCTION Anatomic and reverse total shoulder arthroplasties (TSAs) are effective treatment options for end-stage glenohumeral osteoarthritis. Those undergoing TSA may also have fibromyalgia, a musculoskeletal condition. However, the association of fibromyalgia with shorter and longer term outcomes after TSA has not been well characterized. METHODS Patients undergoing TSA for osteoarthritis indications were identified in the PearlDiver M165 database from January 2016 to October 2022. Exclusion criteria included age younger than 18 years, shoulder infection, neoplasm, or trauma within 90 days before surgery, and inactivity in the database within 90 days of surgery. Patients with fibromyalgia were matched in a 1:4 ratio to patients without based on age, sex, and Elixhauser Comorbidity Index. Ninety-day adverse events were compared using univariable and multivariable analyses. Five-year revision-free survival was compared using the log-rank test. RESULTS Of 163,565 TSA patients, fibromyalgia was identified for 9,035 (5.52%). After matching, cohorts of 30,770 non-fibromyalgia patients and 7,738 patients with fibromyalgia were identified. Multivariable analyses demonstrated patients with fibromyalgia were at independently increased odds ratios (ORs) for the following 90-day complications (decreasing OR order): urinary tract infection (OR = 4.49), wound dehiscence (OR = 3.63), pneumonia (OR = 3.46), emergency department visit (OR = 3.45), sepsis (OR = 3.15), surgical site infection (OR = 2.82), cardiac events (OR = 2.72), acute kidney injury (OR = 2.65), deep vein thrombosis (OR = 2.48), hematoma (OR = 2.03), and pulmonary embolism (OR = 2.01) (P < 0.05 for each). These individual complications contributed to the increased odds of aggregated minor adverse events (OR = 3.68), all adverse events (OR = 3.48), and severe adverse events (OR = 2.68) (P < 0.05 for each). No statistically significant difference was observed in 5-year revision-free survival between groups. DISCUSSION This study found TSA patients with fibromyalgia to be at increased risk of adverse events within 90 days of surgery. Proper surgical planning and patient counseling are crucial to this population. Nonetheless, it was reassuring that those with fibromyalgia had similar 5-year revision-free survival compared with those without.
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Affiliation(s)
- Joshua G. Sanchez
- From the Yale Department of Orthopaedics and Rehabilitation (Mr. Sanchez, Mr. Rancu, Mr. Jonnalagadda, Ms. Dhodapkar, and Dr. Grauer), and the Yale Department of Plastic and Reconstructive Surgery, New Haven, CT (Dr. Diatta, Mr. Knoedler, and Dr. Kauke-Navarro)
| | - Albert L. Rancu
- From the Yale Department of Orthopaedics and Rehabilitation (Mr. Sanchez, Mr. Rancu, Mr. Jonnalagadda, Ms. Dhodapkar, and Dr. Grauer), and the Yale Department of Plastic and Reconstructive Surgery, New Haven, CT (Dr. Diatta, Mr. Knoedler, and Dr. Kauke-Navarro)
| | - Fortunay H. Diatta
- From the Yale Department of Orthopaedics and Rehabilitation (Mr. Sanchez, Mr. Rancu, Mr. Jonnalagadda, Ms. Dhodapkar, and Dr. Grauer), and the Yale Department of Plastic and Reconstructive Surgery, New Haven, CT (Dr. Diatta, Mr. Knoedler, and Dr. Kauke-Navarro)
| | - Anshu Jonnalagadda
- From the Yale Department of Orthopaedics and Rehabilitation (Mr. Sanchez, Mr. Rancu, Mr. Jonnalagadda, Ms. Dhodapkar, and Dr. Grauer), and the Yale Department of Plastic and Reconstructive Surgery, New Haven, CT (Dr. Diatta, Mr. Knoedler, and Dr. Kauke-Navarro)
| | - Meera M. Dhodapkar
- From the Yale Department of Orthopaedics and Rehabilitation (Mr. Sanchez, Mr. Rancu, Mr. Jonnalagadda, Ms. Dhodapkar, and Dr. Grauer), and the Yale Department of Plastic and Reconstructive Surgery, New Haven, CT (Dr. Diatta, Mr. Knoedler, and Dr. Kauke-Navarro)
| | - Leonard Knoedler
- From the Yale Department of Orthopaedics and Rehabilitation (Mr. Sanchez, Mr. Rancu, Mr. Jonnalagadda, Ms. Dhodapkar, and Dr. Grauer), and the Yale Department of Plastic and Reconstructive Surgery, New Haven, CT (Dr. Diatta, Mr. Knoedler, and Dr. Kauke-Navarro)
| | - Martin Kauke-Navarro
- From the Yale Department of Orthopaedics and Rehabilitation (Mr. Sanchez, Mr. Rancu, Mr. Jonnalagadda, Ms. Dhodapkar, and Dr. Grauer), and the Yale Department of Plastic and Reconstructive Surgery, New Haven, CT (Dr. Diatta, Mr. Knoedler, and Dr. Kauke-Navarro)
| | - Jonathan N. Grauer
- From the Yale Department of Orthopaedics and Rehabilitation (Mr. Sanchez, Mr. Rancu, Mr. Jonnalagadda, Ms. Dhodapkar, and Dr. Grauer), and the Yale Department of Plastic and Reconstructive Surgery, New Haven, CT (Dr. Diatta, Mr. Knoedler, and Dr. Kauke-Navarro)
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Gurel R, Vidra M, Elbaz E, Factor S, Kazum E, Bivas A, Maman E, Chechik O, Rotman D. Arthroscopic rotator cuff repair in fibromyalgia patients had comparable outcomes to a matched control group. J Orthop Traumatol 2023; 24:21. [PMID: 37169977 PMCID: PMC10175519 DOI: 10.1186/s10195-023-00706-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 05/01/2023] [Indexed: 05/13/2023] Open
Abstract
BACKGROUND Although fibromyalgia is associated with poor outcomes following orthopedic surgeries, several studies show some benefit from surgical intervention and nevertheless recommend operative treatment when indicated. There is sparse evidence of the effect of fibromyalgia on the outcomes of shoulder surgery. The purpose of this study was to investigate the effect of fibromyalgia on patient-reported outcomes of arthroscopic rotator cuff repair (ARCR). METHODS All patients with a confirmed diagnosis of fibromyalgia who underwent ARCR in one institution between 2010 and 2021 were included. Data retrieved from medical records included demographics, characteristics of the cuff tear and the surgical procedure, and preoperative and last follow-up (minimum 1 year) postoperative Disabilities of the Arm, Shoulder and Hand (DASH) score, Subjective Shoulder score (SSV), and Numeric Pain Rating Scale (NPRS). A matched controlled group of patients without fibromyalgia who had undergone ARCR was selected according to age, sex, and preoperative DASH, SSV, and NPRS scores. RESULTS There were no significant differences in demographics, cuff tear and surgical procedure characteristics, and preoperative scores between the fibromyalgia and control groups. The fibromyalgia patients' postoperative scores for all 3 measurements showed significant improvement: SSV by 32.1 (P = 0.004), DASH by 20.3 (P = 0.016), and NPRS by 2.33 (P = 0.017). There were no significant differences in the postoperative DASH, SSV, and NPRS between the fibromyalgia and control groups. CONCLUSION Fibromyalgia patients with rotator cuff tears who undergo ARCR do not have inferior patient-reported outcomes compared with non-fibromyalgia controls. Fibromyalgia should not be a considered a contraindication for ARCR. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Ron Gurel
- Department of Orthopedic Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Matias Vidra
- Department of Orthopedic Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Etay Elbaz
- Department of Orthopedic Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shai Factor
- Department of Orthopedic Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Efi Kazum
- Department of Orthopedic Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Assaf Bivas
- Department of Orthopedic Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eran Maman
- Department of Orthopedic Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ofir Chechik
- Department of Orthopedic Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dani Rotman
- Department of Orthopedic Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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McConaghy K, Rullan P, Murray T, Molloy R, Heinberg LJ, Piuzzi NS. Team Approach: Management of Mental Health in Orthopaedic Patients. JBJS Rev 2023; 11:01874474-202302000-00003. [PMID: 36763707 DOI: 10.2106/jbjs.rvw.22.00167] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
» Mental health evaluation should be considered an essential part of the routine preoperative assessment and should be managed by a multidisciplinary team composed of the primary care physician, orthopaedic provider, and behavioral health specialist. » The scientific literature indicates that patients without comorbid psychiatric symptoms and adaptive coping strategies, resilience, and well-managed expectations have improved functional outcomes and satisfaction after orthopaedic procedures. » Psychological issues are multifaceted and require treatment tailored to each individual patient. Therefore, close communication between all members of the care team is required to create and execute the perioperative plan.
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Affiliation(s)
- Kara McConaghy
- Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Pedro Rullan
- Department of Orthopedic Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Trevor Murray
- Department of Orthopedic Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Robert Molloy
- Department of Orthopedic Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Leslie J Heinberg
- Department of Psychiatry and Psychology, Cleveland Clinic, Cleveland, Ohio
| | - Nicolas S Piuzzi
- Department of Orthopedic Surgery, Cleveland Clinic, Cleveland, Ohio.,Department of Biomedical Engineering, Cleveland Clinic, Cleveland, Ohio.,Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio
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Chen Y, Wang E, Sites BD, Cohen SP. Integrating mechanistic-based and classification-based concepts into perioperative pain management: an educational guide for acute pain physicians. Reg Anesth Pain Med 2023:rapm-2022-104203. [PMID: 36707224 DOI: 10.1136/rapm-2022-104203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 01/13/2023] [Indexed: 01/28/2023]
Abstract
Chronic pain begins with acute pain. Physicians tend to classify pain by duration (acute vs chronic) and mechanism (nociceptive, neuropathic and nociplastic). Although this taxonomy may facilitate diagnosis and documentation, such categories are to some degree arbitrary constructs, with significant overlap in terms of mechanisms and treatments. In clinical practice, there are myriad different definitions for chronic pain and a substantial portion of chronic pain involves mixed phenotypes. Classification of pain based on acuity and mechanisms informs management at all levels and constitutes a critical part of guidelines and treatment for chronic pain care. Yet specialty care is often siloed, with advances in understanding lagging years behind in some areas in which these developments should be at the forefront of clinical practice. For example, in perioperative pain management, enhanced recovery protocols are not standardized and tend to drive treatment without consideration of mechanisms, which in many cases may be incongruent with personalized medicine and mechanism-based treatment. In this educational document, we discuss mechanisms and classification of pain as it pertains to commonly performed surgical procedures. Our goal is to provide a clinical reference for the acute pain physician to facilitate pain management decision-making (both diagnosis and therapy) in the perioperative period.
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Affiliation(s)
- Yian Chen
- Anesthesiology, Stanford University School of Medicine, Stanford, California, USA
| | - Eric Wang
- Anesthesiology and Critical Care Medicine, The Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Brian D Sites
- Anesthesiology and Orthopaedics, Dartmouth College Geisel School of Medicine, Hanover, New Hampshire, USA
| | - Steven P Cohen
- Anesthesiology, Neurology, Physical Medicine & Rehabilitation and Psychiatry & Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
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Masood R, Mandalia K, Moverman MA, Puzzitiello RN, Pagani NR, Menendez ME, Salzler MJ. Patients With Functional Somatic Syndromes-Fibromyalgia, Irritable Bowel Syndrome, Chronic Headaches, and Chronic Low Back Pain-Have Lower Outcomes and Higher Opioid Usage and Cost After Shoulder and Elbow Surgery. Arthroscopy 2022; 39:1529-1538. [PMID: 36592697 DOI: 10.1016/j.arthro.2022.12.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 12/06/2022] [Accepted: 12/15/2022] [Indexed: 12/31/2022]
Abstract
PURPOSE To perform a systematic review assessing the relationship between functional somatic syndromes (FSSs) and patient-reported outcome measures (PROMs), postoperative opioid consumption, and hospitalization costs after shoulder and elbow surgery. METHODS A systematic review of the PubMed and Web of Science databases was conducted according to Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines to identify all studies evaluating the effect of having at least 1 FSS (fibromyalgia, irritable bowel syndrome, chronic headaches, chronic low back pain) on outcomes after shoulder and elbow surgeries. Outcomes of interest included postoperative analgesic use, PROMs, and hospitalization costs. RESULTS The review identified a total of 320 studies, of which 8 studies met the inclusion criteria. The total number of participants in our 8 included studies was 57,389. Three studies (n = 620) reported PROMs. These studies demonstrated that the presence of at least 1 FSS is predictive of significantly greater pain scores and lower quality of recovery, Disability Arm Shoulder and Hand, American Shoulder and Elbow Surgeons Shoulder Score, and Single Assessment Numeric Evaluation scores postoperatively. Although scores were inferior in among patients with FSS, 2 of the 3 studies showed improvement in PROMs in this group of patients. Seven studies (n = 56,909) reported postoperative opioid use. Of these, 5 reported that a diagnosis of at least 1 FSS was a strong risk factor for long-term opioid use after surgery. One study (n = 480) found that time-driven activity-based costs were significantly greater in patients with FSSs. CONCLUSIONS Patients with functional somatic syndromes have less-favorable PROMs postoperatively, consume more opioids postoperatively, and have greater health care costs after elective shoulder and elbow procedures. Although PROMs among patients with FSSs are inferior compared with those without FSSs, PROMs still improved compared with baseline. LEVEL OF EVIDENCE Level III, systematic review of Level II-III studies.
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Affiliation(s)
- Raisa Masood
- Department of Orthopaedic Surgery, Tufts Medical Center, Boston, Massachusetts, U.S.A
| | - Krishna Mandalia
- Tufts University School of Medicine, Boston, Boston, Massachusetts, U.S.A
| | - Michael A Moverman
- Department of Orthopaedic Surgery, Tufts Medical Center, Boston, Massachusetts, U.S.A
| | - Richard N Puzzitiello
- Department of Orthopaedic Surgery, Tufts Medical Center, Boston, Massachusetts, U.S.A
| | - Nicholas R Pagani
- Department of Orthopaedic Surgery, Tufts Medical Center, Boston, Massachusetts, U.S.A
| | - Mariano E Menendez
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Matthew J Salzler
- Department of Orthopaedic Surgery, Tufts Medical Center, Boston, Massachusetts, U.S.A.
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Prevalence and Characteristics of Fibromyalgia in Patients with Foot and Ankle Pain: The Experience of an Academic Podiatry Clinic. MEDICINA (KAUNAS, LITHUANIA) 2022; 59:medicina59010058. [PMID: 36676682 PMCID: PMC9864868 DOI: 10.3390/medicina59010058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 12/13/2022] [Accepted: 12/24/2022] [Indexed: 12/29/2022]
Abstract
Background and Objectives: Research about the prevalence of fibromyalgia in podiatric patients is limited, with data suggesting potentially higher estimates and greater foot impairment in patients with fibromyalgia compared to healthy individuals. The aim of our study is to assess the prevalence of fibromyalgia in the podiatric healthcare setting and to research the characteristics of fibromyalgia patients with foot or ankle disorders. Materials and Methods: Consecutive patients visiting the academic podiatry clinic at the University of Bologna IRCCS Rizzoli Orthopaedic Institute between 11 January and 31 March 2021 were enrolled. Results: Of the 151 patients included, 21 met the fibromyalgia survey diagnostic criteria, accounting for a prevalence of 13.9% (95% CI 8.8-20.5). As part of the podiatric assessment, the Foot Function Index (FFI) was used to calculate the impact of foot and ankle problems. Moreover, patients with fibromyalgia were asked to complete the fibromyalgia impact questionnaire (FIQ). Fibromyalgia patients had significantly worse total FFI scores (63.4 ± 23.0% vs. 53.2 ± 20.3%, p = 0.038) and there was a significant linear correlation between the FFI and the FIQ (r = 0.72, p < 0.001). Conclusions: The prevalence of fibromyalgia in the academic podiatry clinic being 13.9% confirms that, in the healthcare setting, the disease can be more frequent than in the general population. Furthermore, our findings suggest a strong correlation between foot impairment and the impact of fibromyalgia.
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THE ECONOMIC BURDEN OF FIBROMYALGIA: A SYSTEMATIC LITERATURE REVIEW. Semin Arthritis Rheum 2022; 56:152060. [DOI: 10.1016/j.semarthrit.2022.152060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 06/23/2022] [Accepted: 06/27/2022] [Indexed: 11/19/2022]
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Evaluating the Relationship Between Myofascial Pain Syndrome (MPS) and Physical and Mental Health Status in Patients with Stroke. ARCHIVES OF NEUROSCIENCE 2021. [DOI: 10.5812/ans.119465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Myofascial pain syndrome (MPS) is a non-inflammatory disorder with muscle stiffness and pain that occurs with the appearance of palpable and irritating nodules in the muscular system. Stroke is one of the most common neurological diseases that in many cases leads to disability and reduction of quality of life (QOL). Objectives: This study aimed to evaluate the relationship between MPS and physical and mental health (MH) status in patients with stroke. Methods: Using available sampling method, this case-control study included 260 patients with stroke. To collect data, demographic characteristics, Visual Analogue Scale (VAS), 36-item Short Form Survey (SF-36), and Depression, Anxiety and Stress Scale (DASS-21) were used. Data analysis was performed using SPSS 16. Mean and standard deviation were used for descriptive statistics and independent t-test, paired t-test, and analysis of variance (ANOVA) were used for inferential tests. Results: While the pain score was 6.35 (1.39), QOL score was 38.86 (11.69), and MH score was 16.26 (2.75) in the intervention group, these scores were 2.15 (0.96), 63.96 (17.52), and 9.02 (4.63), respectively, in the control group. The results showed no statistically significant relationship between MPS and QOL. But there was a statistically significant relationship between MPS and MH, so that the MH status of patients with MPS was lower than the MH status of other patients. Conclusions: Necessary interventions have been done to improve the health status of patients with MPS, which will lead to an increase in the health status of these patients.
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Diagnostic difficulty, delayed diagnosis, and increased tendencies of surgical treatment in fibromyalgia syndrome. Clin Rheumatol 2021; 41:831-837. [PMID: 34671855 DOI: 10.1007/s10067-021-05970-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 10/03/2021] [Accepted: 10/17/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Aimed to evaluate the time elapsed between the onset of early symptoms and the diagnosis of fibromyalgia syndrome (FMS), the delays in diagnosis and frequent physician visits, increased tendencies of surgical treatment, and the effects of FMS symptoms on the post-surgical result. PATIENTS AND METHODS While there were 101 patients diagnosed with FMS in the 1st group, there were 100 patients in the 2nd group who presented with musculoskeletal complaints but were not diagnosed with FMS. In both groups, information on duration of complaints, time until diagnosis, and number of evaluating physicians were included. They were questioned in terms of whether they had undergone elective surgery before and after FMS diagnosis, and in terms of operation sites. Among these operations, the ones regarding the musculoskeletal system were evaluated, and the preoperative and postoperative, before and after FMS diagnosis. RESULTS It was determined that the diagnosis of FMS was made late; the number of doctor visits increased in the period until the diagnosis, and the rate of surgical treatment was higher than in patients without FMS. It was determined that the patients who were operated on after being diagnosed with FMS gained from the operation while the rate of gaining from surgery was lower in patients with FMS symptoms who were operated on before the diagnosis was made. CONCLUSION The diagnosis of FMS reduces healthcare use, including referrals and examinations. Educating clinicians in the recognition and diagnosis of FMS will provide both patients and healthcare providers with benefits. Key Points • Early detection of FMS reduces healthcare utilization and expenditure, including referrals and examinations. • Educating clinicians in the recognition and diagnosis of FMS will provide both patients and healthcare providers with benefits. Therefore, it is important to understand why the diagnosis of FMS is made in a delayed manner. • Providing pragmatic tools to improve the methodology of primary care providers may help with diagnosing FMS accurately. • Early diagnosis and treatment of FMS may lead to a decrease in the number of operations and an improvement in the results of the operation.
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