Suicidal ideation in female individuals with fibromyalgia and comorbid obesity: prevalence and association with clinical, pain-related, and psychological factors

Mu-opioid receptor expression on B cells as a potential biomarker for chronic pain: a follow-up study with patients with fibromyalgia

Introduction

Before COVID-19 pandemic, we identified the percentage of B cells expressing the Mu-opioid receptor (Mu+ B cells) as a potential marker, named Mu-Lympho-Marker (MLM), for chronic pain (CP) in patients with fibromyalgia (FM) and osteoarthritis.

Objectives

Here, we demonstrate the stability of MLM over time through a comparative analysis of biological, clinical, and psychological data collected from a subgroup of patients with FM across 2 distinct research periods.

Methods

This is an observational, longitudinal study. Fibromyalgia participants enrolled in the first study were called back for follow-up sampling. Clinical data were recorded. Pain score was reported using the Numerical Rating Scale. Mu+ B cells percentage of expression was analyzed by flow cytometry. Immunofluorescence analyses were performed to explore the cellular localization of Mu-opioid receptor. Pain-free subjects served as control group. All the participants filled out self-reported psychological tests. Data were statistically analyzed.

Results

Mu+ B cells percentage of expression was constant in patients with FM, who consistently showed lower values than control group after 2 years (difference in the mean: 32.0 ± 4.4, t = 7.330, IC 95% [23.2-40.9], P < 0.0001). Confocal microscopy analyses revealed Mu cytoplasmic localization in patients with FM. We observed no significant changes between psychological outcomes during the 2 phases of the study, nor did we find any correlations with biological findings.

Conclusion

Mu-Lympho-Marker could be a promising marker for CP, as seen in FM cohort, and could be helpful for accurate diagnosis and tailored rehabilitation strategies. Further studies are needed to study MLM in CP of different aetiologies.

Pain, Anger, and Rumination in Fibromyalgia: A Vicious Cycle?

Background/Objectives: Fibromyalgia is a debilitating syndrome characterized by persistent pain. Emerging evidence highlights the role of emotional and cognitive processes in modulating pain experience. Anger, for example, can influence pain and patients' adjustment to the disease. Studies showed that metacognitions and anger rumination can worsen state anger, thereby increasing perceived pain intensity. The present study aims to investigate the presence of a relationship between pain, dysfunctional metacognitions, anger rumination, and state anger. Methods: The study included 446 participants who self-reported having a diagnosis of fibromyalgia confirmed by a rheumatologist or pain specialist. Participants completed self-report measures of metacognitions, anger rumination, state anger, and pain intensity. The serial mediation analysis was performed using Hayes' PROCESS macro (Model 6). Results: Pain intensity showed a significant positive effect on negative beliefs about worry (β = 0.09; p < 0.05), need to control thoughts (β = 0.09; p < 0.05), and cognitive self-consciousness (β = 0.12; p < 0.05), but not on anger rumination. Across all serial mediation models, the direct effect of pain intensity on state anger remained significant even after controlling for the effect of mediators, indicating partial mediation. Conclusions: This study suggests a vicious cycle involving dysfunctional metacognitions, anger rumination, state anger, and pain intensity. Our findings also indicate a potential influence of pain on metacognitions and suggest a direct association between pain intensity and state anger. Interventions for anger management in fibromyalgia should consider dysfunctional metacognitions and anger rumination.

Fibromyalgia severity and symptoms are associated with the disorders of gut-brain interaction

INTRODUCTION

Fibromyalgia remains an idiopathic common disorder characterised by widespread pain with no universally accepted treatment. Irritable bowel syndrome is prevalent among women living with fibromyalgia. The prevalence of other disorders of gut-brain interaction (DGBI) and associations with fibromyalgia symptoms and severity is unknown.

OBJECTIVES

To evaluate the prevalence of the range of DGBI and associations with the symptoms and severity of fibromyalgia in women.

METHODS

A prospective observational study was conducted in New Zealand in 2022. A comprehensive survey included validated measures to identify DGBI (Rome IV) and items assessing the severity of fibromyalgia and pain symptoms, sleep quality, quality of life, mental health and migraine. Analysis was conducted employing Spearman's rho, Mann-Whitney U, Kruskal-Wallis and chi-square tests.

RESULTS

A total of 111 adult women with fibromyalgia enrolled in the study. Of these, 98 (93%) met the criteria for at least one DGBI, and 67 (68%) satisfied criteria for more than one. All groups of DGBI, and 11 specific DGBI were significantly associated with measures of pain, fibromyalgia severity, sleep problems and migraine (p < 0.05). Severity of pain and symptoms associated with fibromyalgia, including sleep problems, were also significantly associated with the functional bowel disorder severity index.

CONCLUSION

This study demonstrated that the prevalence of DGBI in women with fibromyalgia extends beyond irritable bowel syndrome. Presence of multiple DGBI correlates with pain, severity indices of fibromyalgia and sleep problems. Further research is required to examine the aetiology of DGBI in this population.

SIGNIFICANCE STATEMENT

This observational study has identified important relationships between the broader DGBI, fibromyalgia pain and associated symptoms, particularly migraine and sleep disturbance. Notable correlations between the severity indices of each are demonstrated, suggesting that improvements in one domain may reduce pain and improve overall well-being. These findings highlight the importance of addressing each clinical feature of the condition when supporting patients with fibromyalgia.

Effects of transcranial magnetic stimulation on sleep quality in fibromyalgia: A double-blind randomized clinical trial

OBJECTIVES

The aim of the current study was to assess the therapeutic impact of repeated low frequency repetitive transcranial magnetic stimulation (rTMS) over the right dorsolateral prefrontal cortex (rDLPFC) on sleep problems in patients with fibromyalgia.

METHODS

Forty two patients with fibromyalgia who had sleep difficulties were randomly assigned to receive either real or sham rTMS treatment. Patients received 20 treatment sessions (5 sessions per week) in which 1200 rTMS pulses were applied over the rDLPFC using a frequency of 1 Hz and an intensity of 120 % of the resting motor threshold. All participants were evaluated at baseline, and then 1 month and 3 months after treatment using the Fibromyalgia Impact Questionnaire (FIQ), Pittsburgh Sleep Quality Index (PSQI), Medical Outcomes Study Sleep Scale (MOS-SS) and polysomnography (PSG).

RESULTS

There were significant time (pre, 1month, and 3 months)X group (real versus sham group) interactions in all 3 clinical rating scales; FIQ (Df = 1.425, F = 237.645, P = 0.001), PSQI (Df = 2, F = 64.005, P = 0.001), MOS-SS (Df = 2, F = 28.938, P = 0.001) due to the fact that the real group improved significantly more over time than the sham group. Similarly, the real group improved more on the PSG parameters than the sham group. The effect sizes were large both in the rating scales and PSG, indicating a substantial clinical improvement. Correlation as an exploratory analysis between the changes (pre - post 3 months) in MOS-SS and PLMs index (/h) showed significant negative correlation (r = -0.643, P = 0.002).

CONCLUSIONS

20 sessions of LF-rTMS over rDLPFC can improve sleep quality in both subjective (PSQI and MOSS) as well as objective (PSG) rating scales.

The impact of exercise intensity on depression in fibromyalgia: a randomized controlled trial

Background

Fibromyalgia (FM) is characterized by widespread chronic pain. Although pain is the main symptom, approximately 90% of patients have depression. This study aimed to analyze the effects of Resistance Training (RT) with low and high intensity on depression in patients with FM.

Methods

Thirty-eight women with FM and 31 healthy women were allocated to the low-intensity, high-intensity, preferred-intensity, and control groups. The patients underwent 8 weeks of supervised RT, with two sessions per week of approximately 1 h. The low-intensity resistance training group (LIRT) performed two sets of 12 maximum repetitions. The high-intensity resistance training group (HIRT) performed four sets with six maximum repetitions, and the preferred intensity group (PI) performed three sets, with eight to 12 repetitions, according to the patient's tolerance. The healthy control group did not perform any type of exercise. Depression was assessed using the Beck depression inventory before the start of the intervention, after 4 and 8 weeks.

Results

FM patients have higher levels of depression than women without the disease. After 4 weeks, there was a difference in depressive symptoms between the HIRT and LIRT (p = 0.048), and the PI and LIRT (p = 0.048).

Conclusion

Prescribing RT with low or high intensity did not significantly reduce depression in patients with FM after 8 weeks, however, analyses between groups after 4 weeks indicated that low-intensity training is more effective than high-intensity training. The prescription of RT exercise to FM could vary among low, high, and preferred intensity, following the patient's tolerance for pain.

Clinical trial registration

https://ensaiosclinicos.gov.br/rg/RBR-74pcmw, RBR-74pcmw.

Long versus short-term opioid therapy for fibromyalgia syndrome and risk of depression, sleep disorders and suicidal ideation: a population-based, propensity-weighted cohort study

OBJECTIVE

Fibromyalgia syndrome (FMS) is characterised by widespread pain and is associated with mood disorders such as depression as well as poor sleep quality. These in turn have been linked to increased risk of suicidal ideation. Clinical guidelines generally do not recommended opioids in FMS, but they are routinely prescribed to a considerable proportion of FMS patients. We assessed the association of long-term opioid prescription for FMS with risk of depression, sleep disorders and suicidal ideation, when compared with short-term opioid use.

METHODS

Retrospective cohort study combing several population-wide databases covering a population of five million inhabitants, including all adults who received an initial opioid prescription from 2014 to 2018 specifically prescribed for FMS. We examined the occurrence of depression, sleep disorders or suicidal ideation outcomes in patients with an initial long-term opioid prescription (>90 days) versus those who received a short-term treatment (<29 days). We employed multivariable Cox regression modelling and inverse probability of treatment weighting based on propensity scores and we performed several sensitivity analyses.

RESULTS

10 334 patients initiated short-term (8309, 80.40%) or long-term (2025, 19.60%) opioids for FMS. In main adjusted analyses, long-term opioid use was associated with an increased risk for depression (HR: 1.58, 95% CI 1.29 to 1.95) and sleep disorder (HR: 1.30, 95% CI 1.09 to 1.55) but not with suicidal ideation (HR: 1.59, 95% CI 0.96 to 2.62). In models assessing outcomes since day 90, an increased risk for suicidal ideation was observed (HR: 1.76, 95% CI 1.05 to 2.98).

CONCLUSION

These findings suggest that continued opioid use for 90 days or more may aggravate depression and sleep problems in patients with FMS when compared with patterns of short-term treatment.

Mood states and well-being of spouses of fibromyalgia patients: a systematic review and meta-analysis

Background

We carried out a systematic review of the medical literature on potential effects of caregiving on the health and well being of spouses of Fibromyalgia (FM) patients and pooled the results in a meta-analysis.

Methods

The review is comprised of original studies that examined the mood states and well-being of husbands/wives, or long-term intimate partners, of FM patients. The authors searched the PubMed, Scopus, APA PsycNet and Web of Science databases using the key words "fibromyalgia and spouses," "fibromyalgia and partners," and "fibromyalgia and husbands." Of 570 papers that were initially identified using the search words, 18 papers were considered eligible. We used the Joanna Briggs Institute Critical Appraisal Checklist (JBICAC) and Critical Appraisal Skills Program (CASP) tools to assess the risk of bias in the analytical cross-sectional and qualitative studies, respectively.

Results

The overall score in mood states was significantly higher among spouses of FM patients than among spouses of individuals without FM (SMD [95% CI] = 0.52 [0.30; 0.74]). The strongest evidence was found for depression, SMD [95% CI] = 0.68 [0.33; 1.03]. The overall standardized score of quality of life was significantly lower among spouses of FM patients, SMD [95% CI] = -0.59 [-0.79; -0.38], with significant differences in physical function and role, emotional role, and mental health subscales.

Limitation

Limitation of this review is the scant number of studies that addressed several health domains, which made it impossible to carry out meta-analyses in these domains.

Conclusion

Spouses of FM patients show the emotional and physical consequences of caregiving, and impaired quality of life. Addressing these problems can prevent deterioration of their health and improve their quality of life.

The relationship between weight-adjusted-waist index and suicidal ideation: evidence from NHANES

BACKGROUND

Amidst growing evidence of the intricate link between physical and mental health, this study aims to dissect the relationship between the waist-to-weight index (WWI) and suicidal ideation within a representative sample of the US population, proposing WWI as a novel metric for suicide risk assessment.

METHODS

The study engaged a sample of 9500 participants in a cross-sectional design. It employed multivariate logistic and linear regression analyses to probe the association between WWI and suicidal ideation. It further examined potential nonlinear dynamics using a weighted generalized additive model alongside stratified analyses to test the relationship's consistency across diverse demographic and health variables.

RESULTS

Our analysis revealed a significant positive correlation between increased WWI and heightened suicidal ideation, characterized by a nonlinear relationship that persisted in the adjusted model. Subgroup analysis sustained the association's uniformity across varied population segments.

CONCLUSIONS

The study elucidates WWI's effectiveness as a predictive tool for suicidal ideation, underscoring its relevance in mental health evaluations. By highlighting the predictive value of WWI, our findings advocate for the integration of body composition considerations into mental health risk assessments, thereby broadening the scope of suicide prevention strategies.