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Del-Río-Guerrero V, Martínez-Martínez LA, Arias-Callejas K, Carbonell-Bobadilla N, Mejía-Segura A, Azamar-Morales G, Espinosa-Orantes A, Molina-Sánchez JR, Mora-Ramírez M, Mejía-Ávila MF, Vargas Guerrero A, Silveira LH, Martínez-Lavín M. The value of inquiring patients about local discomfort during blood pressure measurement for fibromyalgia detection. A cross-sectional study. Semin Arthritis Rheum 2023; 61:152218. [PMID: 37229846 DOI: 10.1016/j.semarthrit.2023.152218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 04/14/2023] [Accepted: 05/02/2023] [Indexed: 05/27/2023]
Abstract
BACKGROUND Fibromyalgia overlaps and/or mimics other rheumatic diseases and may be a confounding factor in the clinimetric assessment of these illnesses. Allodynia is a distinctive fibromyalgia feature that can be elicited during routine blood pressure measurement. For epidemiological purposes fibromyalgia can be diagnosed using the 2016 Wolfe et al. criteria questionnaire. No physical examination is required. OBJECTIVE To evaluate the role of a straightforward question formulated during routine blood pressure measurement for fibromyalgia detection in a rheumatology outpatient clinic. PATIENTS AND METHODS All adult patients attending our Rheumatology outpatient clinic were invited to participate. While awaiting their medical consultation, they filled-out the 2016 Wolfe et al. FM diagnostic criteria questionnaire. During the ensuing routine physical examination, the physician advanced the following guideline: "I am going to take your blood pressure; tell me if the cuff's pressure causes pain". Then, blood pressure cuff was inflated to 170 mm/Hg. Sphygmomanometry induced allodynia was defined as any local discomfort caused by blood pressure measurement. If a patient voiced any uneasiness, a follow-up dichotomic question was formulated "did it hurt much or little". Sphygmomanometry-induced allodynia was correlated with the presence of fibromyalgia according to the 2016 Wolfe diagnostic criteria. RESULTS Four hundred and ninety-one patients were included in the study; most of them (84%) were female. The female cohort displayed the following features: Twenty five percent had fibromyalgia. Twenty seven percent had sphygmomanometry-induced allodynia. In women, sphygmomanometry-evoked allodynia had 63% sensitivity and 84% specificity for fibromyalgia diagnosis. The area under curve was 0.751. Moreover, having "much" local pain elicitation during blood pressure testing had 23% sensitivity and 96% specificity for fibromyalgia diagnosis. Men behaved differently; 15% fulfilled the fibromyalgia diagnostic criteria, but only 2% had sphygmomanometry induced allodynia. CONCLUSIONS Inquiring female patients about local discomfort during routine blood pressure measurement is a simple and efficient procedure for fibromyalgia detection. This undemanding approach could be implemented in all clinical settings. There is marked sexual dimorphism in the link between sphygmomanometry-induced allodynia and fibromyalgia diagnosis. The presence of fibromyalgia is almost certain in those individuals having substantial pain elicitation during blood pressure measurement.
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Affiliation(s)
| | | | - Karina Arias-Callejas
- Rheumatology Department, National Institute of Cardiology, Juan Badiano 1, Mexico City 14080, Mexico
| | | | - Alejandra Mejía-Segura
- Rheumatology Department, National Institute of Cardiology, Juan Badiano 1, Mexico City 14080, Mexico
| | - Gibran Azamar-Morales
- Rheumatology Department, National Institute of Cardiology, Juan Badiano 1, Mexico City 14080, Mexico
| | | | - José-Raúl Molina-Sánchez
- Rheumatology Department, National Institute of Cardiology, Juan Badiano 1, Mexico City 14080, Mexico
| | - Mauricio Mora-Ramírez
- Rheumatology Department, National Institute of Cardiology, Juan Badiano 1, Mexico City 14080, Mexico
| | | | - Angélica Vargas Guerrero
- Rheumatology Department, National Institute of Cardiology, Juan Badiano 1, Mexico City 14080, Mexico
| | - Luis H Silveira
- Rheumatology Department, National Institute of Cardiology, Juan Badiano 1, Mexico City 14080, Mexico
| | - Manuel Martínez-Lavín
- Rheumatology Department, National Institute of Cardiology, Juan Badiano 1, Mexico City 14080, Mexico.
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Eldin C, Boudjema S, Meddeb L, Boyer L, Soriano C, Parola P, Lagier JC, Stein A, Gouriet F, Gautret P, Million M, Raoult D. Evaluation of pain susceptibility by taking blood pressure in patients with infections: A prospective comparative study. Medicine (Baltimore) 2021; 100:e26511. [PMID: 34397794 PMCID: PMC8341363 DOI: 10.1097/md.0000000000026511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Accepted: 06/10/2021] [Indexed: 01/04/2023] Open
Abstract
Pain sensitization leading to polyalgia can be observed during infectious diseases. The blood pressure cuff-evoked pain threshold (BPCEPT) has been used in previous studies as a screening tool for fibromyalgia.We aimed to use the BPCEPT as a screening test for detecting pain sensitization in patients suffering from infectious diseases. We also investigated whether specific factors were associated with pain sensitization.We performed a prospective comparative study including all patients of our infectious diseases center in a 1-year period. We created a positive control group of patients suffering from fibromyalgia and a negative control group of "apparently healthy" patients consulting for vaccination.The blood pressure (BP) cuff was inflated until the patient signaled that they experienced pain, and this pressure value was noted.A total of 2355 patients were included. The positive control group had significantly lower values of the BPCEPT than all other groups. Among hospitalized patients with infectious diseases, a low BPCEPT was significantly associated with high temperature (P < .0001), older age (P = .002), being a woman (P = .004), high serum glutamic-oxaloacetic transaminase (P = .007), and high C reactive protein levels (P = .02). Moreover, in multivariate analysis, respiratory infection, meningitis, urinary tract infection, febrile neutropenia, and Q fever were independently associated with a low BPCEPT. A significant negative dynamic correlation between the BPCEPT and temperature was also observed (P < .001).We demonstrated for the first time in a large sample of patients that the BPCEPT method can be used to detect pain susceptibility. We observed a significant dynamic correlation between pain sensitization and temperature. Additionally, pain sensitization was associated with some diseases, suggesting that they trigger pain sensitivity.
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Affiliation(s)
- Carole Eldin
- Aix Marseille University (AMU), Development Research Institute (IRD), Public Hospitals Marseille (APHM), French Defense Health Service (SSA), Vectors - Tropical and Mediterranean Infection research unit (VITROME), Marseille, France
- Institut Hospitalo-Universitaire Méditerranée Infection, Marseille, France
| | - Sophia Boudjema
- Institut Hospitalo-Universitaire Méditerranée Infection, Marseille, France
- Aix Marseille University, Development Research Institute (IRD), Public Hospitals Marseille (APHM), Microbes, Evolution, Phylogeny and Infection (MEPHI), Marseille, France
| | - Line Meddeb
- Institut Hospitalo-Universitaire Méditerranée Infection, Marseille, France
| | - Laurent Boyer
- Faculty of Medicine - Timone Medical Campus, EA 3279: Health service Research and quality of life Center, Aix Marseille University, Marseille, France
| | | | - Philippe Parola
- Aix Marseille University (AMU), Development Research Institute (IRD), Public Hospitals Marseille (APHM), French Defense Health Service (SSA), Vectors - Tropical and Mediterranean Infection research unit (VITROME), Marseille, France
- Institut Hospitalo-Universitaire Méditerranée Infection, Marseille, France
| | - Jean-Christophe Lagier
- Institut Hospitalo-Universitaire Méditerranée Infection, Marseille, France
- Aix Marseille University, Development Research Institute (IRD), Public Hospitals Marseille (APHM), Microbes, Evolution, Phylogeny and Infection (MEPHI), Marseille, France
| | - Andreas Stein
- Institut Hospitalo-Universitaire Méditerranée Infection, Marseille, France
- Aix Marseille University, Development Research Institute (IRD), Public Hospitals Marseille (APHM), Microbes, Evolution, Phylogeny and Infection (MEPHI), Marseille, France
| | - Frédérique Gouriet
- Institut Hospitalo-Universitaire Méditerranée Infection, Marseille, France
- Aix Marseille University, Development Research Institute (IRD), Public Hospitals Marseille (APHM), Microbes, Evolution, Phylogeny and Infection (MEPHI), Marseille, France
| | - Philippe Gautret
- Aix Marseille University (AMU), Development Research Institute (IRD), Public Hospitals Marseille (APHM), French Defense Health Service (SSA), Vectors - Tropical and Mediterranean Infection research unit (VITROME), Marseille, France
- Institut Hospitalo-Universitaire Méditerranée Infection, Marseille, France
| | - Matthieu Million
- Institut Hospitalo-Universitaire Méditerranée Infection, Marseille, France
- Aix Marseille University, Development Research Institute (IRD), Public Hospitals Marseille (APHM), Microbes, Evolution, Phylogeny and Infection (MEPHI), Marseille, France
| | - Didier Raoult
- Institut Hospitalo-Universitaire Méditerranée Infection, Marseille, France
- Aix Marseille University, Development Research Institute (IRD), Public Hospitals Marseille (APHM), Microbes, Evolution, Phylogeny and Infection (MEPHI), Marseille, France
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Pérez-Fernández MR, Calvo-Ayuso N, Martínez-Reglero C, Salgado-Barreira Á, Muiño López-Álvarez JL. Efficacy of baths with mineral-medicinal water in patients with fibromyalgia: a randomized clinical trial. INTERNATIONAL JOURNAL OF BIOMETEOROLOGY 2019; 63:1161-1170. [PMID: 31161236 DOI: 10.1007/s00484-019-01729-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 05/06/2019] [Accepted: 05/06/2019] [Indexed: 05/19/2023]
Abstract
The layout of this study, designed as a randomized crossover clinical trial, is to evaluate the efficacy of an intervention with mineral-medicinal water from As Burgas (Ourense) in patients suffering from fibromyalgia. This sample was randomly divided into two groups: group A and group B. In phase 1, group A had 14 baths in thermal water for a month and standard pharmacological treatment; group B, standard pharmacological treatment. Washout period is 3 months. In phase 2, group A had standard treatment and group B had 14 baths in thermal water for a month plus standard treatment. The Fibromyalgia Impact Questionnaire (FIQ) was used; this grades the impact of the illness from 1 (minimum) to 10 (maximum), which was measured in both phases. Twenty-five patients were included in each group and the study was concluded with 20 patients in group A and 20 in group B. The intervention group obtained, once the baths finished, a mean score of 60.3 (± 11.8) and the control group of 70.8 (± 13.0) (p < 0.001). Three months later, the intervention group presented a mean score of 64.4 (± 10.6) and the control group of 5.0 (± 11.3) (p < 0.001). We can therefore conclude that the simple baths with mineral-medicinal water from As Burgas can make an improvement on the impact caused by fibromyalgia.
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Affiliation(s)
- María Reyes Pérez-Fernández
- Escuela Universitaria de Enfermería de Ourense, SERGAS, Universidad de Vigo. Ourense, C/Ramón Puga 52-54, 32005, Ourense, Spain.
| | - Natalia Calvo-Ayuso
- Escuela Universitaria de Enfermería de Ourense, SERGAS, Universidad de Vigo. Ourense, C/Ramón Puga 52-54, 32005, Ourense, Spain
| | | | - Ángel Salgado-Barreira
- Unidad de Metodología y Estadística, Instituto de Investigación Sanitaria Galicia Sur, Vigo, Spain
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Jones KD, Aebischer JH, St John AW, Friend R, Bennett RM. A simple screening test to recognize fibromyalgia in primary care patients with chronic pain. J Eval Clin Pract 2018; 24:173-179. [PMID: 29063661 DOI: 10.1111/jep.12836] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2017] [Revised: 08/29/2017] [Accepted: 09/06/2017] [Indexed: 01/01/2023]
Abstract
RATIONALE, AIMS, AND OBJECTIVES Primary care providers are increasingly expected to recognize and treat fibromyalgia (FM) without significant interaction with rheumatologists. The purpose of this study was to evaluate the potential usefulness of 3 simple measures (tenderness to digital pressure, BP cuff-evoked pain, and a single patient question) as a screening test for possible FM in a patient with chronic pain. METHODS A total of 352 patients (mean age 50 ± 16.3 years, 70% female) scheduled for routine examination in 2 primary care practices were studied. They were comprised of 52 patients (14.8%) who carried a chart diagnosis of FM, 108 (30.7%) with chronic pain but not FM, and 192 who had neither pain nor FM (54.5%). Subjects were assessed for tenderness to digital pressure at 10 locations, BP cuff-evoked pain, and a single question, "I have a persistent deep aching over most of my body" (0-10). RESULTS FM patients endorsed the single deep ache question substantially more than those with chronic pain but without FM (7.4 ± 2.9 vs 3.2 ± 3.4; P < .0001) and exhibited greater bilateral digital evoked tenderness (6.1 ± 3.1 vs 2.4 ± 2.4, P < 0.0001), and BP-evoked pressure pain (132.6 mmHg ±45.5 vs 169.2 mmHg ±48.0, P < 0.0001). However, on multivariate logistic regressions, the BP cuff-evoked pain became non-significant. On further analyses, a useful screening test was provided by: (1) pain on pinching the Achilles tendon at 4 kg/pressure over 4 seconds, and (2) and positive endorsement of the question "I have a persistent deep aching over most of my body". CONCLUSION These results suggest that 2 tests, taking less than 1 minute, can indicate a probable diagnosis of FM in a chronic pain patient. In the case of a positive screen, a follow-up examination is required for confirmation or refutation.
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Affiliation(s)
- Kim D Jones
- School of Nursing, Oregon Health and Science University, Portland, USA.,School of Medicine (Anesthesiology and Perioperative Medicine), Oregon Health and Science University, Portland, USA
| | - Jonathan H Aebischer
- School of Medicine (Family Medicine), Oregon Health and Science University, Portland, USA
| | - Amanda W St John
- School of Medicine (Anesthesiology and Perioperative Medicine), Oregon Health and Science University, Portland, USA
| | - Ronald Friend
- School of Nursing, Oregon Health and Science University, Portland, USA.,Department of Psychology, College of Arts and Sciences, Stony Brook University, Stony Brook, New York, USA
| | - Robert M Bennett
- School of Nursing, Oregon Health and Science University, Portland, USA
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Abstract
Fibromyalgia is the currently preferred term for widespread musculoskeletal pain, typically accompanied by other symptoms such as fatigue, memory problems, and sleep and mood disturbances, for which no alternative cause can be identified. Earlier there was some doubt about whether there was an "organic basis" for these related conditions, but today there is irrefutable evidence from brain imaging and other techniques that this condition has strong biological underpinnings, even though psychological, social, and behavioral factors clearly play prominent roles in some patients. The pathophysiological hallmark is a sensitized or hyperactive central nervous system that leads to an increased volume control or gain on pain and sensory processing. This condition can occur in isolation, but more often it co-occurs with other conditions now being shown to have a similar underlying pathophysiology (eg, irritable bowel syndrome, interstitial cystitis, and tension headache) or as a comorbidity in individuals with diseases characterized by ongoing peripheral damage or inflammation (eg, autoimmune disorders and osteoarthritis). In the latter instance, the term centralized pain connotes the fact that in addition to the pain that might be caused by peripheral factors, there is superimposed pain augmentation occurring in the central nervous system. It is important to recognize this phenomenon (regardless of what term is used to describe it) because individuals with centralized pain do not respond nearly as well to treatments that work well for peripheral pain (surgery and opioids) and preferentially respond to centrally acting analgesics and nonpharmacological therapies.
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