EULAR revised recommendations for the management of fibromyalgia

Global mapping of physical activity promotion strategies in Fibromyalgia- A comprehensive methodological scoping review protocol

Fibromyalgia Syndrome (FMS) is a chronic, broad, diffuse, and non-inflammatory musculoskeletal condition. Several studies were conducted on the effects of physical activity (PA) and strategies to promote it in people with FMS. The resulting scoping review will provide an analysis of the strategies being researched and executed. This study outlines the protocol for a scoping review to collect, analyse and compile the promotion strategies for PA in FMS. The proposed protocol will be guided by Arksey and O'Malley's framework and advanced methodology study by Levac et al. The search method will comprise of terms pertaining to FMS, PA, and its promotion. To ascertain relevant studies, predetermined inclusion and exclusion criteria will be used. Studies included must be performed on FMS patients with PA as the intervention with an outcome related to quality of life, pain, and fatigue. Data extraction of the included studies will be done through three investigators using Rayyan software. Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) will be used to describe the study.

Common Pain Disorders in Women: Diagnosis, Treatment, and Rehabilitation Management

There is well-established epidemiologic evidence demonstrating variance in the pain disorders affecting women compared with men, although limited conclusive evidence exists regarding the pathophysiologic mechanisms to account for this difference. Six of the most common pain disorders affecting women include migraine headache, fibromyalgia, endometriosis, interstitial cystitis, temporomandibular disorders, and osteoarthritis. The sex-specific prevalence, risk factors, triggers, presentations, and treatments of these disorders are critical for physicians to appreciate and understand to provide the highest standard of care when treating these common pain conditions.

Brain modulatory effects of rehabilitation interventions in fibromyalgia: a systematic review of magnetic resonance imaging studies

OBJECTIVES

Fibromyalgia imposes a considerable burden of disability worldwide, and its therapies include rehabilitation interventions. However, the overall brain modulatory effects of rehabilitation interventions and their effects on clinical improvements in patients with fibromyalgia remain unclear. This systematic review of magnetic resonance imaging studies synthesised evidence for the brain modulatory effects of rehabilitation in patients with fibromyalgia.

METHODS

We searched PubMed, EMBASE, and Web of Science databases from inception to August 2023 for English articles on rehabilitation-induced brain function changes in patients with fibromyalgia. Methodological evaluation was performed using the Physiotherapy Evidence Database checklist.

RESULTS

We included 17 studies with 416 participants reporting the brain modulatory effects of several rehabilitation methods (i.e. exercises, brain stimulation, cognitive behavioural therapy, nerve stimulation, and neurofeedback). These studies received fair to good scores on the Physiotherapy Evidence Database scale. Rehabilitation-induced changes in brain function were correlated with the presentation of fibromyalgia. From the included studies, baseline brain functions could successfully predict posttreatment changes in disease symptoms. However, limited evidence is available for the effects of rehabilitation on brain structure.

CONCLUSION

Rehabilitation was found to modulate brain functions to alleviate fibromyalgia symptoms and improve patients' quality of life. This finding supports the hypothesis that brain modulation is one of the mechanisms underlying the rehabilitation-mediated mitigation of fibromyalgia. Our results suggest that brain function measured through functional magnetic resonance imaging can help predict the response of patients with fibromyalgia to rehabilitation programmes (PROSPERO registration number: CRD42023387612).

Therapeutic approach to fibromyalgia: a consensus statement on pharmacological and non-pharmacological treatment from the neuropathic pain special interest group of the Italian neurological society

BACKGROUND

Although fibromyalgia is a disabling disease, there is no targeted therapy for specific neurotransmitters or inflammatory mediators. Our aim was to provide neurologists with practical guidance for the management of these difficult patients based on a critical, narrative and non-systematic review of randomized controlled trials (RCTs) from the last 10 years.

METHODS

The members of the Special Interest Group Neuropathic Pain of the Italian Neurological Society evaluated the randomized controlled trials (RCTs) of the last 10 years and answered questions that allow a consensus on the main pharmacological and non-pharmacological approaches.

RESULTS

The neuropathic pain working group agreed on prescribing antiepileptic drugs or antidepressants in the case of comorbidities with anxiety and depression. As a second choice, experts have agreed on the association of antiepileptics and antidepressants, while they disagree with the use of opioids. Medical cannabis and nutraceuticals are promising new treatment options, although more data is needed to prove their efficacy. The neurologists agreed in suggesting physical activity at the first visit, particularly aerobic and strength training. As a second choice, they considered a cognitive behavioral therapy approach to be useful.

CONCLUSIONS

Pharmacologic treatment with antiepileptic drugs and antidepressants in patients with co-occurring anxiety and depression, as well as an early nonpharmacologic approach based primarily on physical activity, may be a useful indication in contemporary neurology clinical practice. Non-pharmacological options, such as cognitive behavioral therapy and non-invasive brain stimulation NIBS, could improve evidence of efficacy and lead to relevant improvement in FM-related disability.

Efficacy of Low-Dose Naltrexone in Treating Patients with Fibromyalgia: systematic Review and Meta-Analysis

Low-dose naltrexone (LDN) has demonstrated mixed efficacy in treating fibromyalgia. This systematic review and meta-analysis aimed to evaluate the efficacy of LDN for fibromyalgia. We systematically searched electronic databases and gray literature from inception to May 2024. Included studies were clinical trials in humans published in English, reporting mean changes in pain scores and fibromyalgia symptom severity, comparing baseline to endpoint and LDN to placebo. Of 575 identified articles, eight met the eligibility criteria. In the LDN group, the Standardized Mean Difference (SMD) for pain decreased by 1.03 (95% confidence interval (CI): -1.25, -0.80; I2 = 25%), and fibromyalgia symptom severity decreased by 1.02 (95% CI: -1.35, -0.69; I2 = 52%) post-LDN treatment compared to the baseline. However, no significant differences in mean change in pain (SMD -0.50, 95% CI: -1.19, 0.19; I2 = 91%) and fibromyalgia symptoms severity scores (SMD -0.67, 95% CI: -1.67, 0.34; I2 = 95%) were observed between the LDN and placebo groups. Although LDN marginally reduced pain and symptom severity from baseline, these effects were not superior to placebo. This suggests that LDN may not provide significant clinical benefit over placebo in fibromyalgia management, warranting further research.

Structural changes in the upper trapezius muscle of fibromyalgia patients identified by quantitative ultrasonography: a cross-sectional study

The heterogeneity of symptoms among patients with fibromyalgia (FM) makes the development of standardized diagnostic criteria challenging. No imaging technique has reliably shown FM-related muscle changes to aid clinical assessment. This study aimed to quantitatively analyze the upper trapezius muscle in FM patients using B-mode ultrasonography and blob analysis and to examine its correlation with clinical parameters. A total of 34 female FM patients and 34 healthy controls were included in this cross-sectional study. B-mode ultrasonography was used to image the dominant-side upper trapezius muscle, and MATLAB-based blob analysis was performed to assess blob size, blob count, and echointensity. These measurements were correlated with disease severity indices, including the Central Sensitization Inventory (CSI), Visual Analog Scale (VAS) for pain, Fibromyalgia Impact Questionnaire (FIQ), 36-Item Short Form Survey (SF-36), and Beck Depression and Anxiety Inventories (BDI, BAI). FM patients had significantly higher total blob size (p < 0.001) and blob size per mm² (p < 0.001) than controls. Echointensity was significantly increased in the FM group (p = 0.009). Total blob size showed a moderate positive correlation with CSI scores (p = 0.002). Regression analysis indicated that pain-VAS was a significant predictor of total blob size per mm² (p < 0.001). Blob analysis demonstrated quantifiable muscle alterations in FM, supporting its potential role as an objective assessment tool. Given the correlation between muscle echotexture and FM severity, quantitative ultrasonography may contribute to a better understanding of FM pathophysiology.

Discounting seems the most toxic dimension of invalidation in fibromyalgia: a cross-sectional analysis

Invalidation, both discounting (overt negative social responses) and lack of understanding (absence of positive social responses), is a common problem in fibromyalgia. The 'Fibromyalgia Imbalance of Threat and Soothing Systems' (FITSS) model indicates that different neuropsychological processes may underlie these two components of invalidation. Guided by this model, the aim of the current study was to clarify the differentiation between these two components of invalidation by examining their association with fibromyalgia severity, anxiety, and depression. This cross-sectional study included the Illness Invalidation Inventory (3*I), the Fibromyalgia Impact Questionnaire (FIQ), and the Hospital and Depression Scale (HADS). Demographics of the 280 respondents with fibromyalgia were: mean age 42.6 ± 11.8 yrs., 95% female, mean FIQ score 59.1 ± 15,5, possible or probable cases of anxiety and depression, 49% and 42%, respectively. Regression analyses revealed that discounting was associated with severity of fibromyalgia (t = 4.10, β = 0.34, p <.001), anxiety (t = 3.50, β = 0.29, p <.001) and depression (t = 3.64, β = 0.30, p <.001) symptoms. Neither lack of understanding (-1.62 ≤ t ≤.10, -0.13 ≤ β ≤ 0.01, p ≥ 0.11) nor the interaction of discounting and lack of understanding (-0.19 ≤ t ≤ 1.10, -0.01 ≤ β ≤ 0.07, p ≥ 0.27) was related to any of the outcome variables. The total model accounted for 8.8%, 5.3%, and 8.3% (adjusted R2) of variance in fibromyalgia severity, anxiety, and depression, respectively. In relation to both mental and physical health, discounting seems the most toxic dimension of invalidation in fibromyalgia. This suggests that overt negative responses should get attention in its management, especially in more severe fibromyalgia. Both people with fibromyalgia and people in their environment have a role in reducing invalidation.

Impact of Manual Therapy on Plantar Pressures in Patients with Fibromyalgia: A Single-Arm, Non-Randomized Pilot Clinical Trial

BACKGROUND

Fibromyalgia (FM) is a chronic disorder causing widespread musculoskeletal pain, often leading to physical deconditioning that affects posture and gait. This study evaluates the effects of a manual therapy protocol targeting dorsal muscles in the lower back on plantar pressure modifications, considering body mass index (BMI) influence.

METHODS

A single-arm, non-randomized clinical trial included 24 women diagnosed with FM for at least three years. They underwent an eight-session manual therapy protocol over four weeks, applying moderate pressure to dorsal muscles in the lower back. Baropodometric analyses were conducted pre- and post-intervention under dynamic conditions. Statistical analyses used paired t-tests and effect size calculations to assess intervention effects and BMI impact.

RESULTS

Significant improvements in plantar pressure distribution were observed in both the left foot (p = 0.01, d = -0.54) and the right foot (p = 0.008, d = -0.59). However, strength and peak pressure metrics showed no significant changes. Patients with normal BMI exhibited greater improvements than those in the overweight category.

CONCLUSIONS

Preliminary findings suggest that manual therapy positively influenced plantar pressure distribution in FM patients, particularly in those with normal BMI. Further research is needed to explore long-term effects and broader clinical applications.

Clinical Relevance of Contact Allergy to Gold Sodium Thiosulphate in Fibromyalgia

Fibromyalgia is a chronic syndrome characterized by pain, fatigue, and cognitive disturbances. The increased prevalence of contact allergy to gold in individuals with fibromyalgia when compared with the general population has previously been described. Gold contact allergy can manifest as a systemic contact dermatitis, with cutaneous and extracutaneous manifestations presenting upon systemic administration of gold. This study aimed to establish whether gold allergy is of significance in the fibromyalgia population. Prior to patch testing with the Swedish baseline series and an extended dental series, 119 females with fibromyalgia answered questionnaires including details of past medical history, dental history, and previous cutaneous and mucous membrane intolerance to metals. Prevalence of allergy to gold sodium thiosulphate (2.0% and 5.0%) was 33.6% (40 individuals). There was a statistically significant overrepresentation of gold allergy among individuals who experienced cutaneous symptoms upon direct contact with gold (p = 0.010). Contact allergy to gold was more frequent among patients with oral symptoms (p = 0.024). This study demonstrates concordance between reported cutaneous symptomatology related to gold exposure and gold allergy in the fibromyalgia population. Whether individuals with oral symptoms and gold allergy have objective oral clinical findings and relevant gold exposure is the focus of ongoing study.

VR-guided exercise and mindfulness program for people with chronic pain: a randomised controlled cross-over pilot trial

BACKGROUND

Physical exercises and mindfulness are important components in the management of chronic pain, but pain may reduce exercise adherence. Virtual reality (VR) can provide cognitive inhibition of the ascending pain signal and may thus be a tool for the delivery of pain management during exercise interventions. In this study we assessed a VR-guided intervention seeking to improve physical fitness in individuals with chronic pain.

METHODS

Participants in rehabilitation for chronic pain were included in a randomised controlled pilot trial with a cross-over design. In counter-balanced order participants were asked to perform, five minutes of aerobic exercise following identical instructions given through either a VR headset or television (TV) screen. The procedures were then repeated with mindfulness exercises. Heart rate (HR) was monitored throughout all four sessions and participants self-reported perceived exercise intensity, benefit, relaxation, and reward. Paired Student's t-test, Wilcoxon signed rank test and McNemar's test were performed to compare the outcome variables across sessions for individuals, as appropriate. (Clinical trial registration NCT06611566 09.09.24, retrospectively registered).

RESULTS

Twenty-seven participants were included in the study. The mean age (SD) was 40.4 (11.3) years, and 17 (63%) were men. Mean HR, the proportion of time spent at moderate-vigorous exercise intensity levels, and all self-reported measurements were comparable between the VR vs. TV sessions. No major adverse events were reported. The physiological and perceived exercise outputs of aerobic exercises were thus similar across modes of delivery (VR vs. TV) in individuals with chronic pain.

CONCLUSIONS

This study confirms the possibilities of VR-guided interventions in the pain management of individuals with chronic pain with comparable levels of exertion to TV-guided exercise and few adverse events. The promise of VR-guided mindfulness in the rehabilitation of patients with chronic pain conditions is also confirmed.

The impact of a heat therapy intervention on pain and fibromyalgia symptoms in patients with fibromyalgia: a pilot study

Introduction

FM is characterized by widespread musculoskeletal pain and associated somatic symptoms including fatigue, cognitive difficulties, and problems with sleeping. Multidisciplinary treatment of fibromyalgia including pharmacologic and non-pharmacologic interventions are recommended to improve symptoms and physical functioning. The goal of the present pilot investigation was to evaluate the effects of heat therapy via hot water immersion on clinical and objective pain measures in addition to blood measurements of heat shock proteins (HSPs) and inflammatory markers in patients with FM.

Methods

After screening, informed consent, and enrollment into the study, all subjects underwent a baseline pre-intervention evaluation which included a battery of pain phenotyping questionnaires, quantitative sensory testing, and collection of blood for measurements of HSPs and inflammatory markers. Subjects received heat therapy three times a week for four weeks, where they were immersed in hot water for 45 min. After four weeks, participants completed the same battery of testing done at baseline.

Results

We found that four weeks of heat therapy via hot water immersion in patients with FM showed statistically significant reductions in average and worst pain NRS severity scores when compared to baseline. There was also statistically significant improvement in overall impact of fibromyalgia symptoms, physical function, and sleep-related impairment. Regarding heat shock proteins, there was a statistically significant reduction in HSP90 and induction of HSP40 and HSC70. The number of extracellular vesicles were also statistically significantly increased. There were no statistically significant changes found in depression, anxiety, quantitative sensory testing measures, or pro- or anti-inflammatory markers.

Conclusions

As a whole, these findings suggest that heat therapy via hot water immersion may be an effective non-pharmaceutical intervention for patients with FM and that its analgesic benefits may be related to decreases in HSP 90 and increases in HSP 40 and 72. Further large-scale, well-powered studies are needed to confirm our preliminary clinical and translational results.

Motor cortex repetitive transcranial magnetic stimulation in fibromyalgia: a multicentre randomised controlled trial

BACKGROUND

Despite affecting 2-4% of the population worldwide, fibromyalgia often remains refractory to treatment. Here we report the first international randomised double-blind, sham-controlled trial developed to assess the efficacy of repetitive transcranial magnetic stimulation (rTMS) as an add-on therapy for fibromyalgia.

METHODS

Women aged ≥18 yr with fibromyalgia refractory to best available treatment were enrolled in Brazil, France, and Japan, and randomised to 10 Hz motor cortex (M1) rTMS, 3000 pulses day-1, or sham stimulation. This included 10 induction sessions over 2 weeks, followed by weekly maintenance (6 weeks), and fortnightly extended maintenance (8 weeks). Primary outcome was ≥50% pain reduction at week 8 compared with baseline. Secondary outcomes included pain interference, mood, global impression of change, and Fibromyalgia Impact Questionnaire (FIQ) scores at weeks 8 and 16.

RESULTS

We randomised 101 women (mean age 48 [range 25-83] yr) into active (n=52) or sham (n=49) arms. Bayesian analysis revealed a 99.4% probability of ≥50% pain reduction at week 8 in the active group vs sham (odds ratio [OR] 3.04; 95% credible interval [95% CrI] 1.26-8.06), with a number needed to treat of 4.54. Frequentist analysis confirmed that relative pain reduction was higher in the active than in the sham group (40.4% vs 18.4%, P=0.028). At week 16, this probability reduced to 34.2% (OR 0.815; 95% CrI 0.313-2.1), but the likelihood of FIQ score reduction was 79.1%. The intervention appeared safe.

CONCLUSIONS

Add-on M1-repetitive transcranial magnetic stimulation reduced pain intensity up to 8 weeks in women with fibromyalgia. Although analgesic effects waned, functional improvements remained during extended maintenance at week 16.

Exploring patient activation and self-management experiences in adults with fibromyalgia: a qualitative evidence synthesis

Objectives

Fibromyalgia syndrome (FMS) is a chronic pain condition that affects involvement in daily activities, including self-care and household responsibilities. Self-management strategies are a primary focus in treatment recommendations. However, their effectiveness depends on an individual's readiness and capacity to adopt health-promoting behaviours. This study aims to explore the experiences of adults in their self-management journey, focusing on the barriers and facilitators influencing patient activation (PA) and effective self-management.

Methods

A qualitative evidence synthesis was conducted. An electronic search was performed using the following databases: CINAHL, PsycINFO, PubMed, Medline, ScienceDirect and AMED. The studies were screened against eligibility criteria to ensure their relevance. The quality of the included studies was assessed against the Critical Appraisal Skills Programme (CASP) questionnaire for qualitative studies and the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist. Findings from the papers were synthesized via the three-stage thematic synthesis process, and common themes were identified.

Results

Nine studies with a total of 130 participants were included. Four major analytical themes were identified, including legitimizing FMS, the value of medical support, receiving peer and social support, and learning to self-manage.

Conclusion

Self-management of FMS requires patients to be actively involved in managing their health. These findings highlight that support from HCPs, family members and peers helps patients learn how to self-manage and engage in health-promoting behaviours. Clinicians treating people with FMS should prioritize education, empathy and personalized support.

Evolution of the Quality of Life of Long-Term Fibromyalgia Users of Millimeter Wave-Based Neuromodulation: A Real-World Retrospective Study

Purpose

Fibromyalgia (FM) is a widespread pain condition, associated with other symptoms such as fatigue, sleep disorders, stiffness, and mood disturbances. It significantly impacts patients' quality of life (QoL) and poses a substantial challenge due to the lack of a definitive cure. This study aimed to report real-world data on the long-term use (18 months) of a millimeter (MMW)-based neuromodulation device and tracking application, and its effects on various health dimensions in a self-declared FM population.

Methods

This retrospective study was based on data including daily MMW wristband use and health parameters assessed at baseline (D0) and tracked weekly (pain, stiffness and fatigue) or quarterly (QoL, quality of sleep and impression of change). The primary inclusion criteria were a self-reported diagnosis of FM and consistent device usage for a minimum of 18 months.

Results

The inclusion criteria were met by 185 users. There was a reduction in the Fibromyalgia Impact Questionnaire (FIQ) scores, with an average reduction of 27% after the first three months (M3), indicating improved QoL, and stabilization thereafter. Similar improvements were observed in sleep quality, stiffness and fatigue. In contrast, pain intensity showed a continuous decline throughout the 18-month period.

Conclusion

The significant improvements in QoL, pain intensity, and sleep quality, maintained over time, underline the MMW device's ability to provide sustained relief and enhance daily lives of people with FM.

How does chronic psychosocial distress induce pain? Focus on neuroinflammation and neuroplasticity changes

Chronic primary pain including fibromyalgia for the musculoskeletal system persists for more than 3 months. Its etiological factors and the pathophysiological mechanisms are not known, and therefore, there is no satisfactory therapy, it is an unmet medical need condition. The only etiological and aggravating factor is chronic psychosocial distress, which is known to cause neuroimmune and endocrine changes both in the periphery and the central nervous system. In this short review, we introduce our research perspective by summarizing the recent literature on the interactions between chronic pain, stress, and commonly co-morbid mood disorders. Immune activation, autoimmunity, neuro-immune-vascular crosstalks and neuroinflammation play roles in the pathophysiology of these conditions. Data on stress-induced neuroplasticity changes at cellular and molecular levels were also collected in relation to chronic primary pain both from clinical studies and animal experiments of translational relevance. Understanding these mechanisms could help to identify novel therapeutic targets for chronic primary pain including fibromyalgia.

Self-management interventions for chronic widespread pain including fibromyalgia: a systematic review and qualitative evidence synthesis

ABSTRACT

Supporting behavioural self-management is increasingly important in the care for chronic widespread pain (CWP), including fibromyalgia. Understanding peoples' experiences of these interventions may elucidate processes and mechanisms that lead to or hinder their intended impact. We conducted a systematic review and thematic synthesis of qualitative studies exploring peoples' experiences of self-management interventions for CWP, including fibromyalgia. MEDLINE, Embase, PsycINFO, CINAHL, and Web of Science were searched. Primary qualitative or mixed-methods studies were included if they explored people's self-management intervention experiences for their CWP, including fibromyalgia. Screening, data extraction, and critical appraisal were conducted by 2 reviewers. Data analysis was conducted through thematic synthesis. Twenty-three studies were included, mostly were rated as high or moderate quality. We developed 4 analytic themes: A multifaceted experience of the intervention, potential for transformative experience of group cohesion, a new outlook, and striving for change after the loss of support. Broadly, personalisation was perceived as beneficial and people experienced a range of emotional experiences. These appeared to support positive behavioural and cognitive changes. For most, group activities promoted acceptance and support, fostering new perspectives and improved self-management, although some found aspects of group contexts challenging. Lack of on-going support after interventions led to challenges in applying behavioural strategies, and some struggled without social support from the group. The experiences of self-management interventions for CWP reflect a complex, multifaceted process. Although many reported positive experiences, addressing issues with integration of physical activity, group dynamics and postintervention support may improve effectiveness for a broader range of people.

Immune-inflammatory effects of the multicomponent intervention FIBROWALK in outdoor and online formats for patients with fibromyalgia

The multicomponent intervention FIBROWALK integrates pain science education (PSE), therapeutic exercise, cognitive behavioral therapy (CBT), and mindfulness training for treating fibromyalgia (FM). This study investigated the effects of the FIBROWALK in online (FIBRO-On) and outdoor (FIBRO-Out) formats compared to treatment-as-usual (TAU) on core clinical variables along with serum immune-inflammatory biomarkers and brain-derived neurotrophic factor (BDNF). Furthermore, the predictive value of these biomarkers on clinical response to FIBROWALK was also evaluated. 120 participants were randomly divided into three groups: TAU, TAU + FIBRO-On or TAU + FIBRO-Out. Clinical and blood assessments were conducted pre-post treatment. Both FIBRO-Out and FIBRO-On showed effectiveness (vs TAU) by improving functional impairment and kinesiophobia. Individuals allocated to FIBRO-Out (vs TAU) additionally showed decreases in pain, fatigue, depressive symptoms, and serum IL-6 and IL-10 levels along with IL-6/IL-4 ratio; patients allocated to FIBRO-On only showed a less stepped increase in IL-6 compared to TAU. An exaggerated pro-inflammatory profile along with higher levels of BDNF at baseline predicted greater clinical improvements in both active treatment arms. Our results suggest that FIBROWALK -in online and outdoor formats- is effective in individuals with FM and has significant immune regulatory effects in FM patients, while immune-inflammatory pathways and BDNF levels may in part predict its clinical effectiveness. Trial registration number NCT05377567 (clinicaltrials.gov).

Efficacy of a home-based stretching programme on fibromyalgia symptoms: study protocol for a randomised controlled trial

BACKGROUND

This protocol was developed to describe the design of a randomised controlled trial that will examine the clinical efficacy of a 6-week, novel, home-based stretching programme compared with usual care on the effect of symptoms experienced by patients with fibromyalgia. The hypothesis is that the total score of the Fibromyalgia Impact Questionnaire (FIQ-R) and other fibromyalgia symptoms will improve 6 weeks following the stretching intervention compared with usual care.

METHODS

Fifty-eight adults under 65 years of age diagnosed with fibromyalgia will be recruited for this study. Participants will be randomised into an intervention group and a control group (waitlist). Randomisation will be stratified by sex. The intervention group will perform 6 weeks of daily stretching exercises for 6 min-a day. The control group will maintain usual care. A mHealth app will support stretching adherence. The primary outcome will be the total score of the Revised Fibromyalgia Impact Questionnaire (FIQ-R). The secondary outcomes include regional and widespread pain sensitivity, range of motion, quality of life (SF-36), mental and physical functioning and adherence. Evaluations will be performed at baseline, following 6 weeks of daily stretches (primary endpoint) and 6 months after the termination of the intervention period (secondary endpoint).

DISCUSSION

By investigating the clinical efficacy of a 6-week, novel, home-based stretching programme, we hope to provide applicable and generalisable knowledge about the efficacy of stretching exercises that can potentially help ease the burden of symptoms experienced by patients with fibromyalgia.

TRIAL REGISTRATION

NTC, NCT06487741. Registered on 24 June 2024.

Fibromyalgia Diagnosis and Treatment Receipt in the U.S. Military Health System

INTRODUCTION

Meta-analytic findings and clinical practice guidance recommend pharmacological (e.g., pregabalin, duloxetine, and milnacipran) and non-pharmacological (e.g., exercise and sleep hygiene) interventions to reduce symptoms and improve quality of life in people living with fibromyalgia. However, some of these therapies may lack robust evidence as to their efficacy, have side effects that may outweigh benefits, or carry risks. Although the annual prevalence of fibromyalgia in active duty service members was estimated to be 0.015% in 2018, the likelihood of receiving a fibromyalgia diagnosis was 9 times greater in patients assigned female than male and twice as common in non-Hispanic Black than White service members. Therefore, the primary goal of this retrospective study is to examine co-occurring conditions and pain-management care receipt in the 3 months before and 3 months after fibromyalgia diagnosis in active duty service members from 2015 to 2022.

MATERIALS AND METHODS

Medical record information from active duty service members who received a fibromyalgia diagnosis between 2015 and 2022 in the U.S. Military Health System was included in the analyses. Bivariate analyses evaluated inequities in co-occurring diagnoses (abdominal and pelvic pain, insomnia, psychiatric conditions, and migraines), health care (acupuncture and dry needling, biofeedback and other muscle relaxation, chiropractic and osteopathic treatments, exercise classes and activities, massage therapy, behavioral health care, other physical interventions, physical therapy, self-care management, and transcutaneous electrical nerve stimulation), and prescription receipt (anxiolytics, gabapentinoids, muscle relaxants, non-opioid pain medication, opioids, selective serotonin and norepinephrine inhibitors, and tramadol) across race and ethnicity and assigned sex. Pairwise comparisons were made using a false discovery rate adjusted P value.

RESULTS

Overall, 13,663 service members received a fibromyalgia diagnosis during the study period. Approximately 52% received a follow-up visit within 3 months of index diagnosis. Most service members received a co-occurring psychiatric diagnosis (35%), followed by insomnia (24%), migraines (20%), and abdominal and pelvic pain diagnoses (19%) fibromyalgia diagnosis. At least half received exercise classes and activities (52%), behavioral health care (52%), or physical therapy (50%). Less commonly received therapies included other physical interventions (41%), chiropractic/osteopathic care (40%), massage therapy (40%), transcutaneous electrical nerve stimulation (33%), self-care education (29%), biofeedback and other muscle relaxation therapies (22%), and acupuncture or dry needling (14%). The most common prescriptions received were non-opioid pain medications (72%), followed by muscle relaxers (44%), opioids (32%), anxiolytics (31%), gabapentinoids (26%), serotonin-norepinephrine reuptake inhibitor (21%), selective serotonin reuptake inhibitors (20%), and tramadol (15%). There were many inequities identified across outcomes.

CONCLUSION

Overall, service members diagnosed with fibromyalgia received variable guideline-congruent health care within the 3 months before and after fibromyalgia diagnosis. Almost 1 in 3 service members received an opioid prescription, which has been explicitly recommended against use in guidelines. Pairwise comparisons indicated unwarranted variation across assigned sex and race and ethnicity in both co-occurring health conditions and care receipt. Underlying reasons for health and health care inequities can be multisourced and modifiable. It is unclear whether the U.S. Military Health System has consolidated patient resources to support patients living with fibromyalgia and if so, the extent to which such resources are accessible and known to patients and their clinicians.

Comparing face-to-face and internet-based basic body awareness therapy for fibromyalgia: a randomized controlled trial

PURPOSE

This study aimed to investigate and compare the effecs of face-to-face and internet-based Basic Body Awareness Therapy (BBAT), in patients with fibromyalgia (FM).

MATERIALS AND METHODS

FM-diagnosed patients were randomly allocated to one of three groups: face-to-face BBAT (F2F-BBAT), internet-based BBAT (I-BBAT), or a waiting list control group (CG). The F2F-BBAT group underwent individual 8-week BBAT sessions (2 sessions per week). The I-BBAT group received an equivalent dosage of BBAT via online video conferencing software. The primary outcome was the Fibromyalgia Impact Questionnaire Revised (FIQR). Secondary outcomes included the pressure pain threshold (PPT) via algometer, the PostureScreen Mobile® (PSM) application, the Short Form McGill Pain Questionnaire (SF-MPQ), the Short Form 36 Health Survey (SF-36), and plasma fibrinogen and haptoglobin levels.

RESULTS

A total of 41 patients completed the study. Both the F2F-BBAT (n = 14) and I-BBAT (n = 13) groups showed significant improvements in all outcome measures (p < 0.05) with no significant difference between them (p > 0.05). Conversely, the CG (n = 14) demonstrated no substantial improvements in the outcome measures (p > 0.05). Compared to the CG, both the F2F-BBAT and I-BBAT groups exhibited superior results in FIQR, PPT, PSM, SF-MPQ, and multiple SF-36 sub-parameters (p < 0.05).

CONCLUSION

This study showed that BBAT delivered via internet-based telerehabilitation can have comparable effective results on clinical parameters with conventional face-to face BBAT in patients with FM.

TRIAL REGISTRATION

ClinicalTrials.gov: NCT04981132.

The effect of health education on symptom severity in patients with fibromyalgia: a systematic review and meta-analysis

Fibromyalgia (FM) is a complex chronic disorder characterized by widespread pain as the primary symptom. To evaluate the effect of health education on the severity of various symptoms in patients with FM, seven databases were searched from inception to August 2024 to identify randomized controlled trials evaluating the effects of health education for FM. The primary outcome was overall symptom severity, and the secondary outcomes were pain, depression, anxiety, sleep quality, fatigue, physical function and self-efficacy. The Cochrane Risk-of-Bias tool for randomized trials and the Grading of Recommendations, Assessment, Development, and Evaluations were used to assess the quality of the included studies and the certainty of evidence, respectively. Treatment effects were estimated by calculating Hedges' g and the corresponding 95% confidence intervals. Meta-analysis included a total of 13 trials. The results revealed that health education significantly reduced overall symptom severity, depression and anxiety and increased sleep quality and physical function among patients with FM (all P values < 0.05). However, no significant effects were observed on pain, fatigue and self-efficacy. Health education may be a beneficial intervention for FM patients, particularly for mitigating symptom severity. Health-care providers should implement health education interventions to empower patients to effectively manage their symptoms.

Fibromyalgia and Inflammation: Unrevealing the Connection

Fibromyalgia represents a chronic pain pathology characterized by severe musculoskeletal pain, fatigue, disturbances in sleep, and cognitive issues. Despite its presence, the underlying mechanisms of fibromyalgia remain inadequately understood; however, recent investigations have suggested that inflammation could play a fundamental role in the pathophysiology of this condition. Several studies highlight elevated concentrations of pro-inflammatory cytokines, dysregulation of immune responses, and neuroinflammation in fibromyalgia patients. Furthermore, chronic low-grade inflammation has been proposed as a potential catalyst for the sensitization of pain pathways, which exacerbates the symptoms of fibromyalgia. Understanding the role of inflammation in this disease might open new avenues for therapeutic interventions while providing a more profound insight into the complex nature of this debilitating disorder. Although progress has been made, further research is needed to uncover the complexities involved. This review investigates the intricate relationship between inflammation and fibromyalgia, analyzing the evidence that supports the involvement of both peripheral and central inflammatory processes in the onset and persistence of the disorder.

Global research trends on fibromyalgia and exercise: a ten-year Web of Science-based bibliometric analysis

Fibromyalgia causes widespread pain, exhaustion, and cognitive deficits, lowering sufferers' quality of life. Exercise supports the management of fibromyalgia by reducing pain and improving mood. This study examines global fibromyalgia and exercise research trends using bibliometric analysis to identify major contributors, citation patterns, and prospective research areas. Data were obtained from the Web of Science (WoS) database utilizing the keywords "fibromyalgia exercise" for publications from 2014 to 2023. The inclusion criteria prioritized original articles and reviews published in the English language. Bibliometric characteristics were examined, including publication year, country, journal, and citation metrics. Statistics adjusted for population and gross domestic product (GDP) were computed to evaluate research productivity in relation to economic and demographic variables. A total of 497 publications satisfied the inclusion criteria. A significant increase trend in publication counts was noted (p = 0.003), with Spain (25.75%), the United States (15.09%), Brazil (13.88%), Türkiye (7.24%), and Sweden (5.23%) identified as the major contributors. Publications were produced by 37 countries, 19 of which were the main active countries. Spain displayed remarkable productivity, ranking first in population- and GDP-adjusted contributions. Based on publication type, 388 (78.06%) were original articles, and the rest were reviews. The median number of original article and review citations were 11 (min = 0; max = 289) and 14 (min = 0; max = 1092). Review citations outnumbered original articles (p = 0.013). The median number of citations for SCIE and/or SSCI and ESCI articles were 12 (min = 0; max = 1092) and 3 (min = 0; max = 92). SCIE and/or SSCI articles were significantly more cited than ESCI ones (p < 0.001). INT J ENV RES PUB HE (n = 18), RHEUMATOL INT (n = 17), ARCH PHYS MED REHAB (n = 15), J CLIN MED (n = 14) and DISABIL REHABIL (n = 13) were the top five journals in terms of article count. This bibliometric analysis evaluates and summarizes global scholarly output on fibromyalgia and exercise, underscoring the increasing research interest in the two. High-income countries, notably Spain, the United States, and Sweden, significantly contributed to the area, underscoring differences in research capacities.

The Association of Pain Medication Usage and Quantitative Sensory Testing Outcomes in Fibromyalgia Patients: A Secondary Data Analysis

BACKGROUND

Fibromyalgia syndrome (FMS), a chronic pain syndrome affecting 0.2-6.6% of the general population, is known for its challenging diagnosis and treatment. The known dysregulation in the Endogenous Pain Modulatory System (EPMS) characteristic of the pathology contributes to enhanced pain sensitivity. Fibromyalgia patients, who are often overmedicated, may experience, in addition to the drug-related known adverse effects, effects on fibromyalgia sensory-related outcomes. Therefore, the focus of this analysis is to explore the bidirectional drug-sensory outcome interactions, indexed by the conditioned pain modulation (CPM), an important assessment element in regard to an EPMS's efficacy.

METHODS

Baseline data from a randomized, double-blind, single-center (Boston-based tertiary hospital) clinical trial (NCT03371225) were analyzed. Participants aged 18-65 with an FMS diagnosis and resistance to common analgesics were included. Demographic, clinical, and sensory variables, including CPM, temporal summation, and Pain-60 outcomes, were collected alongside a pain medication diary. Multivariable regression models adjusted for confounders were applied to explore associations between medication classes and quantitative sensory outcomes.

RESULTS

Out of 101 recruited FMS patients, we categorized the use of the following medications: antidepressants with 50% use (n = 50), muscle relaxants with 26% use (n = 26), and gabapentin with 25% use (n = 25). The results showed that antidepressant use correlated with worsened CPM, Odds Ratio = 0.39 (95% CI = 0.17-0.91), while muscle relaxants were linked to increased TSPS, β coefficient = 0.72 (95% CI = 0.0021-1.4431). On the other hand, gabapentin use was associated with elevated Pain-60, OR = 2.68 (95% CI = 0.98-7.31). Interestingly, the use of low doses of opioids was not associated with altered sensory measures.

CONCLUSION

This cross-sectional analysis suggests that common pain medications may affect quantitative sensory outcomes in FMS patients. We provided important insights into bidirectional drug-sensory outcome interactions and their influence on pain medicine.

The Impact of Standard Care Versus Intrinsic Relaxation at Home on Physiological Parameters in Patients with Fibromyalgia: A Comparative Cohort Study from Romania

Background and Objectives: Fibromyalgia (FM), through the presence of widespread chronic pain, stiffens the musculoskeletal system and causes sleep disturbances and fatigue. Through this study, we aimed to compare the effectiveness of two different recovery interventions for improving sleep quality: a standard, multidisciplinary intervention in a recovery hospital versus a therapy focused on intrinsic relaxation at home. Materials and Methods: This study included 60 adult patients who participated voluntarily and were diagnosed with FM by a rheumatologist, randomly divided into two groups. During this study, 30 patients out of the 60 were randomly assigned to experimental group 1 and underwent treatment at the Recovery Clinical Hospital in Băile Felix. The other 30 patients were assigned to experimental group 2 and underwent treatment at home. They were assessed on the first and last day of the recovery program using the Fatigue Severity Scale (FSS) and the Pittsburgh Sleep Quality Index (PSQI). Results: In experimental group 1, where by patients underwent hospital recovery (EG1), the results show that the severity of fatigue (FSS) was significantly reduced, with p = 0.00 and an effect size of 0.77, which suggests a general improvement in the state of fatigue, as well as in the quality of sleep evaluated with the PSQI (p = 0.00, effect size = 0.55). In experimental group 2 (EG2), no change was observed between assessments in terms of the FSS, but in terms of the quality of sleep, there was a small decrease in the PSQI score (p = 0.083), with a small effect size of 0.09. Conclusions: The results show that, from a clinical point of view, a complex treatment carried out daily improves sleep quality and reduces fatigue.

Healing synchrony? potential benefits of interpersonal synchrony for chronic pain management

Fibromyalgia is called a pathology of misconnection at the neurophysiological, psychological, and social levels, and is characterised by widespread musculoskeletal pain, which is accompanied by a series of symptoms, such as chronic fatigue, depression, anxiety, body perception disturbances, and cognitive deficits. In this article, I argue that interventions that in various ways enhance interpersonal neural synchronisation (INS) may bring long-term benefits to people with fibromyalgia (PwF). In the first part, I briefly introduce studies on INS in the general population. In the second part, I hypothesise that interpersonal synchrony may contribute to symptom reduction for individuals with fibromyalgia, in the sense that repeated experience of being in sync with others may play a role in restoring both the brain-body and self-others connection in this population and consequently result in simultaneous lasting improvement of wellbeing. In the final part, I discuss potential future research directions.

Fibromyalgia: Understanding, Diagnosis and Modern Approaches to Treatment

Fibromyalgia (FM) is a chronic condition characterized by generalized musculoskeletal pain associated with other symptoms, especially sleep and mood disorders, fatigue, and cognitive dysfunctions. The etiopathogenesis of FM is not sufficiently known, and regardless of numerous research, the clinical presentation is nonspecific, which makes it difficult to approve a timely diagnosis and, subsequently, an adequate therapeutic approach. Genetic, hormonal, immunological, and environmental factors are cited as potential factors in the development of this condition. Diagnosis is based on a clinical approach and known diagnostic criteria, while additional methods, such as radiographic, magnetic resonance, or laboratory analyses, can be useful to exclude other conditions. The heterogeneity of FM significantly impacts both diagnosis and treatment, as it presents a wide spectrum of symptoms that vary in severity, combinations, and underlying contributing factors. This variability is a challenge for clinicians and requires a holistic, comprehensive, multidisciplinary, patient-centered approach. According to The European League Against Rheumatism (EULAR) from 2016, treatment begins with patient education and involves the simultaneous application of pharmacological and nonpharmacological treatments. The application of only pharmacological or nonpharmacological treatment is most often not successful. Due to differences in pain threshold, psychological factors, and comorbidities, patients may respond differently to the same interventions. Although there is no universal treatment, this review brings up the fact that the timely recognition of symptoms and a tailored treatment with a patient-centered plan can significantly improve the quality of life of patients.

Serum choline, leptin and interleukin-6 levels in fibromyalgia syndrome-induced pain: a case-control study

BACKGROUND

Fibromyalgia Syndrome (FMS) predominantly affects middle-aged women, characterized by musculoskeletal pain, fatigue, and cognitive issues. Choline, an endogenous molecule, may influence FMS due to its analgesic and anti-inflammatory properties. This study compared choline, leptin, and interleukin-6 (IL-6) levels in FMS patients and controls and examining their association with pain severity.

METHODS

Volunteers with FMS were clinically diagnosed at a Physical Medicine and Rehabilitation Department. The control group included pain-free volunteers. Pain severity was gauged using a numeric scale, dietary choline intake through a questionnaire. Serum choline, leptin and (interleukin)IL-6 levels were measured from fasting blood samples of volunteers with enzyme-linked immunosorbent assays (ELISA).

RESULTS

All FMS patients (n = 38) and healthy volunteers (n = 38) were female. Pain score in patients with FMS was 7.6 ± 0.2. Dietary choline intake was lower in patients with FMS than the controls (p = 0.036). Serum choline and leptin levels were lower in the FMS group compared to control (p = 0.03). Serum IL-6 levels were higher in the FMS group than in the control (p < 0.001). There was weak positive correlation between IL-6 levels and pain scores and there were no correlation between leptin levels and pain scores in FMS.

CONCLUSIONS

This research highlights FMS's complex nature, involving neurochemical, immunological, and nutritional factors. It suggests the significance of choline's anti-inflammatory effect, leptin's metabolic function, and IL-6's role in FMS pathology. The results suggest that reduced dietary choline might influence serum choline, leptin, and IL-6 levels, potentially impacting FMS-related pain. This points to the potential of supplementary choline intake in FMS management.

TRIAL REGISTRATION

Not applicable (Non-interventional study).

A systematic mapping review of clinical guidelines for the management of fatigue in long-term physical health conditions

PURPOSE

Despite a high prevalence of fatigue and its importance to patients, many people with long-term conditions do not receive fatigue management as part of their treatment. This review is aimed to identify clinical guidance for the management of fatigue in long-term physical health conditions.

METHODS

A systematic mapping review was conducted in accordance with Social Care Institute for Excellence systematic review guidance. Bibliographic databases and guideline repositories were searched for clinical guidelines for long-term conditions, published between January 2008 and July 2018, with a search for updates conducted in May 2023. Data were extracted on the recommendations made for managing fatigue and, where cited, the underlying research evidence used to support these recommendations was also extracted.

RESULTS

The review included 221 guidelines on 67 different long-term conditions. Only 30 (13.6%) of the guidelines contained recommendations for managing fatigue. These were categorised as clinical (e.g. conduct further investigations), pharmacological, behavioural (e.g. physical activity), psychological, nutritional, complementary, environmental, and multicomponent. The guidelines rated much of the evidence for fatigue management as fairly low quality, highlighting the need to develop and test fatigue-management strategies in high-quality trials.

CONCLUSION

This review highlights that management of fatigue is a very important neglected area in the clinical guidelines for managing long-term conditions.

Do patients with fibromyalgia syndrome receive updated management strategies? A web-based survey among Italian physiotherapists

INTRODUCTION

Fibromyalgia syndrome (FMS) causes significant pain, disability, and costs among patients. It is paramount that healthcare professionals have an updated knowledge of its characteristics and Clinical Practice Guidelines (CPGs).

OBJECTIVES

To determine the knowledge, adherence to CPGs, and confidence of Italian physiotherapists in managing patients with FMS, explore barriers to the implementation of CPG' recommendations, compare groups' adherence to CPGs, and determine which variables explained most of the participants' knowledge.

METHODS

The survey was administered via social media and newsletter (i.e., Italian Association of Physiotherapists, AIFI) to Italian practicing physiotherapists. The protocol of this work was prospectively registered in the Open Science Framework.

RESULTS

Total replies were 398. Italian physiotherapists showed a good knowledge of FMS and adherence to CPGs. Ninety-one percent reported a medium or lower confidence in managing patients with FMS. Sixty-seven percent judged their knowledge of CPGs as poor or very poor. The remaining 33% mentioned patients' psychosocial aspects, multidisciplinary relationships, and lack of training on communication strategies as the main barriers to the implementation of CPGs. Being an Orthopaedic Manipulative Physical Therapist (OMPT) resulted in a better adherence to CPGs on 11/14 items. Knowledge scores were correlated (r = 0.244) with being an OMPT (Stand β = 0.123) and years of professional activity (Stand β = -0.126).

CONCLUSIONS

Although Italian physiotherapists demonstrated a good knowledge of FMS and reported a good adherence to CPGs' recommendations, they may still experience barriers to the implementation of evidence-based management strategies.

The impact of community-based, non-pharmaceutical interventions on anxiety and depression in fibromyalgia: A systematic review and network meta-analysis

BACKGROUND

Fibromyalgia syndrome (FMS) is often accompanied by anxiety and depression, seriously affecting the prognosis of patients. Active non-pharmacological therapies are the mainstay of treatment, but the optimal choice is still contentious.

METHODS

We did a network meta-analysis(NMA) of RCTs and compared 7 community-based non-pharmacological interventions based on 29 studies. We searched Embase, MEDLINE, PubMed, Scopus, Google Scholar, Web of Science, and the Cochrane Central Register of Controlled Trials (CENTRAL) from the database inception to March 2022.

RESULTS

The NMA demonstrated that five out of six (83.34%) non-pharmacological interventions were associated with significant improvement in anxiety compared with usual care, with a standardized mean difference (SMD) ranging from -1.14 (95% CI: -1.76 to -0.51) for aquatic exercise to -0.39 (95% CI: 073-0.05) for meditation; six of the seven non-pharmacological interventions (85.71%) were associated with significant improvement in depression, with SMD ranged from -1.18 (95% CI: -1.68 to -0.68) for aquatic exercise to -0.46 (95% CI: -0.86 to -0.05) for education therapy.

LIMITATION

First of all, there were scale translation biases in this study caused by the different languages of the original study. In addition, there was a lack of direct comparison between the aquatic exercise group and the routine care group, and the third included intervention measures lacked unified implementation standards.

CONCLUSION

Aquatic exercise exhibited distinct advantages compared with other community-based non-pharmacological interventions and is likely to have optimal efficacy in improving anxiety and depression. The study protocol is registered with the Prospective Register of Systematic Reviews (PROSPERO, CRD 42022338406).

The effect of the EXOPULSE Mollii Suit on pain and fibromyalgia-related symptoms-A randomized sham-controlled crossover trial

BACKGROUND

Fibromyalgia pain and related symptoms are poorly managed by approved pharmacological and alternative interventions. This trial aimed to evaluate the effects of the EXOPULSE Mollii Suit-a multisite transcutaneous electrical nerve stimulation device-on fibromyalgia pain, fatigue, affective symptoms, disease impact, and quality of life.

METHODS

Adult patients with fibromyalgia were enrolled. Phase 1 implied a randomized, sham-controlled, cross-over, double-blind trial, applying daily 1 h sessions of active or sham intervention, over 2 weeks (2-week washout). In the open-label phase 2, all patients received daily active intervention for 4 weeks. Comparisons on pain, fatigue, disease impact, affective symptoms, quality of life, clinical impression, and comfort ratings were performed using Friedman, Wilcoxon signed rank, and Chi2 tests.

RESULTS

Thirty-three patients completed the study (93.9% female, mean age: 51.3 years). Pain (primary endpoint assessed via a visual analog scale) was significantly reduced after the active (pre-active: 6.9 ± 1.4, post-active: 5.9 ± 1.8, pre-sham: 6.8 ± 1.4, post-sham: 6.6 ± 1.5) versus the sham intervention (X2 = 10.60, p = 0.014). This was also the case of other secondary endpoints (i.e., fatigue, anxiety, and disease impact), except depression and quality of life. The Clinical Global Impression of Change (CGI-C) was significantly different between the active and sham intervention periods (X2 p = 0.035), and the different proportions of categories were as follows: 'worsening' (sham: 18.2% vs. active: 0.0%), 'improvement' (sham: 48.5% vs. active 63.6%) or 'no change (sham: 33.3% vs. active 36.4%) respectively. After phase 2, significant positive effects were observed for most of the outcomes, and 78.8% of patients reported improvement according to CGI-C.

CONCLUSIONS

This study suggests the clinical benefits of the EXOPULSE Mollii Suit in alleviating pain and fibromyalgia-related fatigue, emotional symptoms, and disease impact. It is worth noting that the study has several limitations related to the low number of participants, the short-term analysis of effects in the first blinded and controlled phase, and the open-label nature of phase 2. Future studies with a larger cohort and longer protocol treatment are needed, to further confirm the current results, and evaluate the long-term effects of this technique.

SIGNIFICANCE

Patients with fibromyalgia suffer from pain as well as fatigue, sleep impairment, emotional disturbances, and altered quality of life. Transcutaneous electrical nerve stimulation might help manage those symptoms, but the available systems are limited by the fact that they could be applied at best over two sites. This randomized controlled study is the first to apply a multi-site transcutaneous electrical nerve stimulation device, the EXOPULSE Mollii Suit, with significant effects on fibromyalgia pain and related symptoms.

Fibromyalgia: do I tackle you with pharmacological treatments?

Pharmacological approaches are frequently proposed in fibromyalgia, based on different rationale. Some treatments are proposed to alleviate symptoms, mainly pain, fatigue, and sleep disorder. Other treatments are proposed according to pathophysiological mechanisms, especially central sensitization and abnormal pain modulation. Globally, pharmacological approaches are weakly effective but market authorization differs between Europe and United States. Food and Drug Administration-approved medications for fibromyalgia treatment include serotonin and noradrenaline reuptake inhibitors, such as duloxetine, and pregabalin (an anticonvulsant), which target neurotransmitter modulation and central sensitization. Effect of analgesics, especially tramadol, on pain is weak, mainly on short term. Low-dose naltrexone and ketamine are gaining attention due their action on neuroinflammation and depression modulation, but treatment protocols have not been validated. Moreover, some treatments should be avoided due to the high risk of abuse and severe side effects, especially opioids, steroids, and hormonal replacement.

Management of Fibromyalgia: Novel Nutraceutical Therapies Beyond Traditional Pharmaceuticals

The pathophysiology of fibromyalgia, a condition that causes chronic pain throughout the body, involves abnormal pain signaling, genetic predispositions, and abnormal neuroendocrine function, significantly impairing quality of life. Fibromyalgia is commonly characterized by musculoskeletal pain, chronic fatigue, and severe sleep alterations. Changes in the central processing of sensory input and defects in endogenous pain inhibition could be the basis of enhanced and persistent pain sensitivity in individuals with fibromyalgia. The term central sensitivity syndrome was chosen as an umbrella term for fibromyalgia and related illnesses, including myalgic encephalomyelitis/chronic fatigue syndrome, migraine, and irritable bowel syndrome. Given the substantial impact of fibromyalgia on health, there is a need for new prevention and treatment strategies, particularly those involving bioavailable nutraceuticals and/or phytochemicals. This approach is particularly important considering the adverse effects of current fibromyalgia pharmaceutical treatments, such as antidepressants and anticonvulsants, which can lead to physical dependence and tolerance. Natural products have recently been considered for the design of innovative analgesics and antinociceptive agents to manage fibromyalgia pain. Polyphenols show promise in the management of neuropathic pain and fibromyalgia, especially considering how anti-inflammatory treatments, including corticosteroids and nonsteroidal medical drugs, are effective only when inflammatory processes coexist and are not recommended as the primary treatment for fibromyalgia.

Can mindfulness have long-term impact on patients with fibromyalgia? A two-year prospective follow-up study of a mindfulness-based intervention

To examine changes in symptoms and health status in patients with fibromyalgia (FM) 24 months after participating in the mindfulness-based group-program, the Vitality Training (VTP), followed by physical exercise counselling. Seventy-six participants, mean age (range) 43 (26-52), females 69 (91%), diagnosed with FM according to the ACR 2011-criteria received the VTP in a previous randomised controlled trial. Control group participants could receive the VTP after a 12-month observation period, therefore only data from the intervention group were analysed in the present study. Self-reported data were collected electronically at baseline, 3, 12 and 24 months. Outcomes were patient global impression of change (PGIC), FM-severity, i.e. widespread pain (WPI) and symptom severity (SSS), pain, fatigue, sleep quality, psychological distress, motivation and barriers for physical activity, mindfulness and work participation. Trends across time-points were analysed using mixed models for repeated measurements. At 24-months, 48 (56.5%) participants responded, 94% female, median (range) age 46 (28-54), symptom duration 12 (5-33) years. Seven participants reported much/very much better on the PGIC; 21 (44%) reported no change/minimal improvement. Improvements were observed in WPI (-1.9, ES 0.4), SSS (-1.2, ES 0.6), fatigue (-0.8, p =.014) and self-efficacy for physical activity (1.4, ES 0.4). There was a significant trend of reduced WPI, SSS, pain and fatigue across the four time-points, but no additional improvements from 12 to 24-month follow-up. Participants who had completed the VTP demonstrated small to moderate improvements in symptom burden and FM-severity from baseline to 24-month follow-up. Trial registration number: ISRCTN96836577 https://doi.org/10.1186/ISRCTN96836577 , prospectively registered 12.07.2016.

Effects of manual lymphatic drainage on pain intensity, impact of disease and quality of life in women with fibromyalgia syndrome: a double-blind randomized sham-controlled trial

PURPOSE

This study aimed to investigate the effectiveness of Manual Lymphatic Drainage (MLD) on the pain intensity, impact of the disease, and health-related quality of life among women diagnosed with Fibromyalgia syndrome (FMS).

METHODS

The study was designed as a single-center, double-blind, randomized, and sham-controlled trial. Twenty women with FMS were included and randomized into intervention (n = 11) and sham control (n = 9) groups. In the intervention group, MLD was applied in addition to medical treatment, whereas the sham control group received sham MLD along with medical care over a period of 3 weeks. The Visual Analog Scale (VAS), Fibromyalgia Impact Questionnaire (FIQ-R), and 12-item Short Form Survey (SF-12) were used to measure outcomes. Participants were assessed baseline, immediately after the treatment, at 12 weeks, and at 24 weeks.

RESULTS

The VAS score, the FIQ-R symptom and FIQ-R overall scores, and SF-12 score showed a statistically significant time effect (p < 0.05) in intervention group. No significant main effects in any parameters for any time interval were observed in the sham group (p > 0.05).

CONCLUSION

MLD added to medical treatment may be an effective alternative method that could be used in the treatment of FMS to reduce pain intensity and improve impact of disease.

Knowledge mapping and emerging trends in cognitive impairment associated with chronic pain: A 2000-2024 bibliometric study

Chronic pain is commonly recognized as a distressing symptom or a standalone disease, with over half of those affected experiencing cognitive impairment, which significantly impacts their quality of life. Despite a recent surge in literature on cognitive impairment associated with chronic pain, a comprehensive bibliometric analysis in this field has yet to be conducted. In this study, we performed a bibliometric analysis on this topic. We retrieved English-language publications on chronic pain and cognitive impairment from 2000 to 2024 using the Web of Science Core Collection database. These publications were visually analyzed using tools such as VOSviewer, CiteSpace, and the R package "bibliometrix." We identified 1656 publications from 72 countries/regions across 722 journals on the topic of chronic pain and cognitive impairment. Publication numbers showed a steady increase, peaking in 2022. The United States led in contributions, with Harvard Medical School emerging as the most prominent institution involved. The journal Pain was the most prolific and frequently co-cited in this area. Among the authors, Stefan Duschek was the most productive, while Frederick Wolfe was the most frequently co-cited. Key research areas include investigating the bidirectional long-term effects between chronic pain and cognitive impairment and exploring the mechanisms underlying cognitive changes associated with chronic pain. In conclusion, this study highlights a global surge in research on cognitive impairment related to chronic pain. Emerging hotspots and future research trends point towards brain imaging mechanisms and neuronal circuit-mediated processes.

Shockwave therapy and fibromyalgia and its effect on pain, blood markers, imaging, and participant experience - a multidisciplinary randomized controlled trial

BACKGROUND

Patients with fibromyalgia experience chronic, widespread pain. It remains a misunderstood disorder with multimodal treatments providing mixed results.

OBJECTIVES

To examine the effects of radial shockwave therapy (RSWT) compared to placebo on pain, pain catastrophizing, psychological indices, blood markers, and neuroimaging. Study-related experiences were also explored qualitatively.

METHODS

Quantitative sensory testing (QST), Visual Analog Scale (VAS), Beighton Scoring Screen (BSS), Pain Catastrophizing Scale (PCS), blood biomarker (Interleukin (IL)-6 and IL-10), and brain fMRI were measured pre- and post-treatment along with a post-treatment survey. The RSWT group received five treatments (one week apart over five-week period) to the three most painful areas (500 shocks at 1.5 bar and 15 Hz, then 1000 shocks at 2 bar and 8 Hz, and finally 500 shocks at 1.5 bar and 15 Hz) versus sham treatment for the placebo group.

RESULTS

There were no statistically significant differences in the BSS for hypermobility (p = .21; d = .74), PCS (p = .70; d = .22), VAS (p = .17-.61; d = .20-.83) scores, QST for skin temperature and stimuli (p = .14-.65; d = .25-.88), and for the pressure pain threshold (p = .71-.93; d = .05-.21). The VAS scores had clinically significant changes (MCID greater than 13.90) with improved pain scores in the RSWT group. Neuroimaging scans revealed no cortical thickness changes. Post-treatment surveys revealed pain and symptom improvements and offered hope to individuals.

CONCLUSION

RSWT was implemented safely, without any negative treatment effects reported, and acted as a pain modulator to reduce sensitivity.

CLINICAL TRIALS REGISTRATION

ClinicalTrials.gov identification number NCT02760212.

Effects of home-based exercise on the health of patients with fibromyalgia syndrome: a systematic review of randomized clinical trials

PURPOSE

Analyze the effects of interventions with home-based physical exercise on the health of patients with fibromyalgia and the characteristics of the protocols used.

METHODS

This systematic review was registered at PROSPERO and followed the PRISMA recommendations. Searches were performed in six electronic databases. Eligibility criteria for the selection of studies were compiled using the acronym PICOS. Data were extracted and checked in a Microsoft Excel® spreadsheet and the risk of bias was assessed using the Rob 2 tool.

RESULTS

The search resulted in seven studies included for analysis. Among them, the most common modality was aerobic exercise. The analyzed outcomes were: pain, quality of life, depression, anxiety, disease severity, physical function, pain catastrophizing, self-efficacy, psychological well-being, sleep quality and somatosensory and temporal discrimination. The effects of home-based exercise are limited, and improvements in pain and quality of life was found. For the other outcomes, the results were inconclusive. Most studies presented some concerns about the risk of bias.

CONCLUSION

It is necessary to expand the evidence on home-based exercises for fibromyalgia, as this is the first systematic review on the subject. Subsequent research should focus on methodological rigor and protocol detail, allowing findings to be replicated.

Virtual reality as a treatment for chronic musculoskeletal pain syndromes

Chronic musculoskeletal pain syndromes, including fibromyalgia, are often resistant to conventional medications and invasive therapies. Central hypersensitization, neurotransmitter dysregulation, and autonomic nervous system abnormalities are key pathomechanisms, frequently resulting in widespread pain and a variety of psychosomatic symptoms. Virtual Reality (VR) applications have demonstrated effectiveness in reducing pain, both during and after interventions, and in chronic conditions such as fibromyalgia and back pain. The proposed mechanisms behind VR's effectiveness include distraction and immersion, coupled with cognitive behavioral therapy, which promote neuroplasticity and alter pain perceptions. Functional MRI studies have shown the impact of VR interventions on specific brain regions. Advances in hardware and software, potentially combined with treatments like biofeedback, could enhance VR's role in managing chronic pain. Currently, VR for musculoskeletal pain syndromes is primarily used within multimodal programs, but it is also available for home use as a standalone health application. Future research should focus on the 'drug-like' effects of VR, requiring controlled trials with comparable study populations and appropriate sham interventions.

An immersive virtual reality exergame as a patient education approach in fibromyalgia: Pilot study

Background

Immersive Virtual Reality (VR) has been applied in pain management for various conditions, but its use in fibromyalgia (FM) remains underexplored. While physical activity plays a role in treating FM, patients' low tolerance often limits its effectiveness. After reviewing the literature on VR and games for FM, we designed a novel VR exergame to assist FM patients in performing physical activity, and evaluate its feasibility.

Materials and Methods

This pilot study involved three female subjects with FM and four healthy female volunteers. The main outcomes included qualitative assessments of exertion, pain levels, psychological states experienced during the VR session, but also device comfort.

Results

Improvements in perceived exertion and pain intensity were observed during the VR exergame session in comparison to pre-exergame levels, along with a reduction in depression, stress and anxiety levels while using the VR immersive system. Most participants experienced also increase of relaxation and positive emotions during the exergame. Only one participant was not able to complete all levels of the exergame due to musculoskeletal pain exacerbation; nevertheless, this patient reported an improvement in motivation and enjoyment during the gameplay. Many participants expressed a greater motivation to perform the exercises in the VR environment compared to traditional training methods.

Conclusion

The proposed VR exergame is a feasible system that might reduce depression, stress and anxiety, while boosting motivation and relaxation in both healthy and FM subjects. A calibration protocol is required to tailor the system to each user's pain levels and physical abilities.

Identification and Management of Medical Comorbidities in Patients With HR+/HER2- Metastatic Breast Cancer Treated With CDK4/6 Inhibitors: Literature Review and Recommendations From Experts in Spain Opinion

Approximately one-third of patients with breast cancer have comorbidities at the time of their diagnosis. Recommendations for managing metastatic breast cancer are usually based on the results of clinical trials, which often limit patients with comorbidities. However, comorbidities greatly influence the quality of life, patient survival rate and treatment choice, particularly in older patients. The objective of this review was to identify clinically relevant comorbidities in patients with metastatic breast cancer, analyze the clinical approach to the treatment of these comorbidities, and propose recommendations from experts. An expert panel of eight medical oncologists identified seven therapeutic areas associated with the most relevant comorbidities in metastatic breast cancer: cardiovascular, gastrointestinal, endocrine/metabolic, renal, geriatric, psychological, and pain related. A clinical specialist from each therapeutic area specific to the relevant comorbidities (n = 8) joined the panel of experts (n = 8) to provide guidance on the appropriate management of these comorbidities. The specific comorbidities analyzed were hypertension, atrial fibrillation, venous thromboembolism, obesity, diabetes mellitus, cancer cachexia, chronic kidney disease, age-related disorders, arthritis, and fibromyalgia. In most cases, patients with metastatic breast cancer and medical comorbidities are polymedicated and/or vulnerable to toxicity. The oncologists provided recommendations on initial assessment and monitoring, follow-up recommendations, and warning signs and symptoms for referral to corresponding specialists based on their experience. The panel of experts also explored clinical scenarios related to each comorbidity and recommended a preferred CDK4/6 inhibitor based on available evidence regarding drug-drug interactions and potential for toxicity.

Effectiveness of a Multicomponent Program for Fibromyalgia Patients in a Primary Care Setting (FIBROCARE Program): A Pragmatic Randomized Controlled Trial

Background/Objectives: Multicomponent, non-pharmacological therapies are the preferred first-line treatments for fibromyalgia (FM), but little is known about them in primary care settings. Our study assessed the effectiveness of the FIBROCARE Program in improving the quality of life, functional impact, mood, and pain of people with FM. Methods: We conducted a pragmatic, randomized controlled trial that was not blinded for both patients and the professionals delivering the treatments in the study groups. We compared a group receiving non-pharmacological multicomponent group therapy (MT) based on health education, physical exercise, and cognitive-behavioral therapy with another group receiving the usual clinical care. The MT group was treated in the primary care context in Catalonia (Spain) through 12 consecutive weekly sessions. Both groups were followed up with at the end of the MT group sessions and 6 and 12 months after the group sessions with the Short-Form 36 (SF-36) v2 Health Survey questionnaire, the Hospital Anxiety and Depression Scale (HADS-A and HADS-D), the Visual Analog Scale, and the Revised Fibromyalgia Impact Questionnaire (ClinicalTrials.gov: NCT04049006). Results: Improvements in pain intensity, functional impact, physical health, fatigue, and emotional problems that affect daily activities in the MT group lasted up to 12 months. Benefits measured by the SF-36 Mental Health dimension and the HADS-A subscale were lost after 6 months. Effects on the SF-36 Social Functioning dimension and HADS-D present at 6 months persisted for up to 12 months. Generally, the longer the time since the FM diagnosis, the better was a patient's mood. Conclusions: The FIBROCARE Program effectively improves all the studied health outcomes except patient mood, since anxiety symptoms persist. The program should reinforce patient psychological support overall, focusing particularly on the years initially after diagnosis.

Metformin and fibromyalgia pathophysiology: current insights and promising future therapeutic strategies

Fibromyalgia (FM) is a complex, chronic pain syndrome characterized by widespread musculoskeletal pain, fatigue, and cognitive disturbances. Despite its prevalence, the pathophysiology of FM remains poorly understood, with current treatments often providing limited relief. Recent studies have suggested that metformin, a widely used antidiabetic drug, may have potential therapeutic benefits for chronic pain conditions, including FM. This review aims to provide current insights into the role of metformin in FM pathophysiology, focusing on its neurotransmitter-modulating and anti-inflammatory effects. Metformin has been shown to mitigate neuroinflammation, protect neural tissues, and modulate key neurotransmitters involved in pain and mood regulation. These effects are particularly evident in animal models, where metformin has been observed to reduce pain sensitivity, improve mood-related behaviors, and decrease levels of pro-inflammatory cytokines like interleukin 1-beta (IL-1β). Additionally, the ability of metformin to influence serotonin, norepinephrine, and glutamate levels suggests a potential mechanism for its analgesic and mood-stabilizing effects. However, the current evidence is largely preclinical, and further research is needed to confirm these findings in human studies. This review aims to encourage researchers to explore the association between metformin and FM more deeply, with the hope of uncovering new therapeutic strategies that could offer relief to FM patients.

Knowledge, attitude and practice toward fibromyalgia among fibromyalgia patients: A web-based cross-sectional study in China

BACKGROUND

This study aimed to explore the knowledge, attitude and practice (KAP) of fibromyalgia patients toward fibromyalgia.

METHODS

This web-based cross-sectional study was conducted in China between February and March 2023 among fibromyalgia patients using a self-administered questionnaire.

RESULTS

A total of 401 valid questionnaires were enrolled, including 326 (81.30%) females and with a mean age of 42.42 ± 11.78 years. The mean scores for KAP were 7.14 ± 2.72 (possible range: 0-10), 27.31 ± 4.24 (possible range: 8-40) and 28.08 ± 5.55 (possible range: 10-50), respectively. Multivariate logistic regression analysis showed knowledge (OR = 1.09, 95%CI: 1.04-1.15, P = 0.001) and patient global impression (PGI) on average pain severity in the last week (OR = 0.89, 95%CI: 0.81-0.97, P = 0.011) were independently associated with positive attitude. Attitude (OR = 1.08, 95%CI: 1.02-1.14, P = 0.006), initial consultation in orthopedics (OR = 2.15, 95%CI: 1.24-3.73, P = 0.006) and age (OR = 0.98, 95%CI: 0.96-1.00, P = 0.037) were independently associated with proactive practice. The structural equation model demonstrated that knowledge had a positive effect on attitude (β = 0.21, P = 0.006), and Widespread Pain Index (WPI) exhibited an impact on both knowledge (β = -0.04, P < 0.001) and attitude (β = -0.52, P = 0.001).

CONCLUSION

Fibromyalgia patients showed suboptimal knowledge, moderate attitude and inactive practice toward fibromyalgia. To enhance fibromyalgia patient outcomes, recommendations include targeted education, addressing rural-urban disparities in knowledge, emphasizing early diagnosis, and adopting patient-centered approaches to promote positive attitude and better disease management.

Using Natural Language Processing and Social Media Data to Understand the Lived Experience of People with Fibromyalgia

BACKGROUND AND OBJECTIVES

Fibromyalgia has many unmet needs relating to treatment, and the delivery of effective and evidence-based healthcare is lacking. We analyzed social media conversations to understand the patients' perspectives on the lived experience of fibromyalgia, factors reported to trigger flares of pain, and the treatments being discussed, identifying barriers and opportunities to improve healthcare delivery.

METHODS

A non-interventional retrospective analysis accessed detail-rich conversations about fibromyalgia patients' experiences with 714,000 documents, including a fibromyalgia language tag, which were curated between May 2019 and April 2021. Data were analyzed via qualitative and quantitative analyses.

RESULTS

Fibromyalgia conversations were found the most on Twitter and Reddit, and conversation trends remained stable over time. There were numerous environmental and modifiable triggers, ranging from the most frequent trigger of stress and anxiety to various foods. Arthritis and irritable bowel syndrome (IBS) were the most frequently associated comorbidities. Patients with fibromyalgia reported a wide range of symptoms, with pain being a cardinal feature. The massage, meditation and acupuncture domains were the most reported treatment modalities. Opportunities to improve healthcare delivered by medical providers were identified with current frustration relating to a lack of acknowledgement of their disease, minimization of symptoms and inadequately meeting their care needs.

CONCLUSIONS

We developed a comprehensive, large-scale study which emphasizes advanced natural language processing algorithm application in real-world research design. Through the extensive encapsulation of patient perspectives, we outlined the habitual symptoms, triggers and treatment modalities which provide a durable foundation for addressing gaps in healthcare provision.

Effectiveness of a brief multicomponent intervention to improve physical activity level and functional capacity in fibromyalgia and chronic fatigue syndrome (Synchronize+)

Introduction

Fibromyalgia (FM) and chronic fatigue syndrome (CFS) are complex central sensitization syndromes that represent an important public health problem. Low cardiorespiratory fitness and muscle function with habitual intolerance to efforts are common characteristics of FM and CFS. This study aimed to examine the effect of a brief multicomponent intervention based on physical activity (PA), nutrition, and chronobiology on movement behaviors (PA, sedentary and sleep time), muscle strength, and cardiorespiratory capacity.

Methods

randomized controlled trial was conducted in primary healthcare in Catalonia. A total of 143 individuals with FM or FM and CFS concomitantly (age 50.8, SD 8.1; 94.4% women) were randomly allocated to the intervention (IG, n = 69) or control (CG, n = 74) groups. The IG participated in a brief multicomponent (PA, nutrition, and chronobiology) group-based intervention (4 sessions, 3 h/session) while the CG received usual primary care practice. Primary outcome measure was PA measured by the REGICOR-Short Physical Activity Questionnaire. Secondary outcomes were sedentary (International Physical Activity Questionnaire) and sleep time (Pittsburgh Sleep Quality Index), upper- and lower-body muscle strength (handgrip and sit-to-stand test, respectively), and aerobic capacity (6-min walk test). Data were collected at baseline and 3 months post-intervention.

Results

The IG showed positive differences at 3-month follow-up, with highly appreciably PA levels, less sedentary time, and significantly improved sleep time. Significant between-group differences were also observed at 3 months, with better health values in the IG: PA and sleep time (370.3 ± 307.0 vs. 195.9 ± 289.1 min/week and 6.1 ± 1.6 vs. 5.5 ± 1.8 h/night, respectively) and less sedentary time (266.2 ± 153.3 vs. 209.4 ± 199.9 min/day). The IG also showed higher upper limb strength and significant lower-body strength both between and within groups, as well as significantly improved cardiorespiratory capacity.

Conclusion

The Synchronize + multicomponent program implemented at primary healthcare has shown short-term effectiveness in improving 24-h movement behaviors and health outcomes in individuals with FM, with or without CFS. This intervention may be a first step in educating and motivating people with FM and CFS to adopt an active lifestyle, leading to improved health. Long-term follow-up will determine whether the changes are maintained over time and their impact on quality of life and healthcare costs.

Effect of Pilates on Pain and Health-Related Quality of Life in Fibromyalgia Patients: A Systematic Review and Meta-Analysis

Background: Pilates is one of the non-pharmacological interventions for fibromyalgia (FM). However, its impacts on pain and health-related quality of life (HRQOL) in fibromyalgia patients (FMPs) are inconclusive. This study aimed to assess the effects of Pilates on pain and HRQOL among FMPs. Methods: A systematic review and meta-analysis were conducted. Four databases-PubMed, ScienceDirect, Scopus, and Cochrane CENTRAL-along with one grey literature source, Google Scholar, were searched for randomized controlled trials comparing Pilates with other exercises or usual care in FMPs. The outcomes were pain and HRQOL. A meta-analysis was performed using a random-effects model. Results: Six studies were included (n = 265). We found that the effects of Pilates from each individual study on pain were inconsistent. Our pooled analysis of visual analog scale (VAS) scores demonstrated significant pain reduction (mean difference (MD), -0.71, 95%CI, -1.33 to -0.10, p = 0.023; (I2 = 29.3%, p = 0.226)). However, neither the algometric score (AS) nor tender point count (TPC) showed an insignificant difference (AS: MD, -0.43, 95%CI, -2.60 to 1.74, p = 0.700; (I2 = 0.0%, p = 0.654); TPC: MD, -0.16, 95%CI, -2.22 to 1.89, p = 0.520; (I2 = 0.0%, p = 0.515)). Regarding HRQOL, Pilates showed statistically significant improvements on the Fibromyalgia Impact Questionnaire (FIQ) (MD, -7.28, 95%CI, (-12.06 to -2.49), p = 0.003; (I2 = 95.7%, p < 0.001)). A sensitivity analysis of three RCTs (n = 176) based on the ACR 2010 supported this finding (MD, -7.68, 95% CI, -8.60 to -6.76, p < 0.001; (I2 = 0.0%, p = 0.832)) with non-important heterogeneity. Conclusions: Pilates may benefit FMPs. It could reduce pain and improve HRQOL. Given the small number of studies and the presence of data heterogeneity, future high-quality RCTs would provide a clearer conclusion.

Electroacupuncture Mitigates TRPV1 Overexpression in the Central Nervous System Associated with Fibromyalgia in Mice

BACKGROUND

Fibromyalgia (FM) is characterized by chronic pain, significantly affecting the quality of life and functional capabilities of patients. In addition to pain, patients may experience insomnia, chronic fatigue, depression, anxiety, and headaches, further complicating their overall well-being. The Transient Receptor Potential Vanilloid 1 (TRPV1) receptor responds to various noxious stimuli and plays a key role in regulating pain sensitivity and inflammation. Thus, targeting TRPV1 may provide analgesic and anti-inflammatory benefits. This study investigates the efficacy of electroacupuncture (EA) in alleviating chronic pain in FM through TRPV1 and its downstream molecules in the central nervous system (CNS).

METHODS

To model FM, we subjected mice to intermittent cold stress (ICS) for three days. The study comprised five rodent groups: Control (CON), ICS, ICS + EA, ICS + Sham EA, and ICS + KO (TRPV1 knockout mice).

RESULTS

Our findings revealed that ICS induced allodynia and hyperalgesia in mice by day four, persisting until day 21. EA at 2 Hz and TRPV1 KO significantly decreased both mechanical and thermal hypersensitivity (Withdrawal-Day 14: 2.43 ± 0.19 g; Day 21: 5.88 ± 0.47 g, n = 6, p < 0.05; Latency-Day 14: 2.77 ± 0.22 s; Day 21: 5.85 ± 0.41 s, n = 6, p < 0.05). In contrast, sham EA did not produce significant effects. Additionally, TRPV1 and several pain-related proteins were significantly elevated in the thalamus, somatosensory cortex (SSC), medial prefrontal cortex (mPFC), hippocampus, hypothalamus, cerebellum regions V (CB V), VI (CB VI) and VII (CB VII) after the ICS model. Both EA at the ST36 acupoint and TRPV1 KO mice showed diminished overexpression of pain-related proteins, with the sham EA group showing no significant changes compared to the ICS group.

CONCLUSIONS

Chronic widespread pain was reduced by EA and TRPV1 KO, with the effects of EA on the TRPV1 pain pathway clearly evident in the CNS after 21 days.