Health inequities and societal costs for patients with fibromyalgia and their spouses: a Danish cohort study

Effects of Transcutaneous Electrical Acustimulation on Patients with Fibromyalgia Syndrome: Study Protocol of a Randomized, Double-Blind, Sham-Controlled Trial

Background

Fibromyalgia Syndrome (FMS) is a chronic disorder characterized by widespread musculoskeletal pain, fatigue, and localized tenderness. Transcutaneous Electrical Acustimulation (TEA) is a non-invasive therapy that combines Traditional Chinese Medicine with electrical stimulation at specific acupoints. Previous studies have shown that TEA is effective in treating pain-related conditions. This study aims to evaluate the efficacy and mechanisms of TEA treatment for FMS.

Design

This is a prospective, randomized, double-blind, and placebo-controlled trial with two parallel groups, conducted at a single center. Forty participants will be randomly assigned to either the TEA group or the sham-TEA group in a 1:1 ratio. Participants will receive 2 weeks of treatment followed by 2 weeks of follow-up. The primary outcome is the change in VAS pain scores before and after treatment. Secondary outcomes include FMS and pain-related questionnaire scales, infrared thermography (IRT), vibration-controlled transient elastography (VCTE), blood neurobiological markers, cytokines, and metabolomics.

Trial Registration

http://itmctr.ccebtcm.org.cn/ identifier ITMCTR2024000638.

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.

Early diagnostics of fibromyalgia: an overview of the challenges and opportunities

INTRODUCTION

Fibromyalgia is a common pain disorder with features of widespread musculoskeletal pain, fatigue, disrupted sleep, cognitive dysfunction, autonomic dysfunction, and mood disorders. Despite its high prevalence and significant impact on quality of life, the diagnosis and management of fibromyalgia remain challenging. Advancements in classification and diagnostics in broad areas have improved our understanding and treatment approach for this condition. We culminate with a discussion of future directions for research into early diagnostics in fibromyalgia.

AREAS COVERED

This perspective examines the current landscape of fibromyalgia biomarker discovery, highlighting challenges that must be addressed and opportunities that are presented as the field evolves.

EXPERT OPINION

Advances in fibromyalgia diagnostics provide an opportunity to dramatically reduce the cost burden placed on health resources for fibromyalgia once we have discovered a reliable reproducible biomarker that is widely accepted among practitioners and patients. Promising results in a number of fields may lead to point of care technologies that will be applicable in the office or bedside without the need for transport to specialized centers. Future research should focus on integrating these various diagnostic approaches to develop a comprehensive, multi-modal diagnostic tool for fibromyalgia.

Effects of Mental Disorders on Fibromyalgia Mediated by Insomnia: A Mendelian Randomization Study

Background

This study employed Mendelian randomization (MR) analysis to confirm the causal effects of mental disorders on fibromyalgia.

Methods

The summary data for exposures, mediator, and outcome were extracted from the GWAS catalog project, IEU openGWAS project, and Finn biobank database. Significantly associated and independent single-nucleotide polymorphisms (SNPs) meeting the criteria of p < 5×10-8, r2 < 0.001, and kb = 10,000 were selected for MR analysis. We used univariate and multivariate Mendelian randomization (i) to investigate the causal relationship between mental disorders/insomnia and fibromyalgia and (ii) to examine the mediating role of insomnia. The inverse variance weighted (IVW) method along with other MR methods was employed for analysis, while sensitivity analyses were conducted to assess reliability and stability.

Results

The results provided strong evidence to confirm the causal and positive associations between depression (OR = 6.749; 95% CI: 2.293-19.868, P = 0.001), irritability (OR: 1.873, 95% CI: 1.023-3.428, P = 0.042), insomnia (OR: 8.395, 95% CI: 1.384-50.931, P = 0.021), and fibromyalgia. Moreover, a positive causal relationship was detected between depression (OR = 1.230; 95% CI: 1.178-1.285; P < 0.001), irritability (OR = 1.084; 95% CI: 1.046-1.122; P < 0.001) and insomnia. Multivariate Mendelian randomization analysis showed that insomnia mediated the effects of depression and irritability on fibromyalgia, and the proportion of insomnia-mediated cases ranged from 25.2% to 26%.

Conclusion

This study showed a positive causal relationship between depression, irritability, insomnia, and fibromyalgia. Insomnia partly mediates this overall effect. Understanding the causal relationship between mental disorders and fibromyalgia and the mediating role of insomnia may provide more information for fibromyalgia intervention and prevention strategies.

Relationship Between Morphofunctional Alterations of the Foot and Its Functionality in Patients with Fibromyalgia Syndrome: A Case-Control Study

Objective: To evaluate the morphofunctional alterations in the foot and their association with functionality, considering aspects such as disability, pain, and limitations in daily activities in patients with fibromyalgia syndrome (FMS). Methods: A case-control study was conducted in patients with FMS (case group) and without FMS (control group), matched by age and sex. Foot posture was assessed using the foot posture index (FPI), along with the presence of hallux valgus (HV), trigger points, hyperkeratosis, and dorsiflexion of the first metatarsophalangeal joint and ankle. Foot functionality was evaluated using the foot function index (FFI) questionnaire. Results: A total of 100 women with FMS and 100 women without FMS, with a mean age of 61.97 ± 9.26 years, were recruited. HV (p < 0.001), hyperkeratosis (p < 0.001), pronated and supinated foot (p < 0.001), as well as limitations in dorsiflexion of the first metatarsophalangeal joint (p < 0.001) and the ankle with the knee flexed (p < 0.001) and extended (p < 0.001), along with the activity of the flexor hallucis brevis (p = 0.006), adductor hallucis (p = 0.006), and dorsal interosseous (p = 0.002) muscles, were significantly associated with the FFI, being higher in individuals with FMS, indicating greater impairment of foot functionality in these patients. Multivariate analysis revealed a statistical association between FMS and low educational level (OR = 2.57, 95% CI 1.05-5.72), the presence of another rheumatic disease (OR = 5.07, 95% CI 2.34-11), and the presence of any active trigger point (OR = 11.15, 95% CI 3.97-31.31). Conclusions: The study highlights the relationship between morphofunctional foot alterations, specifically the presence of active myofascial trigger points, and functionality in patients with FMS.

Social costs associated with fibromyalgia in Spain

BACKGROUND

Fibromyalgia is a chronic rheumatic disease of unknown aetiology, highly disabling and mainly affecting women. The aim of our work is to estimate, on a national scale, the economic impact of this disease on the employment of patients and non-professional (informal) care dimension.

METHODS

Survey on Disabilities, Autonomy and Dependency carried out in Spain in 2020/21 was used to obtain information on disabled individuals with AD and their informal caregivers. Six estimation scenarios were defined as base case, depending on whether the maximum daily informal caregiving time was censored or not, and on the approach chosen for the valuation of informal caregiving time (contingent valuation and replacement time). Another six conservative scenarios were developed using the minimum wage for the estimation of labour losses.

RESULTS

Our estimates range from 2,443.6 (willingness to pay, censored informal care time) to 7,164.8 million euros (replacement cost, uncensored informal care time) (base year 2021). Multivariate analyses identified that the degree of dependency of the person suffering from fibromyalgia is the main explanatory variable for both the probability of being employed and the time spent in informal care. Conservative scenarios estimates range from 1,807 to 6,528 million euros.

CONCLUSIONS

The high economic impact revealed should help to position a health problem that is relatively unknown in society and for which there are significant research and care gaps to be filled.