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Mohabbat AB, Salonen BR, Davis XD, Volcheck MM, Luedtke CA, Natividad LT, Pena Guzman TD, Johnson SM, Ledvina AJ, Merza CTL, Wight EC. In-Person or Virtual Educational Preferences in Patients With Fibromyalgia: A Cross-Sectional Survey Study at an Academic Medical Center. Pain Manag Nurs 2024:S1524-9042(24)00104-8. [PMID: 38570215 DOI: 10.1016/j.pmn.2024.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 03/06/2024] [Accepted: 03/10/2024] [Indexed: 04/05/2024]
Abstract
PURPOSE Patient education is a core component of treating fibromyalgia and central sensitization disorders. We sought to evaluate whether patients with fibromyalgia prefer virtual or in-person educational classes as part of their treatment program, identify underlying factors with their educational modality choice, and highlight benefits or barriers associated with in-person or online educational sessions. DESIGN A cross-sectional survey with a qualitative feedback component was utilized. METHODS A voluntary, anonymous survey was distributed to all participants (in-person and virtual) of the fibromyalgia and chronic fatigue clinic treatment program from October 2021 through March 2022. RESULTS In total 90 participants completed the survey. Nearly all (94%) agreed that the pathophysiologic education was relevant and valuable and (98%) agreed to feeling confident with implementing management strategies. Perceived connection between the participants varied between groups (85% of in-person vs 48% of online; p < .001), as did perceived engagement (100% of in-person vs 71% of online; p = .001). CONCLUSIONS Patients value education and find it useful in treating fibromyalgia, regardless of the educational modality. The online group reported more limitations including less engagement, class participation, and connection with peers. CLINICAL IMPLICATIONS As virtual education platforms become more widely available and may be easier to access than in-person options, it is important to understand patient preferences, benefits, and disadvantages of educational modalities to ensure education and patient outcomes remain equitable.
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Affiliation(s)
- Arya B Mohabbat
- Mayo Clinic, Division of General Internal Medicine, Rochester, MN.
| | | | - Xiomari D Davis
- Mayo Clinic, Enterprise Office of Access Management, Access Technologies & Systems Unit, Rochester, MN
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Volcheck MM, Graham SM, Fleming KC, Mohabbat AB, Luedtke CA. Central sensitization, chronic pain, and other symptoms: Better understanding, better management. Cleve Clin J Med 2023; 90:245-254. [PMID: 37011956 DOI: 10.3949/ccjm.90a.22019] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023]
Abstract
Central sensitization, a pathophysiologic process in which the central nervous system undergoes changes that alter its processing of pain and other sensory stimuli, may be the mechanism underlying various conditions in which patients have unexplained pain and fatigue. Patients frequently misunderstand the cause of their symptoms and pursue unnecessary evaluations and treatments. Clinicians have a pivotal role in decreasing this misunderstanding by providing patient education, which can affect perception, management, functional status, and quality of life.
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Affiliation(s)
| | | | - Kevin C Fleming
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN
| | - Arya B Mohabbat
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN
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Morrison EJ, Tsai-Owens MS, Luedtke CA, Eickhoff AL, Evans MM, Oetjen LA, Johannsen AL, Schiebel CJ, Boyum KK, Reynolds AL, Dresher ER, Ellingson AM, Harrison TE, Rohe DE, Gilliam WP, Loukianova LL, Harbeck-Weber C. Young Adult Pain Rehabilitation: Interdisciplinary development and preliminary outcomes of a novel treatment program. Pain Medicine 2022:6839948. [DOI: 10.1093/pm/pnac172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 10/31/2022] [Accepted: 11/01/2022] [Indexed: 11/24/2022]
Abstract
Abstract
Young adults with chronic pain and symptoms experience disruptions to their social, emotional, physical, and vocational functioning. Interdisciplinary pain rehabilitation programs for pediatric and adult populations are not designed specifically to address the developmental needs of young adults. This paper describes the development of a novel intensive interdisciplinary outpatient rehabilitation program tailored to the unique needs of young adults with chronic pain and symptoms. Tailored content included vocational assessment and consultation, financial literacy education, and sexual health education. Outcome data demonstrate treatment gains with reductions in pain interference, pain severity, pain catastrophizing and depressive symptoms, and improvements in mental and physical quality of life, perceived performance, perceived satisfaction with performance, and objective measures of physical functioning. The paper concludes with clinical recommendations for the management of chronic pain and symptoms in young adults, applicable across multiple treatment settings.
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Affiliation(s)
- Eleshia J Morrison
- Mayo Clinic Department of Psychiatry and Psychology, , Rochester, MN, USA
| | - Michele S Tsai-Owens
- Indiana University School of Medicine Department of Psychiatry, , Indianapolis, IN, USA
| | | | | | | | - Laurel A Oetjen
- Mayo Clinic Department of Physical Medicine and Rehabilitation, , Rochester, MN, USA
| | - Amanda L Johannsen
- Mayo Clinic Department of Physical Medicine and Rehabilitation, , Rochester, MN, USA
| | - Cindy J Schiebel
- Mayo Clinic Department of Physical Medicine and Rehabilitation, , Rochester, MN, USA
| | - Kirsti K Boyum
- Mayo Clinic Department of Physical Medicine and Rehabilitation, , Rochester, MN, USA
| | - Andrea L Reynolds
- Mayo Clinic Department of Physical Medicine and Rehabilitation, , Rochester, MN, USA
| | | | | | | | - Daniel E Rohe
- Mayo Clinic Department of Psychiatry and Psychology, , Rochester, MN, USA
| | - Wesley P Gilliam
- Mayo Clinic Department of Psychiatry and Psychology, , Rochester, MN, USA
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Loftus CG, Ebbert JO, Aakre CA, Caine NA, DeZutter MA, Eastman RJ, Fischer SM, Gilman EA, Johnson MG, Luedtke CA, Mohabbat AB, Reinschmidt KJ, Roellinger DL, Sanchez W, Philpot LM. Creation of a Multispecialty Clinic for Patients with Central Sensitization-Based Chronic Pain Conditions. Mayo Clin Proc Innov Qual Outcomes 2022; 6:45-54. [PMID: 35005437 PMCID: PMC8715289 DOI: 10.1016/j.mayocpiqo.2021.11.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Objective To design and evaluate, through a human-centered design approach, a multispeciality clinic for patients with central sensitization syndromes that combined virtual previsit consultations, traditional face-to-face appointments, and technology-enabled educational programming. Patients and Methods Patients with suspected fibromyalgia and chronic abdominal pain were seen in a multispecialty practice, and the performance of the clinic was evaluated against a contemporary cohort. Quantitative and qualitative evaluation measures included team estimates of time spent on care-related tasks, physician rank of alignment of patient need with clinic design, major appointment changes, and nonvisit care tasks. Members of the care team also evaluated strengths, weaknesses, opportunities, and threats to the success of the clinic. Results The pilot clinic was operated from April 1, 2020, to April 30, 2021, and included 34 patients with suspected fibromyalgia/chronic abdominal pain. During the pilot period, physicians ranked the value of the virtual previsit consultations in providing care as 7.5 on a scale of 0 to 10 and reported an average of 50 minutes in preparation for the appointment, execution of the appointment, and postvisit documentation. We did not observe substantial differences in the number of added appointments or messages received within the patient portal when compared with a comparison cohort. Patients who participated in the combination nurse educator–led and digital education program provided positive feedback about their experience. Conclusion Our clinic model provides a framework for the treatment of patients with debilitating centrally sensitized conditions and future expansion of virtual care delivery models to better meet patient care and educational needs.
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Gilliam WP, Schumann ME, Cunningham JL, Evans MM, Luedtke CA, Morrison EJ, Sperry JA, Vowles KE. Pain catastrophizing as a treatment process variable in cognitive behavioural therapy for adults with chronic pain. Eur J Pain 2020; 25:339-347. [PMID: 33030769 DOI: 10.1002/ejp.1671] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 09/28/2020] [Accepted: 10/01/2020] [Indexed: 11/09/2022]
Abstract
BACKGROUND Interdisciplinary cognitive behavioural therapy (CBT) for chronic pain is effective at improving function, mood and pain interference among individuals with disabling chronic pain. Traditionally, CBT assumes that cognitive change is an active therapeutic ingredient in the determination of treatment outcome. Pain catastrophizing, a cognitive response style that views the experience of pain as uncontrollable, permanent and destructive, has been identified as an important maladaptive cognition which contributes to difficulties with the management of chronic pain. Consequently, pain catastrophizing is commonly targeted in CBT for chronic pain. OBJECTIVES To examine change trajectories in pain catastrophizing during treatment and assess the relevance of these trajectories to outcomes at posttreatment. METHODS Participants included individuals with chronic pain (N = 463) who completed a 3-week program of interdisciplinary CBT. Pain catastrophizing was assessed weekly over the 3 weeks of treatment and latent growth curve modelling was used to identify trajectories of change. RESULTS Findings indicated the presence of two classes of linear change, one with a significant negative slope in pain catastrophizing (i.e. improved class) and the other with a non-significant slope (i.e. unchanged class). Next, latent growth mixture modelling examined treatment outcome in relation to class membership. These results indicated that individuals in the 'improved' PCS class had significantly greater improvement in pain interference and mood, as well as physical and mental quality of life compared to the 'unchanged' class. CONCLUSIONS Implications for our findings, in relation to the CBT model, are discussed.
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Affiliation(s)
- Wesley P Gilliam
- Department of Psychiatry and Psychology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Matthew E Schumann
- Department of Psychiatry and Psychology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Julie L Cunningham
- Department of Pharmacy, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Michele M Evans
- Department of Psychiatry and Psychology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Connie A Luedtke
- Department of Psychiatry and Psychology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Eleshia J Morrison
- Department of Psychiatry and Psychology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Jeannie A Sperry
- Department of Psychiatry and Psychology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Kevin E Vowles
- School of Psychology, Queen's University Belfast, Belfast, UK
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Luedtke CA, Guderian K. C12 Sharing the Legacy of Pain Management Nursing through Storytelling. Pain Manag Nurs 2019. [DOI: 10.1016/j.pmn.2018.11.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Gilliam WP, Craner JR, Cunningham JL, Evans MM, Luedtke CA, Morrison EJ, Sperry JA, Loukianova LL. Longitudinal Treatment Outcomes for an Interdisciplinary Pain Rehabilitation Program: Comparisons of Subjective and Objective Outcomes on the Basis of Opioid Use Status. The Journal of Pain 2018; 19:678-689. [DOI: 10.1016/j.jpain.2018.02.010] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Revised: 12/15/2017] [Accepted: 02/02/2018] [Indexed: 01/19/2023]
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Luedtke CA, Volcheck M. Educating Patients on the Physiology of Central Sensitization & the Neurochemical Relationship to Chronic Pain. Pain Manag Nurs 2017. [DOI: 10.1016/j.pmn.2017.02.157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Bruce BK, Harrison TE, Bee SM, Luedtke CA, Porter CBJ, Fischer PR, Hayes SE, Allman DA, Ale CM, Weiss KE. Improvement in Functioning and Psychological Distress in Adolescents With Postural Orthostatic Tachycardia Syndrome Following Interdisciplinary Treatment. Clin Pediatr (Phila) 2016; 55:1300-1304. [PMID: 26983448 DOI: 10.1177/0009922816638663] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Significant functional impairment and psychological distress have been observed in adolescent patients with postural orthostatic tachycardia syndrome (POTS). Interdisciplinary rehabilitation programs have been shown to be beneficial in the treatment of chronic pain in adults and adolescents. Only preliminary data have examined interdisciplinary rehabilitation efforts in patients with POTS. This study evaluated the impact of an interdisciplinary rehabilitation program on the functional impairment and psychological distress in 33 adolescents diagnosed with POTS. Patients included in the study were adolescents ages 11 to 18 diagnosed with POTS. Measures completed at admission and discharge from the program included the Functional Disability Index, Center for Epidemiological Studies-Depression-Child scale, and the Pain Catastrophizing Scale for Children. After participation in the 3-week program, adolescents with POTS demonstrated a significant increase in overall functional ability and significant reductions in depression and catastrophizing.
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Weingarten TN, Vincent A, Luedtke CA, Beebe TJ, Welch TL, Chong EY, Schroeder DR, Warner DO. The Perception of Female Smokers with Fibromyalgia on the Effects of Smoking on Fibromyalgia Symptoms. Pain Pract 2015; 16:1054-1063. [PMID: 26603674 DOI: 10.1111/papr.12402] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Accepted: 07/20/2015] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Smokers with fibromyalgia have greater pain intensity and function impairment compared to nonsmokers. Patients' perceptions of interactions between smoking and fibromyalgia symptoms have not been described. The primary aim of this study was to report the perceptions of female smokers with fibromyalgia on how smoking affects symptoms. METHODS Forty-eight daily smokers with fibromyalgia enrolled in the Mayo Clinic Fibromyalgia Treatment Center completed the Fibromyalgia Impact Questionnaire, Fagerstrom Test for Nicotine Dependence, Patient Health Questionnaire-9, General Anxiety Disorder-7 and a Fibromyalgia Symptoms and Smoking Survey which queried how smoking directly affected fibromyalgia symptoms (eg, pain, tiredness/fatigue, stiffness, nervousness/anxiety, depression/blueness, irritability, concentration, and overall) or indirectly as a coping mechanism. RESULTS The majority of subjects reported smoking had no direct effect on fibromyalgia physical symptoms (pain [60% reported no effect], fatigue [56%], stiffness [81%]) but direct improvement of emotional symptoms (anxiety [62% reported improvement], irritability [64%]). The majority of subjects used smoking to cope with pain (69%) via distraction (83%) and relaxation (77%), lessening emotional distress by reducing a sense of frustration (83%) or sadness (54%) because of pain, and as a justification for resting vis-à-vis "smoke breaks" (69%). Thirty-one smokers were mildly and 17 moderately/severely dependent on tobacco, and no difference in fibromyalgia impact score (P = 0.70), pain (P = 0.39), depression (P = 0.20), and anxiety (P = 0.64) scores were detected, but more moderately/severely dependent subjects reported smoking improved pain (50% vs. 17%, P = 0.04). DISCUSSION Smokers with fibromyalgia reported smoking helped to cope with fibromyalgia pain but generally did not directly ameliorate fibromyalgia physical symptoms.
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Affiliation(s)
- Toby N Weingarten
- Department of Anesthesiology, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Ann Vincent
- Department of General Internal Medicine, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Connie A Luedtke
- Pain Rehabilitation Center, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Timothy J Beebe
- Health Services Research, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Tasha L Welch
- Department of Anesthesiology, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Elisa Y Chong
- Mayo Medical School, Mayo Clinic, Rochester, Minnesota, U.S.A
| | | | - David O Warner
- Department of Anesthesiology, Mayo Clinic, Rochester, Minnesota, U.S.A
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Jiao J, Davis III JM, Cha SS, Luedtke CA, Vincent A, Oh TH. Association of rheumatic diseases with symptom severity, quality of life, and treatment outcome in patients with fibromyalgia. Scand J Rheumatol 2015; 45:49-56. [DOI: 10.3109/03009742.2015.1052553] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Jiao J, Vincent A, Cha SS, Luedtke CA, Oh TH. Relation of age with symptom severity and quality of life in patients with fibromyalgia. Mayo Clin Proc 2014; 89:199-206. [PMID: 24485133 DOI: 10.1016/j.mayocp.2013.09.021] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2013] [Revised: 09/24/2013] [Accepted: 09/30/2013] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To examine the relation of age with symptom severity and quality of life (QOL) in patients with fibromyalgia, and to compare physical and mental health of our female patients with those of the US female general population. PATIENTS AND METHODS We studied 978 patients with fibromyalgia from May 1, 2001 through April 30, 2004, and divided them into age groups of young (≤39 years), middle-aged (40-59 years), and older (≥60 years). They completed the Fibromyalgia Impact Questionnaire and the Short Form-36 Health Status Questionnaire (SF-36). Standardized SF-36 physical and mental health summary scores were compared with those of the US female general population of similar age. One-way analysis of variance and post hoc paired t test analyses were performed to detect differences across age groups. RESULTS Pairwise comparison found young and middle-aged patients having worse fibromyalgia symptoms in all subscales except the anxiety subscale compared with older patients (P≤.01). Similarly, these young and middle-aged patients had worse QOL in the SF-36 mental component summary, as well as SF-36 general health perceptions, vitality, social functioning, and mental health index, compared with older patients (all P<.001). When the QOL of our female patients was compared with that of the US female general population of similar age with standardized SF-36 scores, all age groups had lower QOL in physical, as well as mental, health, with more reduction in physical health, particularly in young patients. CONCLUSION Our study shows that symptom severity and QOL differ across age groups in patients with fibromyalgia, with young and middle-aged patients having poorer QOL and worse fibromyalgia symptoms than do older patients. QOL in physical health was reduced more than in mental health, particularly in young patients, compared with the general population.
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Affiliation(s)
- Juan Jiao
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN
| | - Ann Vincent
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN; Fibromyalgia and Chronic Fatigue Clinic, Mayo Clinic, Rochester, MN
| | - Stephen S Cha
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN
| | - Connie A Luedtke
- Fibromyalgia and Chronic Fatigue Clinic, Mayo Clinic, Rochester, MN
| | - Terry H Oh
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN; Fibromyalgia and Chronic Fatigue Clinic, Mayo Clinic, Rochester, MN.
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Whipple MO, McAllister SJ, Oh TH, Luedtke CA, Toussaint LL, Vincent A. Construction of a US fibromyalgia registry using the Fibromyalgia Research Survey criteria. Clin Transl Sci 2013; 6:398-9. [PMID: 24127929 DOI: 10.1111/cts.12056] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Utilizing billing records, we identified patients seen at Mayo Clinic with a diagnosis or history of fibromyalgia who were then contacted for enrollment in a fibromyalgia research registry. Fibromyalgia was confirmed through medical record review. Eligible patients were mailed an invitation that included a demographic questionnaire and the Fibromyalgia Research Survey. The Fibromyalgia Research Survey yields a widespread pain score (scale range 0-19) and a symptom severity score (scale range 0-12). A total of 4,034 patients returned the completed survey; 92.8% were female, their mean age was 57.4 (±13.4), and 83.7% were from the Midwest region of the United States. The mean widespread pain score for all participants was 11.3 (±4.5) and the mean symptom severity score was 8.2 (±2.4), indicating moderate-to-severe fibromyalgia symptoms, which is not unusual for patients presenting to a tertiary care center. Using a systematic process, we describe the creation of a fibromyalgia registry for future research.
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Affiliation(s)
- Mary O Whipple
- Fibromyalgia and Chronic Fatigue Clinic, Mayo Clinic, Rochester, Minnesota, USA
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Kim CH, Vincent A, Clauw DJ, Luedtke CA, Thompson JM, Schneekloth TD, Oh TH. Association between alcohol consumption and symptom severity and quality of life in patients with fibromyalgia. Arthritis Res Ther 2013; 15:R42. [PMID: 23497427 PMCID: PMC3672769 DOI: 10.1186/ar4200] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2012] [Accepted: 02/07/2013] [Indexed: 01/03/2023] Open
Abstract
Introduction Although alcohol consumption is a common lifestyle behavior with previous studies reporting positive effects of alcohol on chronic pain and rheumatoid arthritis, no studies to this date have examined alcohol consumption in patients with fibromyalgia. We examined the association between alcohol consumption and symptom severity and quality of life (QOL) in patients with fibromyalgia. Methods Data on self-reported alcohol consumption from 946 patients were analyzed. Subjects were grouped by level of alcohol consumption (number of drinks/week): none, low (≤3), moderate (>3 to 7), and heavy (>7). Univariate analyses were used to find potential confounders, and analysis of covariance was used to adjust for these confounders. Tukey HSD pairwise comparisons were used to determine differences between alcohol groups. Results Five hundred and forty-six subjects (58%) did not consume alcohol. Low, moderate, and heavy levels of alcohol consumption were reported for 338 (36%), 31 (3%), and 31 patients (3%), respectively. Employment status (P <0.001), education level (P = 0.009), body mass index (P = 0.002) and opioid use (P = 0.002) differed significantly among groups with drinkers having higher education, a lower BMI, and a lower frequency of unemployment and opioid use than nondrinkers. After adjusting for these differences, the measures including the number of tender points (P = 0.01), FIQ total score (P = 0.01), physical function (P <0.001), work missed (P = 0.005), job ability (P = 0.03), and pain (P = 0.001) differed across groups, as did the SF-36 subscales of physical functioning (P <0.001), pain index (P = 0.002), general health perception (P = 0.02), social functioning (P = 0.02), and the physical component summary (P <0.001). Pairwise comparison among the 4 groups showed that the moderate and low alcohol drinkers had lower severity of fibromyalgia symptoms and better physical QOL than nondrinkers. Conclusions Our study demonstrates that low and moderate alcohol consumption was associated with lower fibromyalgia symptoms and better QOL compared to no alcohol consumption. The reasons for these results are unclear. Since recent studies have demonstrated that γ-Aminobutyric Acid (GABA) levels are low in fibromyalgia, and alcohol is known to be a GABA-agonist, future studies should examine whether alcohol could have a salutary effect on pain and other symptoms in fibromyalgia.
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Oh TH, Hoskin TL, Luedtke CA, Weingarten TN, Vincent A, Kim CH, Thompson JM. Predictors of clinical outcome in fibromyalgia after a brief interdisciplinary fibromyalgia treatment program: single center experience. PM R 2012; 4:257-63. [PMID: 22541373 DOI: 10.1016/j.pmrj.2011.10.014] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2011] [Revised: 10/18/2011] [Accepted: 10/31/2011] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To determine which patient characteristics are closely associated with a positive response to a brief interdisciplinary fibromyalgia treatment program (FTP). DESIGN A prospective cohort study. SETTING FTP at a tertiary medical center. PARTICIPANTS A total of 536 patients with a confirmed diagnosis of fibromyalgia who underwent the FTP and completed the Fibromyalgia Impact Questionnaire (FIQ) at baseline and 6-12 months after treatment. INTERVENTIONS A brief 1.5-day interdisciplinary FTP, which included evaluation with a registered nurse and a physician for a diagnosis or confirmation of fibromyalgia, fibromyalgia education, interactive self management session, and physical and occupational therapy. MAIN OUTCOME MEASUREMENTS The responder definition was an improvement of 14% or more in the FIQ total score from their baseline to 6-12 months after treatment. RESULTS Mean (standard deviation) age of our patients was 50.3 ± 13.0 years; 515 women (96%) and 23 men (4%). Two hundred forty-eight patients (46%) met the responder definition at 6-12 months follow-up. In an univariate analysis, younger age (P = .008), college or higher education (P = .02), fewer tender points (P = .048), and higher FIQ depression subscore (P = .02) significantly predicted positive response. In a multivariate analysis, these factors all remained statistically significant. In addition, a positive abuse history became significant (P = .03). There was no significant association for gender, duration of symptoms, marital status, employment, smoking status, or 3 numeric rating scale pain scores. CONCLUSIONS Patients with younger age, more years of education (with college or graduate degree), higher baseline FIQ depression score, lower tender point count, and absent abuse history experience greater benefit from a brief FTP.
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Affiliation(s)
- Terry H Oh
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA.
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Engen DJ, Wahner-Roedler DL, Vincent A, Chon TY, Cha SS, Luedtke CA, Loehrer LL, Dion LJ, Rodgers NJ, Bauer BA. Feasibility and effect of chair massage offered to nurses during work hours on stress-related symptoms: a pilot study. Complement Ther Clin Pract 2012; 18:212-5. [PMID: 23059434 DOI: 10.1016/j.ctcp.2012.06.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2012] [Revised: 06/06/2012] [Accepted: 06/07/2012] [Indexed: 11/24/2022]
Abstract
This study assessed feasibility and effect of weekly, 15-min chair massages during work for 38 nurses. Mean Perceived Stress Scale-14 (PSS-14), Smith Anxiety Scale (SAS), linear analog self-assessment scale (LASA), and symptom visual analog scale (SX-VAS) scores were tracked at baseline, 5 weeks, and 10 weeks. Of 400 available massage appointments, 329 were used. At 10 weeks, mean PSS-14 score decreased from 17.85 to 14.92 (P = .002); mean SAS score, from 49.45 to 40.95 (P < .001). Mean LASA score increased from 42.39 to 44.84 (P = .006); mean SX-VAS score, from 65.03 to 74.47 (P < .001). Massages for nurses during work hours reduced stress-related symptoms.
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Affiliation(s)
- Deborah J Engen
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN, USA
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Kim CH, Luedtke CA, Vincent A, Thompson JM, Oh TH. Association of body mass index with symptom severity and quality of life in patients with fibromyalgia. Arthritis Care Res (Hoboken) 2012; 64:222-8. [PMID: 21972124 DOI: 10.1002/acr.20653] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To examine the association between body mass index (BMI) and symptom severity and quality of life (QOL) in patients with fibromyalgia. METHODS We assessed BMI status and its association with symptom severity and QOL in 888 patients with fibromyalgia who were seen in a fibromyalgia treatment program and who completed the Fibromyalgia Impact Questionnaire (FIQ) and the Short Form 36 (SF-36) health survey. RESULTS The BMI distribution of nonobese (BMI <25.0 kg/m(2)), overweight (BMI 25.0-29.9 kg/m(2)), moderately obese (BMI 30.0-34.9 kg/m(2)), and severely obese (BMI ≥35.0 kg/m(2)) patients was 28.4% (n = 252), 26.8% (n = 238), 22.2% (n = 197), and 22.6% (n = 201), respectively. Age was significantly different among the 4 groups, with those having a greater BMI being older (P = 0.004). After adjustment for age, group differences were significant in the number of tender points (P = 0.003) and the FIQ and SF-36 scores. The groups with the greater BMI had greater fibromyalgia-related symptoms with worse FIQ total scores (P < 0.001), as well as worse scores in the FIQ subscales of physical function (P < 0.001), work missed (P = 0.04), job ability (P = 0.003), pain (P < 0.001), stiffness (P < 0.001), and depression (P = 0.03). These groups also had poorer SF-36 scores in physical functioning (P < 0.001), pain index (P = 0.005), general health perceptions (P = 0.003), role emotional (P = 0.04), and physical component summary (P < 0.001). Post hoc analysis among the 4 groups showed that differences resided primarily in the severely obese group compared with the other groups. CONCLUSION In patients with fibromyalgia, severe obesity (BMI ≥35.0 kg/m(2)) is associated with higher levels of fibromyalgia symptoms and lower levels of QOL.
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Vincent A, Whipple MO, Luedtke CA, Oh TH, Sood R, Smith RL, Jatoi A. Pain and other symptom severity in women with fibromyalgia and a previous hysterectomy. J Pain Res 2011; 4:325-9. [PMID: 22003306 PMCID: PMC3191932 DOI: 10.2147/jpr.s25490] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objective Fibromyalgia is a troubling disease characterized by chronic pain. This study explored whether pain and other fibromyalgia symptoms are worse among women who had undergone a hysterectomy with or without an oophorectomy versus those who had not. Methods Consecutive women who were seen at the Fibromyalgia Treatment Program at a tertiary medical center between 2001 and 2004 and who completed the Fibromyalgia Impact Questionnaire (FIQ) and Short Form-36 Health Survey (SF-36) at initial evaluation were included in this study. Results A total of 813 women were included; 328 had had a hysterectomy. Total FIQ scores from women who had had a hysterectomy were higher (worse symptoms) than those who had not (58.1 vs 56.4, P = 0.002). FIQ subscale scores of pain (P = 0.003), fatigue (P = 0.030), stiffness (P = 0.035), and depression (P = 0.008) were also worse in women who had had a hysterectomy. Similar to the FIQ, SF-36 physical component scores were worse in women who had had a hysterectomy (P = 0.045). Conclusion Pain and other fibromyalgia symptom severity was worse in women who had had a hysterectomy with or without an oophorectomy.
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Affiliation(s)
- Ann Vincent
- Department of Medicine, Mayo Clinic, Rochester, MN, USA
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Wahner-Roedler DL, Thompson JM, Luedtke CA, King SM, Cha SS, Elkin PL, Bruce BK, Townsend CO, Bergeson JR, Eickhoff AL, Loehrer LL, Sood A, Bauer BA. Dietary soy supplement on fibromyalgia symptoms: a randomized, double-blind, placebo-controlled, early phase trial. Evid Based Complement Alternat Med 2011; 2011:350697. [PMID: 18990724 PMCID: PMC3136370 DOI: 10.1093/ecam/nen069] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/25/2008] [Accepted: 05/28/2009] [Indexed: 11/21/2022]
Abstract
Most patients with fibromyalgia use complementary and alternative medicine (CAM). Properly designed controlled trials are necessary to assess the effectiveness of these practices. This study was a randomized, double-blind, placebo-controlled, early phase trial. Fifty patients seen at a fibromyalgia outpatient treatment program were randomly assigned to a daily soy or placebo (casein) shake. Outcome measures were scores of the Fibromyalgia Impact Questionnaire (FIQ) and the Center for Epidemiologic Studies Depression Scale (CES-D) at baseline and after 6 weeks of intervention. Analysis was with standard statistics based on the null hypothesis, and separation test for early phase CAM comparative trials. Twenty-eight patients completed the study. Use of standard statistics with intent-to-treat analysis showed that total FIQ scores decreased by 14% in the soy group (P = .02) and by 18% in the placebo group (P < .001). The difference in change in scores between the groups was not significant (P = .16). With the same analysis, CES-D scores decreased in the soy group by 16% (P = .004) and in the placebo group by 15% (P = .05). The change in scores was similar in the groups (P = .83). Results of statistical analysis using the separation test and intent-to-treat analysis revealed no benefit of soy compared with placebo. Shakes that contain soy and shakes that contain casein, when combined with a multidisciplinary fibromyalgia treatment program, provide a decrease in fibromyalgia symptoms. Separation between the effects of soy and casein (control) shakes did not favor the intervention. Therefore, large-sample studies using soy for patients with fibromyalgia are probably not indicated.
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Weingarten TN, Podduturu VR, Hooten WM, Thompson JM, Luedtke CA, Oh TH. Impact of Tobacco Use in Patients Presenting to a Multidisciplinary Outpatient Treatment Program for Fibromyalgia. Clin J Pain 2009; 25:39-43. [DOI: 10.1097/ajp.0b013e31817d105e] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Townsend CO, Kerkvliet JL, Bruce BK, Rome JD, Hooten MW, Luedtke CA, Hodgson JE. A longitudinal study of the efficacy of a comprehensive pain rehabilitation program with opioid withdrawal: comparison of treatment outcomes based on opioid use status at admission. Pain 2008; 140:177-189. [PMID: 18804915 DOI: 10.1016/j.pain.2008.08.005] [Citation(s) in RCA: 100] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2008] [Revised: 07/22/2008] [Accepted: 08/11/2008] [Indexed: 10/21/2022]
Abstract
UNLABELLED Use of opioids for chronic non-cancer pain is controversial and the efficacy of comprehensive pain rehabilitation programs (CPRPs) that incorporate opioid withdrawal requires further investigation. We test the hypothesis that patients with chronic pain and longstanding opioid use who undergo opioid withdrawal in the course of rehabilitative treatment will experience significant and sustained improvement in pain and functioning similar to patients who were not taking opioids. A longitudinal design study compared 373 consecutive patients admitted to the Mayo Clinic Pain Rehabilitation Center at admission, discharge and six-month posttreatment by opioid status at admission. Measures of pain severity, depression, psychosocial functioning, health status, and pain catastrophizing were used to assess between- and within-group differences. Treatment involved a 3-week interdisciplinary pain rehabilitation program focused on functional restoration. Over one-half of patients (57.1%) were taking opioids daily at admission. The majority of patients (91%) completed rehabilitation and 70% of patients who completed the program returned questionnaires six months posttreatment. On admission, patients taking low- and high-dose opioids reported significantly greater pain severity (P=.001) and depression (P=.001) than the non-opioid group. Significant improvement was found on all outcome variables following treatment (P<.001) and six-month posttreatment (P<.001) regardless of opioid status at admission. There were no differences between the opioid and non-opioid groups upon discharge from the program or at six months following treatment. CONCLUSION Patients with longstanding CPRP on chronic opioid therapy, who choose to participate in interdisciplinary rehabilitation that incorporates opioid withdrawal, can experience significant and sustained improvement in pain severity and functioning.
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Affiliation(s)
- Cynthia O Townsend
- Mayo Clinic, Department of Psychiatry and Psychology, Pain Rehabilitation Center, Generose 2W, 1216 Second Street SW, Rochester, MN 55902, USA
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Abstract
The majority of fibromyalgia treatment programs are weeks or months in duration. This tertiary care center draws people worldwide for diagnostic purposes; however, most patients are unable to stay for extended treatment. It was deemed important to offer a brief multidisciplinary fibromyalgia treatment program that provided fundamental education and established a foundation for self-management strategies. This article describes the components of a brief multidisciplinary program for fibromyalgia. Initial results indicate improvement in patient outcomes and in patient and physician satisfaction. Patients who complete any fibromyalgia program need to maintain a relationship with their primary care providers for ongoing care. Some patients may need a more comprehensive program because of their level of functional impairment.
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Affiliation(s)
- Connie A Luedtke
- Fibromyalgia Treatment Program, Mayo Clinic, Rochester, Minnesota, USA.
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Townsend CO, Sletten CD, Bruce BK, Rome JD, Luedtke CA, Hodgson JE. Physical and emotional functioning of adult patients with chronic abdominal pain: Comparison with patients with chronic back pain. The Journal of Pain 2005; 6:75-83. [PMID: 15694873 DOI: 10.1016/j.jpain.2004.10.009] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2004] [Revised: 10/02/2004] [Accepted: 10/20/2004] [Indexed: 01/01/2023]
Abstract
UNLABELLED Adults with chronic abdominal pain remain a poorly defined population, despite the debilitation and depression associated with this therapeutically challenging condition. This study compared patients with chronic abdominal pain with an empirically well-known group of patients with chronic pain (back pain) to investigate similarities and differences in their physical and mental functioning. This retrospective, cross-sectional study included 136 patients with abdominal pain and 364 patients with back pain seen in a comprehensive pain rehabilitation center. Patients' functioning was assessed with the Short Form-36 Health Survey, Multidimensional Pain Inventory, Center for Epidemiological Studies-Depression scale, and Coping Strategies Questionnaire-Catastrophizing subscale. Both the abdominal and back pain patients reported long-standing and severe pain, numerous surgery procedures, poor functioning, and high prevalence of depression. When age, education, and marital status were controlled for, analyses showed that although patients with abdominal pain reported significantly better physical functioning than patients with back pain (P < .001), their overall health perception was significantly poorer (P < .001). Although less prevalent, it is clear that patients with chronic abdominal pain exhibit poor functioning and prevalence of depression that are comparable to patients with chronic back pain. This study also suggests distinct characteristics that are vital to consider for effective treatment of this chronic pain population. PERSPECTIVE As a result of being an overlooked and poorly defined population, adults with chronic abdominal pain might not receive adequate pain management treatment. Learning more about the physical and emotional functioning of patients with long-standing abdominal pain can increase recognition of the needs of and improve treatment for this population.
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Affiliation(s)
- Cynthia O Townsend
- Department of Psychiatry and Psychology, Pain Rehabilitation Center, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
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Rome JD, Townsend CO, Bruce BK, Sletten CD, Luedtke CA, Hodgson JE. Chronic noncancer pain rehabilitation with opioid withdrawal: comparison of treatment outcomes based on opioid use status at admission. Mayo Clin Proc 2004; 79:759-68. [PMID: 15182090 DOI: 10.4065/79.6.759] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To study differences in treatment outcomes between patients with chronic noncancer pain taking vs those not taking maintenance opioids at admission to a pain rehabilitation program. PATIENTS AND METHODS A nonrandomized 2-group prepost design was used to compare 356 patients admitted to the Mayo Comprehensive Pain Rehabilitation Center from January 2002 to December 2002 at admission and discharge by opioid status at admission. Measures of pain severity, interference due to pain, perceived life control, affective distress, activity level, depression, and catastrophizing (an exaggerated negative mental set associated with actual or anticipated pain experiences) were used to compare opioid and nonopioid groups. The patients entered a 3-week intensive outpatient multidisciplinary pain rehabilitation program designed to improve adaptation to chronic noncancer pain. The program uses a cognitive-behavioral model and incorporates opioid withdrawal. RESULTS More than one third of patients (135/356) were taking opioids daily at admission. At completion of the program, all but 3 of the 135 patients had successfully discontinued opioid treatment. No significant pretreatment differences were found between the opioid and nonopioid group regarding demographics, pain duration, treatment completion, or all outcome variables, including pain severity. Significant improvement was noted at discharge for all outcome variables assessed regardless of opioid status at admission. CONCLUSION Patients with symptomatically severe and disabling pain while taking maintenance opioid therapy can experience significant improvement in physical and emotional functioning while participating in a pain rehabilitation program that incorporates opioid withdrawal.
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Affiliation(s)
- Jeffrey D Rome
- Pain Rehabilitation Center, Mayo Clinic College of Medicine, Rochester, MN 55905, USA.
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