Sleep Dysfunction in Fibromyalgia and Therapeutic Approach Options

Fibromyalgia, characterised by persistent pain, sleep disturbance, fatigue and cognitive dysfunction, is a central sensitivity syndrome that also involves abnormality in peripheral generators and in the hypothalamic pituitary adrenal axis. Heterogeneity of clinical expression of fibromyalgia with a multifactorial aetiology has made the development of effective therapeutic strategies challenging. Non-restorative sleep associated with poor sleep quality is a characteristic of fibromyalgia which is linked to symptom severity. A relationship between sleep disorder and central sensitization could be a possible factor involved in development, exacerbation and/or maintenance of fibromyalgia. Association between disordered sleep and the risk of fibromyalgia suggests that limiting sleep problems would reduce the incidence of the condition. Therapeutic approaches with treatments that consolidate or deepen sleep may be preferential to improve sleep in patients with fibromyalgia. Thus, disordered sleep appears fundamental to the pathophysiology of fibromyalgia and as such the risk of sleep disturbances needs to be proactively assessed and when identified in this patient group be actively managed to improve health outcomes for patients with fibromyalgia

Today\u27s Fibromyalgia

Fibromyalgia is a chronic musculoskeletal disorder which results in widespread pain, fatigue, cognitive difficulties, and emotional distress (CDC, 2017). It is also associated with abnormal pain processing. About 2% of US adults have Fibromyalgia, and the disease is more common in middle-aged women, particularly those who have other illnesses like Lupus or Rheumatoid Arthritis (CDC, 2017). The exact cause of the disease is unknown, but it is likely a combination of genetics, infections and physical and emotional trauma. Since the exact cause of Fibromyalgia is unknown, treatment options vary. Medication, stress management techniques and an exercise plan are all examples of treatments used for Fibromyalgia. Treatment is important due to the negative impact Fibromyalgia has on life functioning. Fibromyalgia research has progressed in recent years as more clinicians put definitive diagnostic measures in place, researchers investigated various theories on causes and they have continued to explore new treatment options

Pain Perception after Isometric Exercise in Women with Fibromyalgia

Objective: The purpose of this study was to identify exercise protocols incorporating isometric contractions that provide pain relief in women with fibromyalgia. Design: A before-after trial. Setting: A physical therapy department in an academic setting. Participants: Fifteen women (mean ± SD, 52 ± 11y) with fibromyalgia. Interventions: Subjects completed 4 sessions: 1 familiarization and 3 experimental. The following randomized experimental sessions involved the performance of isometric contractions with the elbow flexor muscles that varied in intensity and duration: (1) 3 maximal voluntary contractions (MVCs), (2) 25% MVC held to task failure, and (3) 25% MVC held for 2 minutes. Main Outcome Measures: Experimental pain (pain threshold and pain rating), Fibromyalgia Impact Questionnaire, and fibromyalgia pain intensity (visual analog scale). Results: After all 3 isometric contractions, there was considerable variability between subjects in the pain response. Based on the changes in experimental pain, subjects were divided into 3 groups (increase, decrease, no change in pain). Multiple regression analysis revealed that age, baseline experimental pain, and change in fibromyalgia pain intensity were significant predictors of the experimental pain response after the isometric contractions. Conclusions: We identified subgroups of women with fibromyalgia based on how they perceived pain after isometric contractions. The greatest pain relief for women with fibromyalgia occurred at a younger age and in women with the greatest experimental pain before exercise. Additionally, we established a link between experimental and clinical pain relief after the performance of isometric contractions

Hypervigilance for innocuous tactile stimuli in patients with fibromyalgia: an experimental approach

Background: Hypervigilance, i.e., excessive attention, is often invoked as a potential explanation for the observation that many individuals with fibromyalgia show a heightened sensitivity to stimulation in various sensory modalities, such as touch and hearing. Compelling evidence for this assumption is, however, lacking. The aim of the present study was to investigate the presence of somatosensory hypervigilance in patients with fibromyalgia. Methods: Fibromyalgia patients (n=41) and a matched control group (n=40) performed a tactile change detection task in which they had to detect whether there was a change between two consecutively presented patterns of tactile stimuli presented to various body locations. The task was performed under two conditions: in the unpredictable condition, tactile changes occurred equally often at all possible body locations; in the predictable condition, the majority of tactile changes occurred at one specific body location. Results: It was hypothesized that the fibromyalgia group would show better tactile change detection in the unpredictable condition and when changes ocurred at unexpected locations in the predictable condition. The results did not support this hypothesis. In neither condition was the fibromyalgia group better than the control group in detecting tactile changes. Conclusions: No evidence was found to support the claim that patients with fibromyalgia display somatosensory hypervigilance. This finding challenges the idea of hypervigilance as a static feature of fibromyalgia and urges for a more dynamic view in which hypervigilance emerges in situations when bodily threat is experienced

Fibromyalgia: A Unifying Neuroendocrinologic Model for Understanding Its Pathophysiology

Fibromyalgia is believed to affect at least 2% of the population. Despite advances in the scientific understanding of the derangements of central and peripheral pain processing mechanisms in fibromyalgia, no current models of its pathophysiology account for the other clinical conditions associated with it such as fatigue, migraine headache, irritable bowel syndrome, and sleep cycle abnormalities. A neuroendocrinologic model of fibromyalgia is presented that accommodates both its known central and peripheral pain mechanisms as well as the myriad of hormonal, visceral, and psychological symptoms associated with that disorder. This model also provides a unifying pathophysiologic basis of fibromyalgia and chronic muscle pain, and offers the potential for developing new avenues of research and treatment for these enigmatic, frequently disabling medical conditions

On multifractals: a non-linear study of actigraphy data

This work aimed, to determine the characteristics of activity series from fractal geometry concepts application, in addition to evaluate the possibility of identifying individuals with fibromyalgia. Activity level data were collected from 27 healthy subjects and 27 fibromyalgia patients, with the use of clock-like devices equipped with accelerometers, for about four weeks, all day long. The activity series were evaluated through fractal and multifractal methods. Hurst exponent analysis exhibited values according to other studies ($H>0.5$) for both groups ($H=0.98\pm0.04$ for healthy subjects and $H=0.97\pm0.03$ for fibromyalgia patients), however, it is not possible to distinguish between the two groups by such analysis. Activity time series also exhibited a multifractal pattern. A paired analysis of the spectra indices for the sleep and awake states revealed differences between healthy subjects and fibromyalgia patients. The individuals feature differences between awake and sleep states, having statistically significant differences for $\alpha_{q-} - \alpha_{0}$ in healthy subjects ($p = 0.014$) and $D_{0}$ for patients with fibromyalgia ($p = 0.013$). The approach has proven to be an option on the characterisation of such kind of signals and was able to differ between both healthy and fibromyalgia groups. This outcome suggests changes in the physiologic mechanisms of movement control.Comment: Preprint accepted for publication at Physica A: Statistical Mechanics and its Application

Oral burning with dysphagia and weight loss

Fibromyalgia is a disorder characterized by an abnormal pain regulation. Widespread pain, fatigue, and sleep disturbance are the prevalent symptoms. When unusual symptoms are overbearingly predominant at clinical presentation, the diagnosis becomes challenging. We report on the case of a patient with fibromyalgia, who presented with dysphagia, odynophagia, and glossodynia as prevalent symptoms. Difficulty in swallowing gradually developed over a month prior hospitalization, and worsened progressively so that nourishment and fluid intake were impeded. Because anemia with mild iron deficiency was found, esophagogastroduodenoscopy was performed, but no lesions were seen in the upper digestive tract. Levels of zinc and vitamin B12 were normal. Intense pain at pelvis and the inferior limbs, which was at a first glance referred to as osteoarthrosis, associated with oral symptoms and feeling of being in the clouds allowed us to diagnose fibromyalgia. Amitriptyline was used, with relief of symptoms. Although oropharyngeal symptoms were occasionally reported in fibromyalgia, they are often overlooked. The present case, therefore, testifies the need to consider the diagnosis of fibromyalgia when the patient presents with such symptoms that cannot be readily explained on other grounds

Providing effective maternity care for women affected by fibromyalgia

Fibromyalgia is a condition for which information is not readily accessible in midwifery or obstetric text books. This ‘invisible disability’ can have detrimental implications for all aspects of maternity care. From the physiology and psychology of fibromyalgia during the antenatal through to the postnatal period, this article highlights key issues which can have a hidden but significant impact on the maternity experience of women with fibromyalgia. The author explores these issues and suggests ways in which midwives can improve the quality of the care given to women affected with this condition

Spa treatment for primary fibromyalgia syndrome: a combination of thalassotherapy, exercise and patient education improves symptoms and quality of life

Objectives: To study the effect of a combination of thalassotherapy, exercise and patient education in people with fibromyalgia. -\ud Methods: Patients with fibromyalgia, selected from a rheumatology out-patient department and from members of the Dutch fibromyalgia patient association, were pre-randomized to receive either 2 weeks of treatment in a Tunisian spa resort, including thalassotherapy, supervised exercise and group education (active treatment) or treatment as usual (control treatment). Primary outcome measure was health-related quality of life, measured with the RAND-36 questionnaire. Secondary measures included the Fibromyalgia Impact Questionnaire, the McGill Pain Questionnaire, the Beck Depression Inventory, tender point score and a 6-min treadmill walk test. -\ud Results: Fifty-eight participants receiving the active treatment reported significant improvement on RAND-36 physical and mental component summary scales. For physical health, differences from the 76 controls were statistically significant after 3 months, but not after 6 and 12 months. A similar pattern of temporary improvement was seen in the self-reported secondary measures. Tender point scores and treadmill walk tests improved more after active treatment, but did not reach significant between-group differences, except for walk tests after 12 months. -\ud Conclusions: A combination of thalassotherapy, exercise and patient education may temporarily improve fibromyalgia symptoms and health-related quality of life

Sedentary Time Accumulated in Bouts is Positively Associated with Disease Severity in Fibromyalgia: The Al-andalus Project

To examine the associations of prolonged sedentary time (ST) with disease severity in women with fibromyalgia, and to analyse the combined association of total ST and prolonged ST with the disease severity in this population. Women (n = 451; 51.3 +/- 7.6 years old) with fibromyalgia participated. Sedentary time and moderate-to-vigorous physical activity (MVPA) were measured using triaxial accelerometry and ST was processed into 30- and 60-min bouts. Dimensions of fibromyalgia (function, overall, symptoms) and the overall disease impact were assessed with the Revised Fibromyalgia Impact Questionnaire (FIQR). Body fat percentage was assessed using a bio-impedance analyser, and physical fitness was assessed with the Senior Fitness Tests Battery. Greater percentage of ST in 30-min bouts and 60-min bouts were associated with worse function, overall, symptoms and the overall impact of the disease (all, P 60-min bouts) presented lower overall impact compared to participants with high levels of total ST and prolonged ST (mean difference = 6.56; 95% confidence interval (CI) = 1.83 to 11.29, P = 0.002). Greater percentage of ST accumulated in 30- and 60-min bouts and a combination of high levels of total and prolonged ST are related to worse disease severity. Although unable to conclude on causality, results suggest it might be advisable to motivate women with fibromyalgia to break prolonged ST and reduce their total daily ST