Nonpharmacologic Treatment for Fibromyalgia

Fibromyalgia is a common musculoskeletal pain condition associated with chronic widespread pain, tenderness at various points on the body, fatigue, and sleep abnormalities. Individuals with fibromyalgia often have comorbid anxiety, depression, and/or other pain syndromes. Research into pharmacologic remedies for fibromyalgia has demonstrated efficacy for a variety of agents, but pharmacology is only one piece of the puzzle when it comes to successful management of fibromyalgia. Nonpharmacological treatments, complementary and alternative medicines, and therapies can support alleviating fibromyalgia symptoms.There are many studies with regard to these treatment options

Comparison of the effectiveness of conventional physical therapy and extracorporeal shock wave therapy on pain, disability, functional status, and depression in patients with chronic low back pain

Objectives: The aim of this study was to compare the effectiveness of conventional physical therapy (transcutaneous electrical nerve stimulation, hot pack, and therapeutic ultrasound) and extracorporeal shock wave therapy (ESWT) on pain, disability, functional status, and depression in patients with chronic low back pain (LBP).Patients and methods: Ninety-one patients with chronic LBP were included in the study and randomized to groups that received ESWT or conventional physiotherapy; of these, 70 completed the study (37 males, 33 females; mean age: 46.4 +/- 13.3 years; range, 18 to 65 years). Outcome measures included the Visual Analog Scale, the pressure pain algometer, Oswestry Disability Index (ODI), Health Assessment Questionnaire (HAQ), fingertip-to-floor distance, and the Beck Depression Inventory. The assessments were made before treatment and at the first and 12th weeks after treatment. Results: Extracorporeal shock wave therapy was more effective than conventional physical therapy in terms of Visual Analog Scale scores, the pressure algometer, ODI, HAQ, and fingertip-to-floor distance at the first and 12th week.Conclusion: Extracorporeal shock wave therapy is superior to conventional physical therapy in terms of improving pain, spinal mobility, and functional status in patients with chronic LBP

Superior cluneal nerve entrapment neuropathy due to lower crossed syndrome: A case with low back pain [Alt çapraz sendroma bağlı superior kluneal sinir tuzaklanma nöropatisi: Bel ağrılı bir olgu sunumu]

The superior cluneal nerve (SCN) is a sensory nerve known to be originated from the dorsal rami of the lower thoracic and lumbar nerve roots. One of the overlooked causes of low back pain (LBP) is the SCN Entrapment Neuropathy (SCNEN). SCNEN may also be associated with SCN stretching due to lumbar movement and the poor body posture through an increase in the paravertebral muscle tonus. A 59-year-old female patient presented with chronic LBP localized on the right iliac crest and radiating to the right buttock, groin, and leg. She had increased lumbar lordosis and anterior pelvic tilt. She had a tender point over the right iliac crest, and the pain was radiating to the buttock and posterolateral thigh (Tinel sign +). She was diagnosed with lower crossed syndrome and SCNEN, and a therapeutic nerve block was performed. Clinicians should consider SCNEN as a possible diagnosis of LBP

Is Low-Dose Dextrose Prolotherapy as Effective as High-Dose Dextrose Prolotherapy in the Treatment of Lateral Epicondylitis? A Double-Blind, Ultrasound Guided, Randomized Controlled Study

Objectives: To investigate the effects of prolotherapy (PrT) on pain, functionality, clinical improvement and to compare the 5% low and 15% high dose dextrose PrT in chronic lateral epicondylitis. Design: A double-blind, parallel groups, randomized controlled study. Settings: Outpatient Clinic. Participants: Sixty patients (N=60), aged 44.30±10.31 years old, with chronic lateral epicondylitis were allocated randomly into 3 groups. Interventions: To Group 1 5% dextrose PrT, to Group 2 15% dextrose PrT, to Group 3 0.9% saline injections were done at 3 times (weeks 0, 3, 6), to the entheses of forearm extensors and annular ligament. Main Outcome Measures: The primary outcomes were handgrip strength, visual analog scale-rest (VAS-R), visual analog scale-activity (VAS-A), pressure-pain threshold, and Quick Disability of the Arm, Shoulder and Hand (Q-DASH). The secondary outcomes were clinical improvement (Disease Global Assessment Questionnaire), side effects, and complications. Primary outcomes were collected at baseline week 0, week 3, and 12. Secondary outcomes were collected at weeks 3 and 12. Results: In Group 2, VAS-A and VAS-R (at week 3), handgrip strength and pressure-pain threshold (at week 12) were significantly different than other groups (P<.05). In Groups 1 and 2, there was a difference in primary outcomes at week 12 than baseline (P[removed].05). Conclusion: In chronic lateral epicondylitis, 5% and 15% dextrose PrT is more effective in pain, handgrip strength, functionality, and clinical improvement than %0.9 saline. There was no difference in functionality, clinical improvement, side effects, and complications between the PrT groups. 15% dextrose PrT was more effective in handgrip strength and pressure-pain threshold at week 12 and pain at week 3. We recommend 15% dextrose PrT based on this study. © 2022 American Congress of Rehabilitation Medicin

Response to Letter to the Editor: Low-Dose Dextrose Prolotherapy as Effective as High-Dose Dextrose Prolotherapy in the Treatment of Lateral Epicondylitis? A Double-Blind, Ultrasound Guided, Randomized Controlled Study

In lateral epicondylitis, angiofibroblastic hyperplasia and poor scar tissue occur in response to recurring microtrauma in the tendon, and consequently, complete healing does not take place. In vitro studies using 50% dextrose as a proliferant have shown that exposure of tenocytes to dextrose elicited an inflammatory response through the upregulation of proinflammatory markers, including interleukin 8, cyclooxygenase 2, and prostaglandin 2, and downregulation of anti-inflammatory marker growth factor b

Does One Trigger The Other? Coexistence of Gout and Haglund: A Case Report

Heel pain is one of the common clinical conditions of musculoskeletal diseases. Heel pain can occur with infectious, inflammatory, mechanical and vascular causes. Haglund's deformity, one of the causes of heel pain, is an abnormal bone formation located in the posterosuperior part of the calcaneus. Achilles enthesopathy, Haglund deformity and lesions in the posterior heel are considered Haglund Syndrome. The diagnosis of Haglund Syndrome is made clinically and radiologically. In the diagnosis of Haglund syndrome, direct radiography and magnetic resonance imaging are used in radiological examination. The bony prominence on the lateral radiograph of the foot supports the diagnosis. The differential diagnosis of Haglund Syndrome with rheumatic diseases such as gout and seronegative spondyloarthritis should be made. Gout is an inflammatory rheumatic disease characterized by the accumulation of monosodium urate crystals in tissues caused by hyperuricemia. In this article, a case diagnosed with gout accompanying bilateral Haglund Syndrome is presented in the light of current literature

Evaluation of the physical and emotional effects of the COVID-19 pandemic on patients with fibromyalgia and chronic low back pain: A multicenter cross-sectional controlled study

Objectives: This study aimed to investigate the physical and emotional effects of the coronavirus disease 2019 pandemic in patients with fibromyalgia syndrome (FMS) and chronic low back pain (CLBP) patients.Patients and methods: The cross-sectional controlled study was performed with 1,360 participants (332 males, 1,028 females; mean age: 42.3 +/- 12.5 years; range, 18 to 65 years) between September 2020 and February 2021. The participants were evaluated in three groups: the FMS group (n=465), the CLBP group (n=455), and the healthy control group (n=440). Physical activity, pain levels, and general health status before and during the pandemic were evaluated in all participants. Stress levels were analyzed with the perceived stress scale (PSS) in all groups, and disease activity was analyzed with the fibromyalgia impact questionnaire (FIQ) in patients with FMS.Results: Patients with FMS had worsened general health status and pain levels during the pandemic compared to the other groups (p<0.01). The FMS group showed significantly higher PSS scores than those in other groups (p<0.01). There was a weak-positive correlation between FIQ and PSS parameters in patients with FMS (p<0.05, r=0.385).Conclusion: The general health status, pain, and stress levels of the patients with FMS and CLBP tended to worsen during the pandemic. This high-stress level appeared to affect disease activity in patients with FMS

Disability Distribution of Geriatric Patients Applying to the Board of Health for Disabled in a Rural Region

Objective:To determine the demographic characteristics, disability ratios, and disability distribution of geriatric patients who applied to an educational research hospital in the rural region to receive a health board report in order to benefit from the disability rights.Materials and Methods:The hospital archive was searched and the records between 01/01/2016 and 31/12/2016 were examined. The demographic characteristics of the patients, whether they were “severely disabled” or not, the number of patients with disabilities according to organ systems were determined and the disability ratios were calculated based on the “Regulation on Disability Criterion, Classification and Health Board Reports for Disability”. A list of diseases constituting the rate of disability was established and its numbers were determined.Results:Among the 699 geriatric patients who referred to the health board, 426 (60.9%) were female and 273 (39.1%) were male. The mean age of the patients was 77.62±7.74 years (minimum: 65, maximum: 104) (female: 78.07±7.54, male: 76.93±8.02), the mean disability ratio was 79.96±17.79% (10-100). The average disability ratio of females was 79.66±17.61% and the average disability ratio of males were 80.41±18.24%. There was no statistically significant difference between the male and female groups in terms of the mean disability ratio (p=0.239). Of the 202 (28.9%) patients who were considered to be severely disabled, 123 were female (60.9%) and 79 were male (39.1%). There was no statistically significant difference between male and female groups in severely disabled ratios (p=0.457). The first three organ systems constituting disability ratio in patients were the cardiovascular system, the musculoskeletal system, and the visual system. The number of patients with disabilities in the cardiovascular and musculoskeletal system was higher in women, but there was no statistically significant difference between the disability percentages of these systems.Conclusion:The highest rate of disability has been seen in the cardiovascular, musculoskeletal, and visual system in geriatric patients. In the practice of routine geriatric outpatient clinics, the pathologies of these organ systems should be evaluated in more detail and managed before creating disability

Complex Regional Pain Syndrome in a Child: A Case Report

Complex regional pain syndrome (CRPS) is a painful clinical condition that usually seen on the distal extremity, affects children and adults. It is more common in adults. CRPS is usually characterized by severe pain, swelling, limitation of movement, trophic disorders, and spotted osteoporosis following triggering stimulus. CRPS-1 is not a peripheral nerve lesion, it develops following trauma, surgical applications and central nervous system lesion. On the other hand CRPS-2 occurs after peripheral nerve lesion. In CRPS-1, a more severe effect is seen than the initiating factor. CRPS-1 is a rare clinical condition in children. In this article, a 9-year-old male patient which developed CRPS-1 following lower extremity fracture is presented in company with current literature

Comparison of the diagnoses, the outpatient clinics they visited, and the number of visits of patients with and without a diagnosis of fibromyalgia syndrome: Do patients with fibromyalgia syndrome come to the hospital more often? [Fibromiyalji sendromu tanısı olan ve olmayan hastaların başvurdukları poliklinik bölümleri, başvuru sayıları ve aldıkları tanıların karşılaştırılması: Fibromiyalji sendromu tanısı olan hastalar, hastaneye daha mı sık geliyor?]

Summary Objectives: Fibromyalgia syndrome (FMS) has a wide spectrum of symptoms that includes all body parts. So FMS is a great imitator. This brings to mind the possibility that fibromyalgia patients visit outpatient clinics in many departments more than non-fibromyalgia patients. However, there is not enough data on this subject. This study aims to compare the number of outpatient visits of patients with FMS with those without a diagnosis of FMS and to examine their diagnoses. Methods: The diagnoses of 140 patients (70 with fibromyalgia and 70 controls), and departments of the outpatient clinics they visited were analyzed retrospectively. In the control group, patients who visited the same outpatient clinic with the complaint of knee pain, but who did not have FMS and who had never been diagnosed with FMS before, were recruited as age- and gender-matched. Results: The total number of outpatient clinic visits, as well as the number of visits to physical medicine and rehabilitation, obstetrics and gynecology, general surgery, internal medicine, and psychiatry departments, were significantly higher in fibromyalgia group patients compared to the control group. In addition, the number of diagnoses in the 5th chapter (mental, behavioral, and neurodevelopmental disorders, F01-F99) of International Classification of Diseases-10 was significantly higher in the fibromyalgia group. Conclusion: It should be kept in mind that patients with FMS visit more hospitals and outpatient clinics than other patients. Physicians and patients should be informed about this issue to reduce unnecessary health costs