SENSIBILIZACIÓN CENTRAL AL DOLOR Y ANTI-NOCICEPCIÓN CARDIOVASCULAR EN FIBROMIALGIA: PROTOCOLO DE ESTIMULACIÓN DOLOROSA LENTAMENTE REPETIDA Y SU ASOCIACIÓN CON PARÁMETROS CLÍNICOS Y CARDIOVASCULARES

La fibromialgia es un síndrome de dolor crónico caracterizado por dolor generalizado, difuso y persistente cuya etiología permanece desconocida. Su patofisiología se relaciona con procesos de sensibilización central y disfunción de los sistemas inhibitorios del dolor. Sin embargo, no se encuentran marcadores clínicos específicos que faciliten su diagnóstico. En esta tesis doctoral se prueba un protocolo de dolor evocado basado en estimulación dolorosa lentamente repetida. Este protocolo generó un patrón de incremento progresivo en la intensidad subjetiva del dolor en las pacientes con fibromialgia, el cual no apareció en individuos sanos ni con otra patología de dolor crónico (artritis reumatoide). Por otra parte, la asociación inversa entre presión arterial y dolor experimental observada típicamente en individuos sanos, sólo fue encontrada en fibromialgia usando este protocolo y no al utilizar medidas estáticas (umbral/tolerancia). El protocolo de dolor evocado lentamente repetido se presenta como un marcador diagnostico complementario con potencial utilidad clínica.Fibromyalgia is a chronic pain syndrome characterized by generalized, diffuse and persistent pain whose etiology remains unknown. Its pathophysiology is related to central sensitization processes and dysfunction of pain inhibitory systems. However, no specific clinical markers have been found to facilitate its diagnosis. This doctoral thesis tests an evoked pain protocol based on slowly repeated painful stimulation. This protocol generated a pattern of progressive increase in the subjective intensity of pain in patients with fibromyalgia, which did not appear in healthy individuals or other chronic pain pathology (rheumatoid arthritis). In other way, the inverse association between blood pressure and experimental pain typically observed in healthy individuals was only found in fibromyalgia using this protocol and not when using static measures (threshold/tolerance). The slowly repeated evoked pain protocol is presented as a complementary diagnostic marker with potential clinical utility.Tesis Univ. Jaén. Departamento de Psicología. leída el 20 de julio de 2018

Online ACT intervention for fibromyalgia: An exploratory study of feasibility and preliminary effectiveness with smartphone-delivered experiential sampling assessment.

Introduction Acceptance and commitment therapy (ACT) is an effective treatment for chronic pain conditions. ACT seeks to produce clinical change by enhancing Psychological Flexibility (PF). This exploratory (feasibility and preliminary effectiveness) study presents a pilot application of an online ACT group intervention for fibromyalgia (FM) with an extensive Experiential Sampling (ES) assessment of outcome and process variables via smartphone. Method 5-weekly ACT online group sessions were applied to 9 female FM patients. Questionnaire-based assessments of several clinical outcomes and PF processes were conducted pre- and post-intervention, and at 6-month follow-up. Extensive (6 weeks pre- and 6 weeks post-intervention) smartphone-delivered ES was implemented to gather process and outcome data in the patients' usual contexts. Clinically significant change was evaluated both at the group level and individually. Results This treatment format appears to be feasible and acceptable to participants, with good adoption and completion rates (75 %) and excellent rates of treatment completion and clinical adherence (100 %). Participants showed significant reductions in affective pain, distress and biopsychosocial impact of FM both post-intervention and at 6-month follow-up (as measured with questionnaires), as well as significant improvements in satisfaction with actions and emotional discomfort (as measured through ES). Multilevel regression analyses indicated that PF-related processes assessed through ES had a significant impact on clinical outcomes and predicted the impact of FM at the 6-month follow-up. Conclusions A brief online group ACT intervention for FM was both feasible and acceptable to participants. Also, there was preliminary evidence of effectiveness in enhancing pain-related PF and producing clinical benefits in FM.This clinical research work has been supported by a postdoctoral fellow from Andalusian government co-financed by European Social Funds (Ref: DOC2020-00462). Funding for open access charge: Universidad de Jaén

Reliability, Factor Structure and Predictive Validity of the Widespread Pain Index and Symptom Severity Scales of the 2010 American College of Rheumatology Criteria of Fibromyalgia

©. This manuscript version is made available under the CC-BY license http://creativecommons.org/licenses/ccby/4.0/ This document is the Published, version of a Published Work that appeared in final form in [Journal of Clinical Medicine]. To access the final edited and published work see [https://doi.org/10.3390/jcm9082460]Fibromyalgia syndrome (FMS) is a chronic condition of widespread pain. In 2010, the American College of Rheumatology (ACR) proposed new diagnostic criteria for FMS based on two scales: the Widespread Pain Index (WPI) and Symptoms Severity (SS) scale. This study evaluated the reliability, factor structure and predictive validity of WPI and SS. In total, 102 women with FMS and 68 women with rheumatoid arthritis (RA) completed the WPI, SS, McGill Pain Questionnaire, Trait Anxiety Inventory, Fatigue Severity Scale, Oviedo Quality of Sleep Questionnaire, and Beck Depression Inventory. Pain threshold and tolerance and a measure of central sensitization to pain were obtained by pressure algometry. Values on WPI and SS showed negative-skewed frequency distributions in FMS patients, with most of the observations concentrated at the upper end of the scale. Factor analysis did not reveal single-factor models for either scale; instead, the WPI was composed of nine pain-localization factors and the SS of four factors. The Cronbach’s α (i.e., Internal consistency) was 0.34 for the WPI,0.83 for the SS and 0.82 for the combination of WPI and SS. Scores on both scales correlated positively with measures of clinical pain, fatigue, insomnia, depression, and anxiety but were unrelated to pain threshold and tolerance or central pain sensitization. The 2010 ACR criteria showed 100% sensitivity and 81% specificity in the discrimination between FMS and RA patients, where discrimination was better for WPI than SS. In conclusion, despite their limited reliability, both scales allow for highly accurate identification and differentiation of FMS patients. The inclusion of more painful areas in the WPI and of additional symptoms in the SS may reduce ceiling effects and improve the discrimination between patients differing in disease severity. In addition, the use of higher cut-off values on both scales may increase the diagnostic specificity in Spanish samples

Análisis, diseño, construcción e implementación de un geoportal con las herramientas Mongo DB, Json y Geojson para el proyecto IDE-UPS

En la actualidad el uso de geoportales ha ido en aumento y más aún con la aparición de las bases de datos NoSQL. El cuál permite almacenar masivamente los archivos JSON facilitando el uso de estos archivos y usados en otros sistemas de georeferenciación. Los geoportales se han convertido en poderosas herramientas para la búsqueda y ubicación geográfica, el presente trabajo de titulación está se orienta a realizar una investigación con análisis, diseño, construcción e implementación de un geoportal, con una base de datos NoSQL La herramienta MongoDB es una base de datos NoSQL que maneja una estructura de datos en forma de documentos llamados BSON, que son similares a JSON y por este motivo también se puede usar datos de tipo GeoJSON, permitiendo así que la integración de los datos en ciertas aplicaciones sea más fácil y rápida. Para llevar a cabo el desarrollo de este trabajo de titulación, se realizó una investigación exhaustiva en el ámbito de la base de Datos NoSQL y la relación con los lenguajes de programación a utilizar, de este modo el geoportal constara de una base de datos NoSQL como es MongoDB, su capa de negocios con JSF y su capa de presentación con PrimeFaces. Así se concluye, que con la implementación del geoportal este aportará beneficios a la Universidad Politécnica Salesiana y a sus áreas de investigación, permitiendo identificar si una base de datos SQL es mejor que una NoSQL en el manejo de la información geográfica siendo este el primer geoportal a ser desarrollado con dichas herramientas en el Ecuador.Today the use of geoportal has increased and even more so with the appearance of the NoSQL database. Which allows the massive storage of JSON files, facilitating the use of these files and allowing them to be used in other georeferencing systems. Geoportals have turned into powerful tools for searching and locating geographical locations. The current job is oriented in carrying out an investigation with analysis, design, construction and the implementation of a geoportal, with a NoSQL database. MongoDB tool is a database that manages a NoSQL data structure in the form of documents called BSON, which are similar to JSON and for this reason you also can use data of type GeoJSON, this allowing the integration of the data in certain applications faster and easier. To carry out the development of this thesis, he conducted an exhaustive investigation in the field of database NoSQL and the relationship with the programming languages to use, in this way the Geoportal will consist of a database as is NoSQL MongoDB, your business layer with JSF and its presentation layer with PrimeFaces. It is concluded, that with the implementation of the Geoportal this will bring benefits to the Universidad Politecnica Salesiana and their research areas, making it possible to identify if a SQL database is better than a NoSQL in the handling of geographic information and this be the first to be Geoportal developed with such tools in Ecuador

Correction: Reduced activity, reactivity and functionality of the sympathetic nervous system in fibromyalgia: An electrodermal study.

[This corrects the article DOI: 10.1371/journal.pone.0241154.]

Narcissistic Personality and Its Relationship with Post-Traumatic Symptoms and Emotional Factors: Results of a Mediational Analysis Aimed at Personalizing Mental Health Treatment

Background: Narcissism is characterized by entitlement, grandiose fantasies and the need for admiration. This personality trait has been associated with both traumatic experiences and emotional problems. Most studies have only focused on narcissism in the context of childhood trauma and negative emotional factors. However, dimensions of grandiose narcissism such as authority have been linked to adaptive outcomes. Furthermore, narcissism might not be linked only to negative childhood experiences; it may also be associated with the presence of post-traumatic symptoms. Therefore, the present study aimed to assess the associations between narcissism and the frequency and severity of post-traumatic symptoms and emotional factors (resilience capacity, emotional regulation, positive and negative affect, intolerance of uncertainty and perceived stress), as well as the possible mediational role of the latter in the relationship between narcissism and post-traumatic symptoms. Method: A total of 115 healthy young psychology undergraduates and their relatives, aged from 18 to 40 years, were asked to complete a set of questionnaires to evaluate the aforementioned variables. Results: The results showed that most of the grandiose narcissism dimensions were positively related to emotional adaptive outcomes, except exploitativeness and entitlement. The negative associations observed between the frequency and severity of post-traumatic symptoms and narcissism (self-sufficiency) were mediated by affect and resilience, which were in turn positively associated with the majority of the narcissism dimensions. Both positive affect and resilience were important factors mediating the association between grandiose narcissism and post-traumatic symptoms. Conclusions: Our findings reaffirm the need to assess not only desirable personality traits, but also ones that are not initially desirable, before pathologizing them. This consideration may be essential to achieve a personalized approach to the prevention of mental health problems, and promotion of positive emotions, in the general population

Impact of homeostatic body hydration status, evaluated by hemodynamic measures, on different pain sensitization paths to a chronic pain syndrome

Abstract Contrasting findings on the mechanisms of chronic pain and hypertension development render the current conventional evidence of a negative relationship between blood pressure (BP) and pain severity insufficient for developing personalized treatments. In this interdisciplinary study, patients with fibromyalgia (FM) exhibiting clinically normal or elevated BP, alongside healthy participants were assessed. Different pain sensitization responses were evaluated using a dynamic 'slowly repeated evoked pain' (SREP) measure, as well as static pain pressure threshold and tolerance measures. Cardiovascular responses to clino-orthostatic (lying-standing) challenges were also examined as acute re- and de-hydration events, challenging cardiovascular and cerebrovascular homeostasis. These challenges involve compensating effects from various cardiac preload or afterload mechanisms associated with different homeostatic body hydration statuses. Additionally, hair cortisol concentration was considered as a factor with an impact on chronic hydration statuses. Pain windup (SREP) and lower pain threshold in FM patients were found to be related to BP rise during clinostatic (lying) rehydration or orthostatic (standing) dehydration events, respectively. These events were determined by acute systemic vasoconstriction (i.e., cardiac afterload response) overcompensating for clinostatic or orthostatic cardiac preload under-responses (low cardiac output or stroke volume). Lower pain tolerance was associated with tonic blood pressure reduction, determined by permanent hypovolemia (low stroke volume) decompensated by permanent systemic vasodilation. In conclusion, the body hydration status profiles assessed by (re)activity of systemic vascular resistance and effective blood volume-related measures can help predict the risk and intensity of different pain sensitization components in chronic pain syndrome, facilitating a more personalized management approach

Attentional function in fibromyalgia and rheumatoid arthritis.

Concentration difficulties, forgetfulness and mental slowness are common in fibromyalgia syndrome (FMS); initial findings suggest that rheumatoid arthritis (RA) may also be accompanied by cognitive impairments. This study aimed to compare attentional performance between patients with FMS and RA. Attention was quantified in the domains of alerting, orienting and executive control using the Attentional Network Test-Interaction (ANT-I) in 56 women with FMS, 41 women with RA and 50 healthy women. Pain severity was statistically controlled in the group comparison. While FMS patients exhibited longer reaction times and made more errors on the ANT-I than RA patients and healthy women, performance did not differ between RA patients and healthy women. The magnitude of group differences did not vary by the experimental conditions of the ANT-I, suggesting a general attentional deficit in FMS rather than specific impairments in the domains of alerting, orienting and executive control. Differences between patient groups may relate to the different pathogenetic mechanisms involved in the disorders, i.e. inflammatory processes in RA and central nervous sensitization in FMS. In FMS, heightened activity in the pain neuromatrix may interfere with attention, because it requires enhanced neural resources in brain areas that are involved in both pain and attentional processing

Clinical status, quality of life, and work productivity in Crohn's disease patients after one year of treatment with adalimumab.

Clinical trials have shown the efficacy of adalimumab in Crohn's disease, but the outcome in regular practice remains unknown. The aim of the study was to examine clinical status, quality of life, and work productivity of Crohn's disease patients receiving adalimumab for one year in the context of usual clinical practice. This was a prospective, observational study with a one-year follow-up. After baseline, Crohn's disease patients were evaluated at 1, 3, 6, 9, and 12 months after starting treatment with adalimumab. Outcome variables included: clinical status (measured with CDAI), quality of life (measured with EuroQoL-5D and IBDQ), and work productivity (measured with WPAI questionnaire). These outcome variables were compared using the Student's t test or Wilcoxon test for paired comparison data according to the data distribution. Statistical significance was set at two-sided p The sample was composed of 126 patients (age [mean] 39.1 ± [standard deviation] 13.8 years; 51% male). Significant changes were observed during the follow-up period: CDAI decreased from [median] 194 ([25-75 percentiles] 121-269) to 48.2 (10.1-122.0) (p In regular practice, adalimumab is clinically effective in the treatment of Crohn's disease patients and results in a significant improvement in quality of life and work productivity

Clinical status, quality of life, and work productivity in Crohn's disease patients after one year of treatment with adalimumab

Objective: Clinical trials have shown the efficacy of adalimumab in Crohn's disease, but the outcome in regular practice remains unknown. The aim of the study was to examine clinical status, quality of life, and work productivity of Crohn's disease patients receiving adalimumab for one year in the context of usual clinical practice. Material and methods: This was a prospective, observational study with a one-year follow-up. After baseline, Crohn's disease patients were evaluated at 1, 3, 6, 9, and 12 months after starting treatment with adalimumab. Outcome variables included: clinical status (measured with CDAI), quality of life (measured with EuroQoL-5D and IBDQ), and work productivity (measured with WPAI questionnaire). These outcome variables were compared using the Student's t test or Wilcoxon test for paired comparison data according to the data distribution. Statistical significance was set at two-sided p < 0.05. Results: The sample was composed of 126 patients (age [mean] 39.1 ± [standard deviation] 13.8 years; 51% male). Significant changes were observed during the follow-up period: CDAI decreased from [median] 194 ([25-75 percentiles] 121-269) to 48.2 (10.1-122.0) (p < 0.05); the EuroQoL-5D increased from 0.735 (0.633-0.790) to 0.797 (0.726-1.000) (p < 0.05); the EuroQoL-5D visual analogue scale increased from 50.0 (40-70) to 80.0 (60-90); (p < 0.05) and the IBDQ increased from 56.7 (51.6-61.5) to 67.5 (60.1-73.6) (p < 0.05). The total work productivity impact decreased from 53% to 24% (p < 0.05). Conclusions: In regular practice, adalimumab is clinically effective in the treatment of Crohn's disease patients and results in a significant improvement in quality of life and work productivity