Increased brain white matter axial diffusivity associated with fatigue, pain and hyperalgesia in Gulf War illness

Background Gulf War exposures in 1990 and 1991 have caused 25% to 30% of deployed personnel to develop a syndrome of chronic fatigue, pain, hyperalgesia, cognitive and affective dysfunction. Methods Gulf War veterans (n = 31) and sedentary veteran and civilian controls (n = 20) completed fMRI scans for diffusion tensor imaging. A combination of dolorimetry, subjective reports of pain and fatigue were correlated to white matter diffusivity properties to identify tracts associated with symptom constructs. Results Gulf War Illness subjects had significantly correlated fatigue, pain, hyperalgesia, and increased axial diffusivity in the right inferior fronto-occipital fasciculus. ROC generated thresholds and subsequent binary regression analysis predicted CMI classification based upon axial diffusivity in the right inferior fronto-occipital fasciculus. These correlates were absent for controls in dichotomous regression analysis. Conclusion The right inferior fronto-occipital fasciculus may be a potential biomarker for Gulf War Illness. This tract links cortical regions involved in fatigue, pain, emotional and reward processing, and the right ventral attention network in cognition. The axonal neuropathological mechanism(s) explaining increased axial diffusivity may account for the most prominent symptoms of Gulf War Illness

Increased brain white matter axial diffusivity associated with fatigue, pain and hyperalgesia in Gulf War illness. PLoS One

Abstract Background: Gulf War exposures in 1990 and 1991 have caused 25% to 30% of deployed personnel to develop a syndrome of chronic fatigue, pain, hyperalgesia, cognitive and affective dysfunction

Effectiveness of land- and water-based exercise on fatigue and sleep quality in women with fibromyalgia: the al-Ándalus quasi-experimental study

Objetivo Evaluar la efectividad de 24 semanas de ejercicio en tierra y agua sobre la fatiga y la calidad del sueño en mujeres con fibromialgia , y la persistencia de los cambios 12 semanas después de la interrupción del ejercicio. Diseño Estudio cuasiexperimental. Configuración Instalaciones universitarias y asociaciones de fibromialgia. Participantes Mujeres con fibromialgia (N=250; 50,8±7,6 años). Intervenciones Los participantes fueron asignados a grupos de ejercicio en tierra (n = 83), ejercicio en agua (n = 85) o control sin ejercicio (n = 82). Los grupos de intervención participaron en un programa de ejercicio multicomponente similar durante 24 semanas. Las principales medidas Se utilizó el Inventario Multidimensional de Fatiga y el Índice de Calidad del Sueño de Pittsburgh . Resultados Los análisis por intención de tratar revelaron que, en comparación con el grupo de control, en la semana 24: (i) el grupo de ejercicio en tierra mejoró la fatiga física (diferencia de medias -0,9 unidades; intervalo de confianza del 95%: -1,7 a -0,1; d de Cohen =0,4) y (ii) el grupo de ejercicio acuático mejoró la fatiga general (-0,8; -1,4 a -0,1, d=0,4) y la calidad global del sueño (-1,6; -2,7 a -0,6, d=0,6). Además, en comparación con el grupo de ejercicio en tierra, el grupo de ejercicio en el agua mejoró la calidad global del sueño (-1,2; -2,2 a -0,1, d=0,4). En general, los cambios no se mantuvieron en la semana 36. Conclusión El ejercicio multicomponente en tierra mejoró la fatiga física, mientras que el ejercicio en el agua mejoró la fatiga general y la calidad del sueño. La magnitud de los cambios fue de pequeña a media y no se mantuvieron los beneficios después de suspender el ejercicio.Objective: To assess the effectiveness of 24 weeks of land- and water-based exercise on fatigue and sleep quality in women with fibromyalgia, and the persistence of changes 12 weeks after exercise cessation. Design: quasi-experimental study Setting: University facilities and fibromyalgia associations. Participants: Women with fibromyalgia (N=250; 50.8 ± 7.6 years old) Interventions: Participants were assigned to land-based exercise (n=83), water-based exercise (n=85) or no exercise control (n=82) groups. The intervention groups engaged in a similar multicomponent exercise program for 24 weeks. Main outcome measures: The Multidimensional Fatigue Inventory (MFI) and Pittsburgh Sleep Quality Index (PSQI) were used. Results: Intention-to-treat analyses revealed that, compared to the control group, at week 24: (i) the land-based exercise group improved physical fatigue (mean difference -0.9 units; 95% CI -1.7 to -0.1; Cohen’s d=0.4), and (ii) the water-based exercise group improved general fatigue (-0.8; -1.4 to -0.1, d=0.4), and global sleep quality (-1.6; -2.7 to -0.6, d=0.6). Additionally, compared to the land-based exercise group, the water-based exercise group improved global sleep quality (-1.2; -2.2 to -0.1, d=0.4). Changes were generally not sustained at week 36. Conclusion: Land-based multicomponent exercise improved physical fatigue, whereas water-based exercise improved general fatigue and sleep quality. The magnitude of the changes was small-to-medium and no benefits were maintained after exercise cessation

Objective and subjective measures of physical functioning in women with fibromyalgia: what type of measure is associated most clearly with subjective well-being?

Purpose: To find modifiable factors that are related to subjective well-being would be valuable for improving interventions in fibromyalgia. Physical activity, sedentary behaviour, and physical fitness may represent potential areas to optimize treatment regimens. In fibromyalgia, there is a discordance between clinical observations and patient-reported outcomes (objective and subjective assessments). Therefore, the present study aims at analyzing the associations of objective and subjective evaluations of physical activity, sedentary behaviour, and physical fitness with subjective well-being and determine if and how objective and subjective associations differ. Methods: In this population-based cross-sectional study participated 375 women with fibromyalgia from the al-Ándalus project (Spain). Physical activity, sedentary behaviour, and physical fitness were objectively (accelerometers and performance testing) and subjectively (questionnaires) measured. Participants self-reported their levels of positive affect, negative affect, and life satisfaction. Results: In the most conservative multivariate analysis, we found independent associations of the objective measures of physical activity with positive affect and life satisfaction and sedentary behaviour with positive affect. No such relationship was seen with subjective measures of the same behaviours. Moreover, we observed that objective and subjective physical fitness evaluations were independent of each other related to subjective well-being. Conclusions: Independent associations of the objective measures (but not the subjective assessments) of physical activity with positive affect and life satisfaction, and of sedentary behaviour with positive affect were observed. However, objective measures and subjective appraisals of physical fitness appear to be independently related to well-being, which should be considered when developing physical exercise interventions for fibromyalgia.Implications for rehabilitation The analysis of concurrent associations of objective and subjective evaluations of physical functioning with subjective well-being offers indications for modifiable targets in rehabilitation that can improve well-being in fibromyalgia. Exercise-based rehabilitation may help women with fibromyalgia to improve subjective well-being, particularly positive affect. Rehabilitation should focus on both the objective physical performance of women with fibromyalgia and on their perceptions of what they can do physically. When rehabilitation aims at enhancing positive affect or life satisfaction by changing the lifestyle of women with fibromyalgia, physical activity and sedentary behaviour should be objectively monitored

Review of pharmacological therapies in fibromyalgia syndrome

This review addresses the current status of drug therapy for the management of fibromyalgia syndrome (FMS) and is based on interdisciplinary FMS management guidelines, meta-analyses of drug trial data, and observational studies. In the absence of a single gold-standard medication, patients are treated with a variety of drugs from different categories, often with limited evidence. Drug therapy is not mandatory for the management of FMS. Pregabalin, duloxetine, milnacipran, and amitriptyline are the current first-line prescribed agents but have had a mostly modest effect. With only a minority of patients expected to experience substantial benefit, most will discontinue therapy because of either a lack of efficacy or tolerability problems. Many drug treatments have undergone limited study and have had negative results. It is unlikely that these failed pilot trials will undergo future study. However, medications, though imperfect, will continue to be a component of treatment strategy for these patients. Both the potential for medication therapy to relieve symptoms and the potential to cause harm should be carefully considered in their administration

Medical Necessity in Private Health Plans: Implications for Behavioral Health Care

This report addresses how the term medical necessity is defined in private health insurance coverage decisions. It summarizes a review of the literature, an extensive review of legal cases that challenge insurer decisions, materials prepared by the insurance industry, consultation with experts in the field, a review of investigations conducted by State departments of insurance and attorneys general, and interviews with health care executives regarding the decision-making process itself. The report does not explore factors that can affect access to care that might be considered clinically necessary by treating professionals or the effects of medical necessity decisions on therapeutic outcomes