Ana Assumpção

Prevalence of fibromyalgia in a low socioeconomic status population

BackgroundThe aim of this study was to estimate the prevalence of fibromyalgia, as well as to assess the major symptoms of this syndrome in an adult, low socioeconomic status population assisted by the primary health care system in a city in Brazil.MethodsWe cross-sectionally sampled individuals assisted by the public primary health care system (n = 768, 35–60 years old). Participants were interviewed by phone and screened about pain. They were then invited to be clinically assessed (304 accepted). Pain was estimated using a Visual Analogue Scale (VAS). Fibromyalgia was assessed using the Fibromyalgia Impact Questionnaire (FIQ), as well as screening for tender points using dolorimetry. Statistical analyses included Bayesian Statistics and the Kruskal-Wallis Anova test (significance level = 5%).ResultsFrom the phone-interview screening, we divided participants (n = 768) in three groups: No Pain (NP) (n = 185); Regional Pain (RP) (n = 388) and Widespread Pain (WP) (n = 106). Among those participating in the clinical assessments, (304 subjects), the prevalence of fibromyalgia was 4.4% (95% confidence interval [2.6%; 6.3%]). Symptoms of pain (VAS and FIQ), feeling well, job ability, fatigue, morning tiredness, stiffness, anxiety and depression were statically different among the groups. In multivariate analyses we found that individuals with FM and WP had significantly higher impairment than those with RP and NP. FM and WP were similarly disabling. Similarly, RP was no significantly different than NP.ConclusionFibromyalgia is prevalent in the low socioeconomic status population assisted by the public primary health care system. Prevalence was similar to other studies (4.4%) in a more diverse socioeconomic population. Individuals with FM and WP have significant impact in their well being.

Quantifying pain threshold and quality of life of fibromyalgia patients

The most typical symptom of fibromyalgia (FM) is diffuse pain, and pain at specific points—tender points—is crucial for its diagnosis. By comparing healthy individuals and FM patients, this study was aimed at assessing pain and quality of life of Brazilian females with FM, while seeking for a correlation between pain threshold and quality of life. A total of 178 women were evaluated: 124 were FM patients and 54 were healthy women. Pain threshold at tender points was quantified by dolorimetry, and diffuse pain by means of the visual analogue scale (VAS); the Fibromyalgia Impact Questionnaire (FIQ) was used to evaluate quality of life. Statistical treatment of the data allowed for proposing two indexes: a pain threshold index (PT) and a quality of life one (QOL). PT is the lowest value among all pain thresholds measured at the 18 tender points; QOL is the mean of responses to the FIQ and VAS. Both indexes were tested and showed significant differences between the test and control groups. By pairing pain threshold values of each tender point in the test and control groups, it was found that the most sensitive points matched between the two groups, that is, the most sensitive anatomic spots in a healthy individual are also likely to be the most sensitive points in a person with FM. This suggests that a stimulus that provokes slight discomfort to a healthy person may produce more pain in FM patients—which may bear implications for FM clinical treatment. In this sample of Brazilian women, FM patients had both lower pain threshold and worse quality of life than healthy women.

Efeitos do alongamento muscular e condicionamento físico no tratamento fisioterápico de pacientes com fibromialgia

Objective: To investigate the effects of muscle stretching exercises and physical conditioning as physical therapy treatment for fi bromyalgia. Methods: Fifteen women with a diagnosis of fi bromyalgia in accordance with the criteria of the American College of Rheumatology were evaluated and divided into two groups: Group 1 (G1, eight patients) underwent treatment consisting of muscle stretching and Group 2 (G2, seven patients), participated in a physical conditioning program. Sleep quality, pain-modulating factors, associated symptoms and medications used were evaluated. Furthermore, the Fibromyalgia Impact Questionnaire (FIQ) was applied to evaluate the impact of fiThe treatment lasted for eight weeks, with one session per week of 40 to 45 minutes in duration. The FIQ data obtained before and after treatment were analyzed by means of Student’s t test for dependent samples (α< 0.05) and other variables were analyzed descriptively. Results: Most of the patients presented poor quality of sleep (86.67%). Many presented worsening of their pain when doing domestic tasks (40%) and there were no factors that relieved their pain (28.57%). All presented sleep disorders with associated symptoms (100%) and most used antidepressives (69.23%). For the FIQ data, statistically signifi cant differences were observed in morning tiredness (p= 0.0428) and stiffness (p= 0.0130) among the G1 patients. Conversely, no difference was observed in G2 after the treatment. Conclusions: It is suggested that the muscle stretching may have had a positive impact on fi bromyalgia, with reductions in morning tiredness and stiffness among the patients evaluated.

Brazilian-Portuguese translation and cross cultural adaptation of the activities-specific balance confidence (ABC) scale

BACKGROUND The Activities-specific Balance Confidence (ABC) scale was developed to quantify the self-perceived level of confidence in performing specific activities without losing balance or becoming unsteady. The ABC scale has been adopted in clinical practice and in research, although cross-cultural differences may impose difficulties in its use. OBJECTIVE To translate, cross-culturally adapt and verify the intra- and inter-rater reliability of the Brazilian-Portuguese version of the ABC scale and describe the self-perceived balance confidence of elderly Brazilian people. METHOD The ABC scale was translated and culturally adapted. To verify the intra- and inter-rater reliability, 40 elderly individuals with ages ranging from 60 to 88 years were interviewed. The scale was administered by two raters on the same day and readministered after seven days by rater 1. To test the reliability, we used the intraclass correlation coefficient (ICC). RESULTS Six items from the ABC scale were considered culturally, semantically or regionally inappropriate and were modified. The intra-rater reproducibility was excellent (ICC=0.94), and the inter-rater reproducibility was very good (ICC=0.80). The self-perception of balance in specific activities of the elderly was considered very good, with an average of 81.7 and scores ranging from 61.2 to 96.7. CONCLUSION The ABC scale was translated and culturally adapted for the Brazilian population and presents good intra- and inter-rater reliability. The self-perceived balance confidence in elderly Brazilian people evaluated with the ABC scale is moderate.

Quality of life and discriminating power of two questionnaires in fibromyalgia patients: Fibromyalgia Impact Questionnaire and Medical Outcomes Study 36-Item Short-Form Health Survey

BACKGROUND Fibromyalgia is a painful syndrome characterized by widespread chronic pain and associated symptoms with a negative impact on quality of life. OBJECTIVES Considering the subjectivity of quality of life measurements, the aim of this study was to verify the discriminating power of two quality of life questionnaires in patients with fibromyalgia: the generic Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) and the specific Fibromyalgia Impact Questionnaire (FIQ). METHODS A cross-sectional study was conducted on 150 participants divided into Fibromyalgia Group (FG) and Control Group (CG) (n=75 in each group). The participants were evaluated using the SF-36 and the FIQ. The data were analyzed by the Student t-test (α=0.05) and inferential analysis using the Receiver Operating Characteristics (ROC) Curve--sensitivity, specificity and area under the curve (AUC). The significance level was 0.05. RESULTS The sample was similar for age (CG: 47.8 ± 8.1; FG: 47.0 ± 7.7 years). A significant difference was observed in quality of life assessment in all aspects of both questionnaires (p<0.05). Higher sensibility, specificity and AUC were obtained by the FIQ (96%, 96%, 0.985, respectively), followed by the SF-36 (88%, 89% and 0.948 AUC). CONCLUSION The FIQ presented the highest sensibility, specificity and AUC showing the most discriminating power. However the SF-36 is also a good instrument to assess quality of life in fibromyalgia patients, and we suggest that both should be used in parallel because they evaluate relevant and complementary aspects of quality of life.

Exercícios de alongamento muscular e aeróbico no tratamento da fibromialgia: estudo piloto

INTRODUCTION: The physical exercises have been beneficial for the control of the fibromyalgia (FM) symptoms. OBJECTIVES: To compare the effects of stretching exercises to aerobic exercises on pain, number of tender points, sleep, anxiety and depression of patients with FM. MATERIALS AND METHODS: Nineteen patients with diagnosis of FM according to the American College of Rheumatology criteria were divided into two groups: the stretching group, with 12 patients, performed a program composed by 45 minutes eight sessions of stretching exercises once a week, and the aerobic group, with seven patients, carried out walking on a treadmill for 30 minutes. Both groups received orientation to exercise at home on the other days. Pain intensity, tenderness threshold at the tender points, sleep, anxiety and depression were evaluated by, respectively, visual analogic scale, dolorimeter, Post Sleep Inventory (PSI), Trait-State Anxiety Inventory (IDATE) and Beck Depression Scale (BDS). RESULTS: The data show that the clinical improvement was higher in the stretching group in relation to pain (25%), number of tender points (15%), sleep (38%) and depression (22%), compared to aerobic group (clinical improvement in pain was 2% and in sleep, 4%; the number of tender points and depression became worse, respectively 3% and 18%). The anxiety clinical improvement was more important in the aerobic group (8% in the trait anxiety and 10% in the state anxiety) compared to stretching group (the trait anxiety become worse at 3% and the state anxiety clinical improvement was 2%). CONCLUSION: This study suggests that the stretching exercises are more effective than the aerobic exercises on pain, number of tender points, sleep and depression in FM. On the other hand, the aerobic exercises seem to produce a more important effect on anxiety reduction compared to stretching exercises.

Associação da qualidade de vida com dor, ansiedade e depressão

O objetivo deste estudo foi verificar associacao entre qualidade de vida relacionada a saude e dor, ansiedade e depressao em individuos de 35 a 60 anos. Foram avaliados 304 individuos (244 mulheres, 60 homens) com queixa de dor, divididos em tres grupos segundo a caracteristica da dor: dor difusa e cronica (DDC), dor regional (DR) e dor esporadica (DE). A intensidade da dor foi avaliada por uma escala visual analogica, ansiedade pelo Inventario de Ansiedade Traco-Estado, depressao pela escala de depressao de Beck e a qualidade de vida (QV), pelo questionario Short-Form Health Survey - SF-36. A media de idade foi 49,1±6,8 anos; 80,3% eram do sexo feminino; e 35% da amostra referiu dor difusa e cronica. Os resultados mostram que o grupo DDC apresentou os sintomas mais intensos de dor, ansiedade, depressao e pior qualidade de vida, seguido pelos grupos DR e DE, com diferenca estatisticamente significante (p<0,001). A correlacao entre qualidade de vida e depressao foi forte (r=-0,73) e moderada entre qualidade de vida e dor (r=-0,41), entre QV e ansiedade-traco (r=-0,65), e entre QV e ansiedade-estado (r=-0,58) (p<0,0001). Os individuos com dor difusa e cronica foram pois os que apresentaram os sintomas mais intensos e pior qualidade de vida; e esta mostrou-se correlacionada negativamente a depressao, dor e ansiedade.

Efeito da acupuntura na melhora da dor, sono e qualidade de vida em pacientes fibromiálgicos: estudo preliminar

Fibromyalgia is a syndrome defined by chronic widespread pain and sensitivity to pressure at at least 11 of 18 tender points. The aim of this random blind clinical trial was to assess the effectiveness of acupuncture on pain relief, on quality of sleep and life in fibromyalgia patients. From 20 female fibromyalgic patients (diagnosed according to the American College of Rheumatology), mean aged 44 years, 12 completed the study, randomly assigned into two groups: group A (GA, n=5) received acupuncture according to the traditional Chinese medicine; and group B (GB, n=7) received acupuncture at eight tender points: at the occiput, trapezius muscle, supraspinatus muscle, and lateral epicondyle. Pain was assessed by a visual analogue scale and by dolorimetry; quality of life, by the Fibromyalgia Impact Questionnaire (FIQ); and sleep, by the Post Sleep Inventory. Both groups received acupuncture once a week for eight weeks, with insertion of eight needles for 25 minutes. Data were statistically analysed and significance level set at α=0.05. Results show significant sleep improvement in GA; and, in GB, lesser pain as detected by VAS, higher pain threshold on tender points, better sleep and improvement in FIQ items pain, morning tiredness, anxiety, and depression (p<0.05). These data suggest that acupuncture, especially that with tender point needle insertion, provides pain relief, better quality of life and of sleep in fibromyalgic patients.

Fibromyalgia: is there association between balance and pain? a pilot study

Studies of balance and risk factors for falling typically focus on the elderly population or on individuals with musculoskeletal pain. Although fibromyalgia is associated with intrinsic factors that predispose to falls (pain, depression, fatigue), few studies have researched balance and falls in this syndrome. The aim of this study was to verify the association between balance, balance self-efficacy and pain in women with and without fibromyalgia, and verify the association between Berg Balance Scale and Activities-specific Balance Confidence Scale (ABC Scale). The sample consisted of 48 women aged between 40 and 59 years, divided into two groups: Fibromyalgia group (n=22) and Control group (n=26) with asymptomatic people. Balance was assessed by Berg Balance Scale, balance self-efficacy by the ABC Scale and pain by the visual analog scale. Mean scores for pain, Berg and ABC Scale were 5.4 cm (SD 2.6), 55 (interquartile range 54-56), and 54.6 (SD 26.6) respectively for Fibromyalgia group, and 0 cm, 56 (interquartile range 55-56), and 89.4 (SD 14.4) respectively for Control group. Statistically significant differences were found in balance on comparing both groups (p=0.000 for Berg Balance Scale and 0.009 for ABC Scale) with lower values for Fibromyalgia group. In Fibromyalgia group, pain was negatively correlated with balance (r=-0.48, p=0.020) and balance self-efficacy (rs=-0.56, p=0.006). Correlation between Berg Balance Scale and ABC Scale was found only in the Fibromyalgia group (rs =0.55, p=0.007). There are associations between poor balance and pain, and poor balance and decreased balance self-efficacy in women with fibromyalgia. There is an association between scales in the Fibromyalgia group.

Fibromialgia: ¿hay una asociación entre el equilibrio y el dolor? un estudio piloto

Studies of balance and risk factors for falling typically focus on the elderly population or on individuals with musculoskeletal pain. Although fibromyalgia is associated with intrinsic factors that predispose to falls (pain, depression, fatigue), few studies have researched balance and falls in this syndrome. The aim of this study was to verify the association between balance, balance self-efficacy and pain in women with and without fibromyalgia, and verify the association between Berg Balance Scale and Activities-specific Balance Confidence Scale (ABC Scale). The sample consisted of 48 women aged between 40 and 59 years, divided into two groups: Fibromyalgia group (n=22) and Control group (n=26) with asymptomatic people. Balance was assessed by Berg Balance Scale, balance self-efficacy by the ABC Scale and pain by the visual analog scale. Mean scores for pain, Berg and ABC Scale were 5.4 cm (SD 2.6), 55 (interquartile range 54-56), and 54.6 (SD 26.6) respectively for Fibromyalgia group, and 0 cm, 56 (interquartile range 55-56), and 89.4 (SD 14.4) respectively for Control group. Statistically significant differences were found in balance on comparing both groups (p=0.000 for Berg Balance Scale and 0.009 for ABC Scale) with lower values for Fibromyalgia group. In Fibromyalgia group, pain was negatively correlated with balance (r=-0.48, p=0.020) and balance self-efficacy (rs=-0.56, p=0.006). Correlation between Berg Balance Scale and ABC Scale was found only in the Fibromyalgia group (rs =0.55, p=0.007). There are associations between poor balance and pain, and poor balance and decreased balance self-efficacy in women with fibromyalgia. There is an association between scales in the Fibromyalgia group.