Aysun Genç

Is there an association between mastalgia and fibromyalgia? Comparing prevalence and symptom severity.

To determine the prevalence of mastalgia in patients with fibromyalgia (FM) and the prevalence of FM in patients with mastalgia in order to investigate coexistence, and to compare the pain patterns in the case of mastalgia or FM alone versus the two in combination. Fifty consecutive patients with mastalgia and 50 consecutive patients with FM were assessed and examined both for the existence and severity of mastalgia and FM. A high proportion of patients with mastalgia (36%) fulfilled the criteria for FM and 42% had mastalgia in the FM group. Two distinctive entities mastalgia and FM, being both unexplained pain syndromes, seem to frequently coexist. Patients with mastalgia or FM should be thoroughly questioned considering each of the diseases so that in case of coexistence an appropriate therapy might be implemented for a successful pain management.

Does aerobic exercise affect the hypothalamic-pituitary-adrenal hormonal response in patients with fibromyalgia syndrome?

[Purpose] The hypothalamic-pituitary-adrenal (HPA) axis in the etiopathogenesis of fibromyalgia is not clear. This study aimed to analyze the effects of a 6-week aerobic exercise program on the HPA axis in patients with fibromyalgia and to investigate the effects of this program on the disease symptoms, patients’ fitness, disability, and quality of life. [Subjects and Methods] Fifty fibromyalgia patients were randomized to Group 1 (stretching and flexibility exercises at home for 6 weeks) and Group 2 (aerobic exercise three times a week and the same at-home exercises as Group 1 for 6 weeks). Serum levels of cortisol, adrenocorticotropic hormone, insulin-like growth factor-1, and growth hormone were analyzed at baseline and at the end of, and 1 hr after an exercise stress test. [Results] Group 2 showed better improvement in morning stiffness duration and pain. Growth hormone levels significantly increased after intervention and cortisol levels significantly decreased at time-time interaction in both groups. No significant differences in adrenocorticotropic hormone and insulin-like growth factor-1 were found. [Conclusion] The results of this study seem to support the hypothesis that there is a dysregulation of the HPA axis in patients with FM, and that a six-week exercise program can influence symptoms and affect the HPA axis hormones.

The effects of exercise on mastalgia.

ABSTRACT Objective: Mastalgia is often ignored by physicians although it is the most common breast-related complaint among women. The effectiveness of exercise therapy for mastalgia is unclear. The aim of this study is to investigate the effects of exercise on mastalgia. Methods: A randomized controlled trial was conducted with twenty women with complaints of mastalgia fulfilling the inclusion and exclusion criteria. Patients were randomly assigned to the control group and to the exercise group. Sports brassiere, refraining from caffeine- and methylxanthine-containing foods, and simple analgesics were recommended for two groups. In the exercise group, an exercise program was conducted three times a week for 6 weeks. Participants in both groups were evaluated for breast pain and using the Short-Form Health Survey (SF-36) questionnaire before and six weeks after study. Serum cytokine levels were also collected and analyzed. Results: No significant differences were detected with respect to age, body mass index, menopausal status, psychiatric condition, and existence of unexplained pain syndromes between the groups. Total breast pain scores were similar in both groups. The sensory component of breast pain questionnaire and visual analogue scale values significantly improved via exercise in only exercise group (p = 0.012 and p = 0.016). There was no significant difference between groups in serum levels of cytokines. SF-36 subscale scores for general health and social functioning significantly improved in the control group and scores for role physical, bodily pain, and social functioning improved in exercise group. Conclusions: Based on our preliminary findings, exercise treatment is beneficial for patients with mastalgia and it can be suggested by clinicians.

A thermal dysregulation problem after breast cancer surgery; what could be?

Rationale: Chronic fatigue syndrome (CFS) is a complicated disorder characterized by severe fatigue that is not relieved with rest and associated with physical symptoms such as sleep problems, headache, muscle pain, or joint pain. Patient concerns: Forty-one year old patient complained from feeling cold after breast cancer surgery. Diagnoses: The diagnoses of fibromyalgia, depression, neurological, psychiatric, and vascular disorders were excluded by appropriate clinical and laboratory investigations. She was diagnosed as CFS. Interventions: The patient was treated successfully via aerobic exercise therapy that scheduled for 30 min at least 3 days per week. Outcomes: At 6-month follow-up, her complaints were almost resolved and the patient regained her physical health and mental attitude. Lessons: A thermal dysregulation should be taken into consideration as one of the symptoms of CFS.

Reliability, Construct Validity and Measurement Potential of the International Classification of Functioning, Disability and Health Comprehensive Core Set for Chronic Widespread Pain

Abstract Objectives: To investigate the reliability and construct validity of the International Classification of Functioning, Disability and Health [ICF] Comprehensive Core Set for Chronic Widespread Pain [CWP] in order to test its possible use as a measuring tool for functioning. Methods: Patient participants with CWP were assessed by the ICF Comprehensive Core Set for CWP, the Short Form-36 Health Survey [SF-36] and the Fibromyalgia Impact Questionnaire [FIQ]. The internal construct validity of the “Body Functions” [BF], “Activity” [A], “Participation” [P] and “Environmental Factors” [EF] domains were tested by Rasch analysis; the reliability by internal consistency and the Person Separation Index; and external construct validity by association with the SF-36 and FIQ. Results: One hundred patients with fibromyalgia syndrome [FMS] were recruited for this study in Ankara, Turkey. Most were literate in Turkish and were able to complete the SF-36 and FIQ unassisted but some were illiterate, so the instruments were read to them by an investigator. In each scale, items showing disordered thresholds were rescored, testlets were created to overcome local dependency problems, and items mismatched to the Rasch model were deleted. Then the internal construct validity of the BF, A, P and EF scales were good, indicating a single underlying construct for each scale. The scales were free of differential item functioning. Reliabilities of the scales were adequate [Cronbach’s alphas 0.78–0.86, Person Separation Index’s 0.68–0.82]. The BF, A and P showed moderate correlations with the SF-36 and FIQ, whereas the EF scale had statistically significant but weak correlation only with SF-36 Social Functioning. Conclusion: Since the four scales derived from BF, A, P and EF components of the ICF core set for CWP were shown to be reliable and valid through Rasch analysis and classical psychometric methods, these might be used as clinical assessment tools.

Clinically Positive Axillary Lymphadenopathy May Lead to False Diagnosis of Overstaged Breast Cancer in Patients with Sjögren's Syndrome: A Case Report

Sjögrens syndrome (SS) is an autoimmune disease that chronic inflammation and lymph node proliferation. Patients with SS carry a greater risk of developing lymphoproliferative malignancy. In addition to other organ cancers, breast cancer may also occur in these patients. Considering these, breast cancer in patients with SS can be misdiagnosed as being in an advanced stage particularly in the presence of axillary lymphadenopathy. Here, we report a rare case of a 45-year-old woman with SS who presented with a breast mass. Radiology showed a 4 cm solid lesion and conglomerates of axillary lymphadonepathy. A breast biopsy revealed ductal carcinoma in situ. A modified radical mastectomy was performed; however, no axillary metastases were detected. Clinicians should remain vigilant to the possibility that a false clinical impression of axillary metastasis may occur in such patients with breast cancer. Therefore, axillary node status should be verified first.