Milton Helfenstein

A comparison of quality of life, demographic and clinical characteristics of Brazilian men with fibromyalgia syndrome with male patients with depression.

The primary aim of this study was to assess the quality of life (Qol) in men with fibromyalgia (FM) as compared to the Qol of depressive patients, using the SF-36 questionnaire. The secondary objectives were as follows: to describe demographic and clinical characteristics of male patients with FM; to evaluate basal levels of dehydroepiandrosterone sulfate (DHEAS) and total testosterone in both groups; and to investigate the relationship among pain, tender points, anxiety, and depression in these patients. Fifty men with FM and 20 depressed males, matched by age and body mass index entered the study. All participants answered the SF-36, the Beck Depression Inventory and the State-Trait Anxiety Inventory questionnaire. Radioimmunoassay was used to determine serum concentration of DHEAS and total testosterone. Patients and controls had similar demographic characteristics. The scores were significantly lower in all domains of the SF-36 in patients with FM as compared with the depressive controls. No significant differences were observed among patient and control in the mean concentration of either DHEAS or total testosterone. Male patients with FM experience worse Qol than depressive men. Depression was influential on mental health, whereas FM impacted on both physical and mental health.

The pervasiveness of the illness suffered by workers seeking compensation for disabling arm pain

Disability from work-related arm pain has become prevalent in several countries in recent years. Many of these individuals present with chronic musculoskeletal symptoms that, for lack of a more specific diagnosis, are often labeled as a repetitive strain injury or cumulative trauma disorder. Indemnity for such conditions can be contentious; many of these sufferers are involved in litigation in their quest for financial compensation for temporary or permanent disability. This article describes our experience with 103 patients referred to a Health Reference Center for Workers for the management of repetitive strain injury. Their illness is far more global than the work-related arm pain that such labeling implies. From the total group, 73 fulfilled the American College of Rheumatology Criteria for the Classification of Fibromyalgia Syndrome. This means that they were suffering pain above and below the diaphragm, far from the arm pain for which they were referred. These 73 patients were clinically and psychologically indistinguishable from 165 patients followed in our clinic at the Federal University of São Paulo, Rheumatology Division, who also fulfilled these criteria but did not consider their illness work-related. This observation calls for longitudinal investigations that might offer insights as to whether the more global aspects of the illness are antecedent, coincident, or confounding aspects of the illness experience labeled repetitive strain injury or cumulative trauma disorder.

Fibromyalgia and Chronic Pain Syndromes: A White Paper Detailing Current Challenges in the Field

This manuscript, developed by a group of chronic pain researchers and clinicians from around the world, aims to address the state of knowledge about fibromyalgia (FM) and identify ongoing challenges in the field of FM and other chronic pain syndromes that may be characterized by pain centralization/amplification/hypersensitivity. There have been many exciting developments in research studies of the pathophysiology and treatment of FM and related syndromes that have the potential to improve the recognition and management of patients with FM and other conditions with FM-like pain. However, much of the new information has not reached all clinicians, especially primary care clinicians, who have the greatest potential to use this new knowledge to positively impact their patients’ lives. Furthermore, there are persistent misconceptions about FM and a lack of consensus regarding the diagnosis and treatment of FM. This paper presents a framework for future global efforts to improve the understanding and treatment of FM and other associated chronic pain syndromes, disseminate research findings, identify ways to enhance advocacy for these patients, and improve global efforts to collaborate and reach consensus about key issues related to FM and chronic pain in general.

EpiFibro - um banco de dados nacional sobre a síndrome da fibromialgia: análise inicial de 500 mulheres

INTRODUCAO: A fibromialgia (FM) e uma condicao dolorosa do sistema musculoesqueletico, geralmente acompanhada de varios sintomas em outros sistemas, com uma prevalencia no Brasil estimada em 2,5%. Apresentamos os dados iniciais do EpiFibro, um banco de dados nacional de pacientes com FM atendidos em servicos publicos e privados. OBJETIVO: Avaliar como e feito o diagnostico da doenca, identificar um conjunto de dominios clinicos considerados relevantes por medicos e por pacientes com FM, analisar o impacto da doenca na qualidade de vida dos pacientes e comparar os achados entre pacientes de servicos publico e privado. METODOS: Foram analisadas as respostas das primeiras 500 mulheres nesse banco de dados. Esse banco de dados foi baseado em um questionario contendo dados demograficos e clinicos. O Fibromyalgia Impact Questionnaire (FIQ), traduzido e validado para o Brasil, foi preenchido pelos medicos e/ou pacientes. RESULTADOS: Uma analise preliminar do banco de dados EpiFibro revelou que as pacientes com FM no Brasil tem um alto impacto da doenca avaliada pelo FIQ, uma alta prevalencia de sintomas associados, um baixo grau de educacao (um achado que pode ser explicado pelo fato de a saude publica no Brasil ser usada principalmente por aqueles desfavorecidos socialmente) e a maioria percebe a sua dor como sendo difusa a partir do inicio da doenca. CONCLUSAO: Depressao e ansiedade sao percebidas como as principais causas dos sintomas da FM, mas uma quantidade significativa considera o esforco no trabalho como o primeiro gatilho. Ha um atraso de poucos anos em busca de ajuda medica e para chegar ao reumatologista.

A Brazilian Portuguese version of the Revised Fibromyalgia Impact Questionnaire (FIQR): a validation study

The Fibromyalgia Impact Questionnaire (FIQ) was specifically developed to assess disease severity and functional ability in fibromyalgia patients. In 2009, a revised version of the FIQ was published, the FIQR; this version achieved a better balance among different domains (function, overall impact, symptoms). Here, we present the validity and reliability of the Brazilian version of the Revised Fibromyalgia Impact Questionnaire (FIQR). Female fibromyalgia patients (n = 106) completed an online survey consisting of the Short Form 36 (SF-36) questionnaire, the original FIQ, and the Brazilian Portuguese FIQR, which was translated by a standard method. Validity was established with correlational analyses between the FIQR, FIQ, and SF-36 items. Three domains were established for the FIQR (function, overall impact, symptoms), and their contribution for the SF-36 subscales was also scrutinized. The Brazilian FIQR validation process showed that the questions performed in a very similar way to the original English FIQR. The new questions in the FIQR symptoms domain (memory, balance, tenderness, and environmental sensitivity) revealed a significant impact in fibromyalgia (FM) patients. The Brazilian Portuguese FIQR demonstrated excellent reliability, with a Cronbach’s alpha of 0.96. There was a gain on weight of the function domain and a decrease of the symptom domain, leading to a better balance among domains. The FIQR predicted a great number of SF-36 subscales, showing good convergent validity. The Brazilian Portuguese version of the FIQR was validated and found to be a reliable, easy-to-use, and score FM-specific questionnaire that should prove useful in routine clinical practice and FM-related research.

EpiFibro – a nationwide databank for fibromyalgia syndrome – the initial analysis of 500 women

INTRODUCTION Fibromyalgia syndrome (FS) is a common painful condition of the musculoskeletal system that is typically accompanied by several symptoms in other systems. In Brazil, the prevalence of FS is estimated at 2.5%. Here, we present the initial data from Epi-Fibro, a nationwide databank of FS patients seen in public and private settings. OBJECTIVE The aims of this study were to assess how the diagnosis of FS was made, identify a set of clinical domains considered relevant by both clinicians and patients in cases of FS, analyse the impact of disease on patient quality of life, and compare the findings among patients of public and private services. METHODS Based on the results of questionnaires, we analysed data corresponding to the first 500 women in the database. Questionnaires pertaining to demographic and clinical data and the Fibromyalgia Impact Questionnaire (FIQ), which was translated and validated for Brazilian patients, were completed by the clinicians and/or patients. RESULTS Preliminary analysis of the EpiFibro databank revealed that female FS patients in Brazil reported a high impact of disease, as measured by the FIQ, a high prevalence of associated symptoms, and a low degree of education (consistent with the public health care in Brazil used mainly by the underserved). In addition, most patients perceived their pain as diffuse from the onset of disease. CONCLUSION Depression and anxiety were seen as the main triggers of FM symptoms, but a significant proportion of the subjects perceived work strain as the initial trigger.We also observed a delay of a few years in seeking medical help and examination by a rheumatologist.

The shoulder in a production line: clinical and ultrasound study

INTRODUCTION: The correlation among shoulder pain, abnormal physical examination and ultrasonography is controversial in the occupational scenario. OBJECTIVE: Establish the association between pain, physical examination and ultrasounds in workers of a pharmaceutical industry. PATIENTS AND METHODS: One hundred workers were invited to take part in the study and submitted to the inclusion and exclusion criteria, and 93 were included. All enrolled patients gave written informed consent, and had a physical examination performed by one of the authors. Ultrasound examination was performed, at the latest one month of the physical examination, by an experienced operator who was blind to the clinical setting. RESULTS: There was statistical correlation between pain and clinical maneuvers in 57 shoulders for supraspinatus tendon (SE) (P = 0,000) and no correlation with biceps tendon maneuvers (P > 0,05). In the comparison between clinical findings and ultrasonography, the maneuvers of Neer, Hawkins and Jobe had statistical association (P < 0,05). The association between pain and altered ultrasonography was statistically significant (16 among 57 individuals with pain, with P < 0,05), but there was significant false-positive ultrasound findings in asymptomatic shoulders (7 individuals). CONCLUSION: The precise diagnosis is a complex process, which requires the association of clinical and occupational anamnesis, accurate physical examination and ultrasonography performed by an experienced operator.

Prevalência da síndrome do cólon irritável em pacientes com fibromialgia

INTRODUCTION: Fibromyalgia is a prevalent syndrome of widespread pain and multiple tender points, with no inflammatory, dystrophic or degenerative changes, probably related to abnormal central modulation of pain processing. Irritable bowel syndrome is considered a dysfunctional syndrome of visceral pain and/or alteration on gastrointestinal motility, also related to the same central nervous system (CNS) abnormalities. OBJECTIVE: The aim of this study was to evaluate the prevalence of irritable bowel syndrome in patients with fibromyalgia and to establish their clinical characteristics. PATIENTS AND METHODS:Two hundred consecutive patients with fibromyalgia syndrome were studied. RESULTS: These, 134 (67%) had irritable bowel syndrome. The most common presentation was the constipation subtype (121 =90.2%). The majority of patients had high scores of anxiety and/or depression. Conclusion: No differences were noted among patients with fibromyalgia without irritable bowel syndrome, and those with both conditions.

Fibromialgia, LER, entre outras confusões diagnósticas

Este e um tipico caso de ocorrencia comum na rotina medica em todas as regioes do pais. Envolve uma jovem profissionalmente ativa, afastada ha diversos anos do trabalho, alegando total ausencia de melhora de sua sintomatologia, contrariamente a uma evidencia cientifica. Relata quadro de dor difusa pelo corpo, erroneamente interpretada como consequencia de seu trabalho, com multiplos diagnosticos de lesoes musculoesqueleticas, que vem piorando, apesar da retirada das incriminadas sobrecargas biomecânicas laborais. O caso foi interpretado como uma doenca, lato sensu, que nao e reconhecida na literatura medica. A possibilidade de fibromialgia, reumatismo psicogenico e de simulacao, envolvendo litigio trabalhista, e trazida em questao.This is a typical case, extremely common on daily practice, occuring in several areas of our country, involving a young female patient, active professionally, deviated from her job for several years, arguing total lack of efficacy on her treatment, conversely to scientific evidence. She complains of diffuse pain, erroneously interpreted as consequence of her job, with multiple specific diagnosis of musculoskeletal lesions, which has becoming worse, despite of withdrawal of the incriminated biomechanical overloading. The case was interpreted as a disease, lato sensu, which is not recognized in the medical literature. The possibility of fibromyalgia, psicogenic rheumatism and simulation, involving litigation, is brought foward.This is a typical case, extremely common on daily practice, occuring in several areas of our country, involving a young female patient, active professionally, deviated from her job for several years, arguing total lack of efficacy on her treatment, conversely to scientific evidence. She complains of diffuse pain, erroneously interpreted as consequence of her job, with multiple specific diagnosis of musculoskeletal lesions, which has becoming worse, despite of withdrawal of the incriminated biomechanical overloading. The case was interpreted as a disease, lato sensu, which is not recognized in the medical literature. The possibility of fibromyalgia, psicogenic rheumatism and simulation, involving litigation, is brought foward.

New guidelines for the diagnosis of fibromyalgia

OBJECTIVE To establish guidelines based on scientific evidence for the diagnosis of fibromyalgia. MATERIAL AND METHODS Evidence collection was performed based on 9 questions regarding the diagnosis of fibromyalgia, structured using the Patient, Intervention or Indicator, Comparison and Outcome (P.I.C.O.), with searches in the main, primary databases of scientific information. After defining the potential studies to support the recommendations, they were graded according to evidence and degree of recommendation.