Thesis (Ph. D.)--University of Texas at Austin, 2007. / Vita. Includes bibliographical references.

Thesis (doctoral)--La Salle University, 2003. / ProQuest dissertations and theses ; AAT 3108296. Includes bibliographical references (leaves 67-91).

Rheumatoid arthritis (RA) is a systemic chronic inflammatory disease that can lead to important functional impairment. Although improvements in treatment have been made, still there are a high proportion of patients in whom response to treatment is not complete. Fibromyalgia (FM) is a condition characterized by bodily pain that often coexists with RA. Cross-sectional studies have shown that patients with RA and FM symptoms, or fibromyalgic RA (FRA), have higher disease activity scores than patients with RA and no FRA. Concern has been raised regarding the validity of RA disease activity scores in patients with coexistent RA and FM. In this prospective study, we hypothesized that patients with FRA have an impaired response to treatment measured by traditionally used scores. The present analysis used a study sample obtained from the ESPOIR French cohort. This is a longitudinal prospective cohort of adults with early RA. Patients with RA were classified in two groups according to the presence of FRA. RA disease activity scores (DAS28, SDAI, CDAI and HAQ) were compared as a measure of response to treatment at 6, 12 and 18 months. Results showed that after adjusting for confounders, patients with FRA (120) had higher activity scores than patients with RA and no fibromyalgic characteristics (548). DAS28 and other disease activity scores started out higher in subjects with FRA and while they improved to a similar extent as in the isolated RA group, they remained consistently higher among FRA patients. Achievement of low disease activity and of remission according to established activity score cut-points was significantly less likely in subjects with FRA. In conclusion, patients with FRA and RA had a similar response to treatment according the decrease in indexes of disease activity but more frequently missed the target of remission or low disease activity. These findings may have implications in RA treatment in patients with FRA, as therapy is escalated not in relation to change in scores but to achieving remission.

abstract: Socioeconomic status (SES) is linked with poorer health outcomes across the range of SES. The Reserve Capacity Model (RCM) proposes that low SES fuels repeated and/or chronic exposure to elevated levels of stress, producing deleterious emotional, psychological, social, and physiological changes that result in development of disease over time. The RCM further asserts that a relative lack of social and psychological resources, including efficacy and social support, among low SES individuals accounts for their greater vulnerability to the effects of stress. Although the links between stress, reserve capacity, and health outcomes are framed in the RCM as an ongoing process that produces disease, the majority of investigations testing the model have not examined its utility in explaining 1) coping with daily stressors or 2) symptom flares among individuals managing a chronic illness. This study investigated the effects of SES, reflected in income level, on the: 1) levels of daily financial events and financial worry; 2) relations between daily financial worry and symptoms of pain and fatigue; and 3) extent to which daily coping efficacy and social support mediated the daily financial worry-symptom relation across 21 daily diary reports collected from 220 individuals with fibromyalgia (FM). Simple correlations showed that income was inversely related to frequency of financial events and level of financial worry across 21 days. Results from multilevel models indicated that daily increases in financial worry were unrelated to pain regardless of income level, but were related to increased fatigue among individuals with lower relative to higher income. Daily efficacy and support mediated the relations between financial worry and pain and fatigue, but the extent of mediation did not differ based on high versus low income level. Taken together, the findings suggest that individuals of low versus high income encounter more frequent financial stress and experience greater daily fatigue exacerbation related to that stress, in line with the RCM. Over time, the greater exposure and reactivity to financial strain may account for the inverse relation between income and disability among those with chronic pain. / Dissertation/Thesis / Masters Thesis Psychology 2017

Introdução: o método Rolfing® de Integração Estrutural é procedimento de integração da estrutura corporal humana, que considera os aspectos físicos, emocionais, mentais, espirituais e sociais do indivíduo. Consiste em dez intervenções manuais profundas (liberação miofascial) aplicadas na estrutura elástica do tecido conjuntivo frouxo (miofáscia) e em reeducação dos movimentos. Objetivos: verificar o efeito do método Rolfing® no tratamento de doentes fibromiálgicos quanto às modificações nas diversas partes da estrutura física e a sua eficácia no alívio da dor e do cansaço, na disposição para executar atividades diárias durante períodos prolongados, qualidade do sono, estados de ansiedade e de depressão, e autoconhecimento por meio da identificação das sensações e da modificação da imagem corporal. Casuística e métodos: trinta pacientes do Centro de Dor da Clínica Neurológica do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo foram submetidos a dez sessões de Rolfing® e mantiveram o tratamento ambulatorial de rotina. Todos foram avaliados de acordo com a Escala Analógica Numérica Verbal de Dor, o Inventário de Depressão Beck, o Inventário de Ansiedade Beck, o Gráfico de Apreciação do Próprio Corpo, o Gráfico de Sintomas e o Questionário Experimental, aplicados durante a entrevista inicial, na última sessão e três meses após o término da aplicação do método. Foram quantificadas a intensidade e a frequência da ocorrência de dor, a disposição, as limitações físicas, a qualidade do sono e o resultado do tratamento. Conclusão: a maioria dos doentes tratados apresentou melhora da condição inicial e esta correlacionou-se com a intervenção do método Rolfing®. / Introduction: The Structural Integration Rolfing® is a method which considers the physical, emotional, mental, spiritual and social aspects of the individual. It consists of a series of ten sessions of deep manual therapy (myofascial release) applied to the elastic structure of the loose connective tissue (myofascial) of the body and also of a reeducation of movements. Objectives: to verify the impact of the Rolfing® method in the modification of the different parts of the physical structure of fibromyalgic patients and the treatment of pain, and improvement of fatigue, disposition to carry out prolonged daily tasks, sleep, stress levels, depression and self-awareness. Patients and methods: thirty patients were treated with ten sessions of Rolfing® at the Pain Center of the Neurological Clinic of the Hospital das Clínicas of the Faculty of Medicine of the University of São Paulo while maintaining their previous routine ambulatory treatment. Verbal Numerical Analogic Pain Scale, Beck Depression Inventory, Beck Anxiety Inventory, Graphic for Appreciation of the Own Body, Graphic of Symptoms and Experimental Questionnaire were all used for the evaluation of the patients, before, at the end of and three months after the end of the treatment. The intensity and frequency of pain episodes, disposition, physical limitations, quality of sleep, anxiety and depression were analysed. Conclusions: the Structural Integration Rolfing® method improved the clinical condition and the quality of life of the majority of the patients treated.

Please read the abstract in the section 00front of this document / Dissertation (MSc (Medical Applied Psychology))--University of Pretoria, 2006. / Psychiatry / unrestricted

Fibromyalgia has a significant impact on the lives of patients; symptoms are influenced by psychological factors, such as psychological flexibility and catastrophizing. The objective of this study was to determine the importance of these variables in moderating the association between the severity and impact of fibromyalgia symptoms. A total of 187 patients from a general hospital population were evaluated using the Combined Index of Severity of Fibromyalgia (ICAF), the Fibromyalgia Impact Questionnaire (FIQ), the Acceptance and Action Questionnaire-II (AAQ-II), and the Pain Catastrophizing Scale (PCS). A series of multiple regression analyses were carried out using the PROCESS macro and decision tree analysis. The results show that psychological flexibility modulates the relation between severity and the impact of fibromyalgia symptoms. Catastrophism has residual importance and depends on the interaction with psychological flexibility. Interaction occurs if the severity of the disease is in transition from a mild to a moderate level and accounts for 40.1% of the variance in the sample. These aspects should be considered for evaluation and early intervention in fibromyalgia patients.

Bakgrund: Fibromyalgi är ett långvarigt smärtsyndrom med en prevalens kring 4 % för kvinnor och 1% för män. Träning rekommenderas till patienter som del i behandling. Tidigare sammanställningar av forskning visar på brister i kvalitet och variation i utformning av interventioner. Osäkerhet råder kring vilken typ av aerob träning som har störst effekt på smärta. Syfte: Denna litteraturstudie syftade till att sammanställa det vetenskapliga evidensläget gällande effekten av aerob träning på upplevd smärta hos fibromyalgipatienter. Metod: En litteraturstudie med systematisk litteratursökning i databaserna PEDro och PubMed. Studiernas kvalitet granskades med PEDros granskningsmall och en evidensgradering genomfördes med hjälp av GRADEstud. Resultat: Nio studier, med 529 deltagare totalt, av lägst medelhög kvalitet inkluderades i studien. Studierna visar på en positiv, kliniskt relevant effekt på smärtintensitet, av aerob träning vid jämförelse med kontrollgrupper och liknande effekt jämfört med annan aerob träningsmodalitet, lågintensiv träning eller styrketräning. Evidensstyrkan var måttligt hög för att likvärdig smärtminskning erhålls oberoende av modalitet av aerob träning. Evidensstyrkan var låg för att konkludera att aerob träning är bättre än en kontrollgruppsintervention, lika bra som styrketräning eller lågintensiv träning. Orsakerna till resultatet av evidensgraderingen beror främst på heterogenitet i studiernas interventioner. Konklusion: Det går utifrån granskningen inte att se någon skillnad avseende smärtintensitet mellan aerob träning och en annan aktiv intervention. Studierna är små, har skillnader i interventioner och resultat. Mot bakgrund av detta kan inga säkra slutsatser dras gällande vilken form av träning som är bäst vid fibromyalgi. / Background: Fibromyalgia is a chronic pain syndrome with a prevalence of around 4% for women and 1% for men. Physical exercise is recommended for patients as part of treatment. Earlier reviews indicate a lack of quality and heterogenity in intervention designs. There are uncertainties of which type of aerobic exercise has the biggest effect on pain. Objective: This review aimed to summarize the scientific level of evidence concerning aerobic exercise on pain level for the fibromyalgia population. Method: For this systematic review a structured litterature search was carried out in the databases PubMed and PEDro. Quality was assessed with the PEDro-scale and reliability was evaluated with GRADEstud. Results: Nine RCT's including 529 subjects, with at least 5 points on the PEDro scale were included. The studies show a positive, clinically relevant effect on pain level, of aerobic training when compared to control groups (evidence: low) and similar effects on pain (evidence: moderately high) when compared to other training modality, low intensity aerobic exercise (evidence: low) or strength training (evidence: low). Heterogeneity in the studies reduces the level of evidence in all categories.  Conclusion: The populations are generally small and generally there is a large heterogenity in the interventions. No difference between aerobic training and other active interventions was observed in terms of pain reduction. It is not possible to conclude which modality of training is best for patients with fibromyalgia. To clarify evidence, there is a need for more studies with similar interventions.

Fibromyalgia is a chronic widespread pain disorder that can also cause fatigue, depression, sleep disturbances, and cognitive symptoms. Because the etiology of fibromyalgia is unknown, it is difficult to treat. Research shows that medication alone is insufficient to treat the symptoms of fibromyalgia and that complementary therapies are required to fully manage this disorder. The purpose of this research was to determine what complementary therapies patients with fibromyalgia were currently using. The sample for the survey was taken from fibromyalgia support groups throughout the state of Florida. A total of 15 people diagnosed with fibromyalgia participated in the survey. The most commonly used complementary therapies included diet and relaxation techniques. The therapies that were rarely or never used were hypnotherapy, Tai Chi, and Chi (Qi) Gong. These findings provide evidence to support client education concerning the use of complementary therapies for individuals with fibromyalgia. Research with larger samples is recommended to provide further evidence of the effectiveness of complementary therapies for this patient population.

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