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Made available in DSpace on 2016-08-10T10:54:37Z (GMT). No. of bitstreams: 1 GESNER JOSE DE ALMEIDA FILHO.pdf: 1366571 bytes, checksum: 931678952ba1fd997cfd4da234bca9a3 (MD5) Previous issue date: 2013-08-28 / Fibromyalgia syndrome is characterized by widespread musculoskeletal pain and stiffness; sleep disturbances, feeling tired upon waking and the presence of specific tender points during palpation. The disease affects more women than men and exerts a major negative impact on the lives of patients. The objective of this study was to investigate the symptoms and the impact of fibromyalgia on quality of life of a group of 50 women clinically diagnosed with the disease and under treatment at CRER (Centro de Reabilitação e Readaptação Dr. Henrique Santillo), in Goiânia, Goiás. The symptomatology and quality of life were evaluated through the FIQ (Fibromyalgia Impact Questionnaire). The results have shown that fibromyalgia affected significantly the functional capacity of the patients, preventing the ability to work and carry out the household chores in 92% of cases and the development of daily activities in 32% of cases. The well being of the patients was seriously compromised in 86% of patients; 82% reported extreme tiredness; 56% reported very intense degree of pain and 54% reported severe morning stiffness, to awaken. Strong anxiety was reported by 74% and 56% of the patients reported severe depression. It is concluded that, in the analysis group, symptoms of fibromyalgia has an important negative impact on quality of life of patients, with consequent restriction of their daily physical activities, besides social and family isolation. / A síndrome fibromiálgica é caracterizada por dor musculoesquelética generalizada, sensação de rigidez, distúrbios do sono, sensação de cansaço ao acordar e a presença de pontos dolorosos específicos durante a palpação. A doença acomete mais as mulheres que os homens e exerce um impacto negativo importante na vida das pacientes. O objetivo deste estudo foi investigar a sintomatologia e o impacto da fibromialgia na qualidade de vida de um grupo de 50 mulheres clinicamente diagnosticadas com a doença e em tratamento no CRER (Centro de Reabilitação e Readaptação Dr. Henrique Santillo), em Goiânia, Goiás. A sintomatologia e a qualidade de vida foram avaliadas por meio do FIQ (Questionário de Impacto da Fibromialgia). Os resultados demonstraram que a fibromialgia afetou de forma importante a capacidade funcional das pacientes, impedindo a capacidade de trabalhar ou realizar as tarefas domésticas em 92% dos casos e o desenvolvimento de atividades diárias em 32% dos casos. O bem estar das pacientes esteve seriamente comprometido em 86% das pacientes; 82% relataram cansaço extremo; 56% relataram grau muito intenso de dor e 54% relataram rigidez matinal severa, ao despertar. Forte ansiedade foi relatada por 74% das pacientes e 56% relataram depressão intensa. Conclui-se que, no grupo analisado, a sintomatologia da fibromialgia exerceu um importante impacto negativo na qualidade de vida das pacientes, com consequente restrição de suas atividades físicas diárias, isolamento social e familiar.

This study examined the applicability of Mishel's model of uncertainty in illness (1990) to the adaptation process of women diagnosed with fibromyalgia. The power of uncertainty and social support to predict an uncertainty appraisal and its corresponding coping strategy utilized in this population were examined.Structural equation modeling was employed to clarify the relationships among uncertainty, social support, the appraisal of uncertainty as either danger or opportunity, and coping as either emotion-focused or problem-focused. One hundred sixty-five participants completed the Mishel Uncertainty in Illness Scale (MUIS-A), the Appraisal of Uncertainty Scale (AUS), the Jalowiec Coping Scale (JCS), and the Social Provision Scale (SPS). After an analysis of several measures of goodness-of-fit, the original model was modified based on theory, the modification indices, and a review of the maximum likelihood estimates (mle) for structural paths. These modifications resulted in a competing model. Finally, a Chi-square test was performed comparing the goodness-of-fit indices of the competing models.Results indicated that Mishel's model is a useful model within which to conceptualize the issues faced by women diagnosed with fibromyalgia. Mishel's model performed adequately; however, the overall goodness-of-fit was significantly improved by modifications which placed greater emphasis on social support. Social support and uncertainty exerted approximately equal effect on a danger appraisal and in the revised model only social support predicted an opportunity appraisal. Results also suggested that uncertainty had a direct effect on emotion-focused coping regardless of the appraisal of the uncertainty as danger or opportunity. The current study did not unequivocally support Mishel's assertion that uncertainty may be evaluated as an opportunity. Although uncertainty demonstrated a significant inverse relationship with an opportunity appraisal in the original model, in the revised model, which considered the direct effects of social support on the appraisal process, uncertainty failed to have a significant effect. Given the depth of evidence and applicability of Mishel's original model, additional research is necessary to determine whether these results are specific to the experience of fibromyalgia or perhaps social support is an under-appreciated factor in Mishel's model. Implications for treatment and directions for future research are explored. / Department of Counseling Psychology and Guidance Services

Diss. (sammanfattning) Linköping : Linköpings universitet, 2004. / Härtill 6 uppsatser.

Orientador: Luis Guillermo Bahamondes / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-24T04:19:28Z (GMT). No. of bitstreams: 1 Nunes_FabianaRoberta_D.pdf: 2671305 bytes, checksum: 31d6fe5674705988e51a42a4f59ee9cf (MD5) Previous issue date: 2014 / Resumo: Introdução: Mulheres com endometriose frequentemente se queixam de dor, que pode interferir na qualidade de vida e de sono. Alguns estudos mostraram maior prevalência de algumas patologias, como fibromialgia, em mulheres com endometriose. Assim, e necessário avaliar as repercussões da endometriose na vida das mulheres. Objetivo: Comparar a prevalência de fibromialgia, o limiar doloroso, a qualidade de vida e do sono em mulheres com e sem endometriose. Métodos: Participaram do estudo 257 mulheres com endometriose, confirmada cirurgicamente e histopatologicamente, e 253 sem historia ou sintomas da doença. As mulheres do grupo com endometriose foram divididas em dois subgrupos, com endometriose grau I-II (n=89), e grau III-IV (n=168), de acordo com os critérios de 1996 da American Society for Reproductive Medicine. As voluntarias responderam aos questionários: Short-form 36 (SF-36) para avaliação da qualidade de vida, Inventario do Sono para avaliar a qualidade de sono e questionário de classificação de fibromialgia de acordo com os critérios de 1990 e 2010 do American College of Rheumatology (ACR). Alem disso, foi avaliada a dor das participantes através da escala visual analógica (EVA) e as mesmas foram submetidas a exame físico para avaliação do limiar de dor em 20 diferentes pontos corporais e a presença de dor nos tender points dos critérios de fibromialgia de 1990. Para a avaliação física foi utilizado um algometro que mensurava a digitopressao realizada pela pesquisadora. O estudo foi aprovado pelo Comitê de Ética em Pesquisa da Universidade de Campinas e todas as mulheres assinaram o termo de consentimento livre e esclarecido. Resultados: Na amostra estudada, não houve casos de fibromialgia de acordo com os critérios de 1990 do ACR e houve quatro casos segundo os critérios de 2010, sendo dois casos no grupo com endometriose e dois no grupo sem a doença. Os escores do Inventario do Sono e dos oito domínios do SF-36 foram significativamente menores no grupo de mulheres com endometriose. O limiar doloroso do trocanter maior e do abdome foi significativamente menor nas mulheres com endometriose quando comparadas com as mulheres sem a doença. Não houve diferença na EVA de dor entre os grupos. Alem disso, não houve diferença na prevalência de fibromialgia, na qualidade de vida e de sono e no limiar doloroso nos subgrupos com endometriose. Conclusão: A prevalência de fibromialgia foi baixa e similar nas mulheres com e sem endometriose. Entretanto, as mulheres com endometriose apresentaram pior qualidade de vida e de sono e menor limiar doloroso em alguns pontos corporais, quando comparadas com as mulheres sem a doença. / Abstract: Introduction: Women with endometriosis commonly complain of pain, which can interfere with quality of life and sleep quality. Furthermore, studies have shown a higher prevalence of some diseases, such as fibromyalgia, in women with endometriosis. Thus, it is necessary to evaluate the impact of endometriosis in women's lives. Objective: The objective of the study was to assess if there is any difference in the prevalence of fibromyalgia, pain threshold, quality of life and sleep quality between women with and without endometriosis. Methods: The study included 257 women with a laparoscopic and histopathological diagnosis of endometriosis, and 253 women with no history of endometriosis and no endometriosis-related symptoms. The women with endometriosis were divided into two groups, with endometriosis stages I-II (n=89) and stage III-IV (n=168), according to the 1996 criteria of the American Society for Reproductive Medicine. The volunteers answered the questionnaires: Short Form-36 (SF-36) to assess quality of life, Post-sleep Inventory to assess the sleep quality and fibromyalgia classification questionnaire, according to the 1990 and 2010 criteria of the American College of Rheumatology (ACR). In addition, volunteers responded the pain visual analog scale (VAS) and underwent physical examination to assess the pain threshold in 20 different body sites and the presence of pain in the tender points of the 1990 fibromyalgia criteria. For the physical examination, an algometer was used to measure the digital pressure applied by the researcher. The study was approved by the Ethics Committee of the University of Campinas and all women signed an informed consent. Results: According to the 1990 ACR criteria, there were no cases of fibromyalgia in both groups. Nevertheless, according to the 2010 criteria, four women, two with endometriosis and two without the disease, were diagnosed with fibromyalgia. The Post-sleep Inventory score and the eight domains of the SF-36 were significantly lower in the group of women with endometriosis. The pain threshold of the greater trochanter and the abdomen was significantly lower in women with endometriosis when compared with those without the disease. There was no difference in the pain VAS between groups. Additionally, there was no difference in the prevalence of fibromyalgia, on the quality of life, sleep quality and pain threshold between subgroups with endometriosis. Conclusion: The prevalence of fibromyalgia was low and similar in women with and without endometriosis; however women with endometriosis showed poorer quality of life and sleep quality and lower pain threshold in some body sites when compared to women without the disease. / Doutorado / Fisiopatologia Ginecológica / Doutora em Ciências da Saúde

Indiana University-Purdue University Indianapolis (IUPUI) / Fibromyalgia Syndrome (FMS) is a chronic, painful rheumatic condition characterized by recurrent musculoskeletal pain, fatigue, and nonrestorative sleep, for which there is currently no biological marker. People who suffer from fibromyalgia are extremely susceptible to the effects of psychological stressors which may in turn exacerbate the symptoms of the disease. As unrelenting pain is the main symptom of fibromyalgia, it follows that patients would experience personal losses and changes in their self-schemas or the way in which they view themselves as a result. This study was particularly focused on identifying the enmeshment of self-schemas and pain-schemas, and the extent to which women with fibromyalgia experience pain and self-schema enmeshment (PSSE). Additionally, this study sought to determine the utility of using the Implicit Association Test as a measure of PSSE. The present study compared FMS patients to a group of diabetes patients on several measures of schema enmeshment, including the IAT. It was hypothesized that the two disease groups would differ significantly on the level of PSSE indicated by the IAT, and the two disease groups would not differ on enmeshment with illness indicated by the IAT. Additionally it was hypothesized that the IAT would be correlated with explicit measures of PSSE. Results did not support either of these hypotheses; however the sample size and statistical power necessary to test these hypotheses was severely lacking and thus they could not be evaluated in an appropriate manner. Results did not support the hypothesis that the IAT would be highly correlated with the explicit measures of PSSE. Based on these results and the existing literature, it is still somewhat unclear as to whether or not the IAT would be an acceptable/feasible tool in assessing PSSE in fibromyalgia patients.

No description available.

Thesis (PhD)--Stellenbosch University, 2013. / ENGLISH ABSTRACT: Research objective To test a novel concept that exposing patients with fibromyalgia syndrome (FMS) to visuals of exercise activities elicits neurophysiological changes in functional brain areas associated with pain catastrophization; thereby providing preliminary support for the further development/testing of a virtual reality exposure therapy (VRET) exercise program aimed at reducing pain catastrophization toward exercise therapy in patients with FMS. Methods The main study of this research consisted of a three-phase exploratory fMRI study. Phase 1 involved the development/validation of the fMRI visual task. Phase 2 involved the exploration of the differences in neural correlates associated with pain catastrophizing between participants with FMS and healthy controls when exposed to various visuals of exercise and passive/relaxing activities. Phase 3 involved the testing of the preliminary efficacy of a novel VRET exercise program on pain catastrophization in participants with FMS. The fMRI task consisted of two stimuli: active (exercise activity visuals)/passive (relaxing activity visuals). Structural images as well as blood-oxygenation-level-dependent (BOLD) contrasts were acquired for the conditions and compared within-subjects/groups and between-groups. The condition of interest was the active>passive condition (where brain activations for the passive condition were subtracted from the active condition). The brain volumes collected during ‗on‘ conditions were compared with the brain volumes collected during ‗off‘ conditions using Students‘ t test. Statistic images were thresholded using clusters determined by Z>2.3 and a (corrected) cluster significance threshold of p=0.05. Results The right (R) middle and inferior frontal gyrus and R posterior cerebellum were significantly activated for the participants with FMS, and not the healthy control group, during the active>passive condition (phase 2). At baseline, during the active>passive condition (phase 3), the intervention/VRET group showed significant activation (p<0.05) in the R insular cortex, R anterior and posterior cerebellum, R parahippocampal gyrus, R middle frontal gyrus, R corpus callosum, R thalamus, R supramarginal gyrus and R middle and superior temporal gyrus; the control group showed significant activation in the R anterior and posterior cerebellum, R middle and superior temporal gyrus, R middle frontal gyrus, R insular cortex, R supramarginal gyrus and R precentral gyrus. Post-intervention, during the active>passive condition, R posterior cerebellum activation was still significant (p<0.05) for the intervention group; R anterior cerebellum, left (L) middle and inferior frontal gyrus, and R superior parietal lobe activation was found to be significant (p<0.000) for the control group, although these areas were not found to be significantly activated at baseline for the control group. Conclusion We could not provide confirmatory evidence for the efficacy of a novel VRET program for pain catastrophization in patients with FMS. However, the findings of this study does suggest that pain catastrophization in patients with FMS could be confirmed with fMRI. Research is therefore warranted to further develop a proper VRET exercise program and to test the effect of this program on pain catastrophization in patients with FMS. / AFRIKAANSE OPSOMMING: Navorsing doelstelling Om 'n nuwe konsep dat die blootstelling van pasiënte met fibromialgie sindroom (FMS) aan beeldmateriaal van oefening, ontlok neurofisiologiese veranderinge in funksionele brein-areas wat verband hou met pyn katastrofering te toets; sodoende voorlopige steun vir die verdere ontwikkeling/toetsing van 'n virtuele realiteit blootstelling terapie (VRET) oefenprogram wat gemik is op die vermindering van pyn katastrofering na oefenterapie in pasiënte met die FMS te bied. Metodes Die hoofstudie van hierdie navorsing bestaan uit 'n drie-fase verkennende fMRI studie. Fase 1 het die ontwikkeling/validering van die fMRI visuele taak behels. Fase 2 het die ondersoek van die verskille in die neurale korrelate geassosieer met pyn katastrofering tussen deelnemers met FMS en gesonde kontroles wanneer hulle blootgestel word aan verskeie beeldmateriaal van oefening en passiewe/ontspannende aktiwiteite behels. Fase 3 het die toets van die voorlopige effektiwiteit van 'n nuwe VRET oefenprogram op pyn katastrofering in deelnemers met FMS behels. Die fMRI taak het bestaan uit twee stimuli: aktiewe (oefening aktiwiteit beeldmateriaal)/passiewe (ontspannende aktiwiteit beeldmateriaal). Strukturele beelde sowel as bloed-suurstof-vlak-afhanklike (BSVA) kontraste is vir die toestande verkry en vergelyk binne-deelnemers/groepe en tussen-groepe. Die toestand van belang was die aktiewe>passiewe toestand (waar brein aktivering vir die passiewe toestand afgetrek is van die aktiewe toestand). Die brein volumes wat ingesamel tydens die 'aan' toestande is vergelyk met die brein volumes wat ingesamel is gedurende die 'af' toestande met die gebruik van Studente se t-toets. Drempel statistiek beelde is gegroepeer deur Z> 2,3 en 'n (gekorrigeerde) groepeerde betekenisvolle drempel van p = 0.05. Resultate Die regter (R) middel- en inferior-frontale gyrus en R posterior serebellum is betekenisvol geaktiveer vir die deelnemers met FMS, maar nie vir die gesonde kontrole groep nie, gedurende die aktiewe>passiewe toestand (fase 2). By basislyn, tydens die aktiewe>passiewe toestand (fase 3), die intervensie / VRET groep het betekenisvolle aktivering (p <0.05) in die R insulaire korteks, R anterior en posterior serebellum, R para- hippokampus gyrus, R middel-frontale gyrus, R korpus kallosum, R talamus, R supramarginale gyrus en R middel- en superior-temporale gyrus; die kontrole groep het betekenisvolle aktivering in die R anterior en posterior serebellum, R middel- en superior-temporale gyrus, R middel-frontale gyrus, R insulaire korteks, R supramarginale gyrus en R presentrale gyrus. Post-intervensie, tydens die aktiewe>passiewe toestand, was R posterior serebellum aktivering betekenisvol (p <0.05) vir die intervensie groep; R anterior serebellum, links (L) middel- en inferior-frontale gyrus en R superior pariëtale lob aktivering was betekenisvol (p <0.000) vir die kontrole groep, alhoewel geen betekenisvolle basislyn aktivering in hierdie areas by die kontrole groep plaasgevind het nie. Gevolgtrekking Ons kan nie bewyse vir die effektiwiteit van 'n nuwe VRET program vir pyn katastrofering in pasiënte met FMS bevestig nie. Nietemin, dui die bevindinge van hierdie studie wel daarop dat pyn katastrofering in pasiënte met FMS bevestig kon word met fMRI. Verdere navorsing is dus geregverdig om 'n behoorlike VRET oefenprogram te ontwikkel en die uitwerking van hierdie program op pyn katastrofering in pasiënte met FMS te toets.

Fibromyalgia (FMS) goes undiagnosed in as many as 3 out of 4 people who have the disease. Primary care providers (PCPs) are the first to evaluate patients; therefore, PCPs need to be able to recognize FMS, implement initial treatment, and refer for further consultation. The Fibromyalgia Diagnostic Screening Tool (FDST), a validated instrument to identify FMS, can improve the speed and accuracy of FMS diagnosis. The purpose of this project was to familiarize PCPS with the FDST, evaluate their receptiveness to the tool, and train them in its use. The Leventhal, Diefenbach, and Levanthal, common sense model of illness provided the theoretical framework to guide this quality improvement project. A 45-minute in-service and accompanying reference manual was given to 4 participating PCPs, along with a demographic questionnaire asking about their age, race, gender, marital status, and years in practice. Following the in-service, a 10-question self-completed questionnaire consisting of a combination of open-ended and nominal scale yes/no questions, was administered. A thematic analysis revealed 2 primary barriers for diagnosis without the FDST: lengthy screening time and trouble differentiating FMS from a patient's other conditions. In response to one of the yes/no questions, the participants all replied that the in-service on FDST was helpful in diagnosing FMS. Implications for social change include improved diagnosis with a diagnostic screening instrument, improved quality of health care, and cost effectiveness at the system level for chronic disease prevention and management. This project demonstrates in a localized primary care setting that the FDST may offers PCPs a reliable method to diagnose FMS.

This thesis presents the findings of an exploratory study undertaken to investigate the illness experience of fibromyalgia in the context of South Africa. It contains the literature review and conceptual framework that guided the study. The theoretical discussions reflect the approaches to health and illness, illness experience and narrative study, context, diagnosis, prognosis, sickness, illness career, treatment, institutional interactions and social support. Following this, the methodological approaches and tools used in conducting this study are explained. In-depth interviews and diaries were used to collect narratives from 15 participants and one practitioner. Additionally, a brief media content analysis was included in order to assess the public perceptions of fibromyalgia in South African news articles. The themes of legitimacy, credibility, flexibility, and accommodation are continually developed throughout the thesis. The Analysis of Findings chapter presents and discusses the evidence gathered from the investigations undertaken in this study. This chapter shows how the contested and confusing illness experience of fibromyalgia can be understood, by viewing the interactions that patients have with their practitioners, families, peers and colleagues. The meanings ascribed to fibromyalgia as a label, and the uncertain prognosis attached to the diagnosis, as well as infrequently effective treatment options are explored here. The gains found in successful practitioner-patient interactions, and the limitations of medical aid coverage for chronic conditions like fibromyalgia in South Africa are discussed in this chapter. The role of family and peers, as well as workplaces and colleagues in offering support to those living with fibromyalgia is analysed. Finally, the conclusions arising from this study are presented, and recommendations for areas of future engagement and research are offered in order to attain a better understanding of the experience and impact of fibromyalgia in the South African context.