Conselho Nacional de Desenvolvimento CientÃfico e TecnolÃgico / A dor à uma das principais causas do sofrimento humano, aflige a humanidade desde o inicio de sua existÃncia e, independentemente de seu carÃter agudo ou crÃnico, desencadeia no homem alteraÃÃes nos padrÃes de sono, apetite e libido, irritabilidade, diminuiÃÃo da capacidade de concentraÃÃo, alÃm de dificuldades em atividades familiares, profissionais e sociais. A fibromialgia (FB) à uma sÃndrome musculoesquelÃtica crÃnica caracterizada por dor generalizada, de etiologia ainda nÃo completamente esclarecida, que ocorre predominantemente em indivÃduos de cor branca, afetando 2,5% da populaÃÃo brasileira, com maior incidÃncia no sexo feminino, na fase produtiva (antes dos 50 anos de idade), podendo tambÃm afetar crianÃas e idosos. Na ausÃncia de marcadores especÃficos, o diagnÃstico da FB à baseado em achados clÃnicos conforme critÃrios estabelecidos pelo American College of Rheumatology: dor generalizada presente no esqueleto axial e em ambos os hemicorpos, acima e abaixo da cintura, presenÃa de 11 ou mais dos18 tender points e dor crÃnica por mais de 3 meses. O tratamento da FB tem como objetivo reduzir a dor e os sintomas associados e melhorar a qualidade de vida. Antidepressivos associados a tratamentos nÃo farmacolÃgicos incluindo exercÃcios aerÃbicos de baixo impacto, alongamentos, programas de fortalecimento ou relaxamento muscular, reabilitaÃÃo e fisioterapia tÃm sido usados com resultados nem sempre satisfatÃrios. Outras terapias sÃo recomendadas, como balneoterapia, termoterapia, terapia magnÃtica, homeopatia, manipulaÃÃo manual, dietoterapia, musicoterapia e acupuntura, pelos seus efeitos auto-reguladores, analgÃsicos e antiinflamatÃrios. Na busca de outras opÃÃes terapÃuticas, este estudo objetiva avaliar os efeitos da acupuntura, da eletro- acupuntura e da moxabustÃo sobre a dor e a qualidade de vida em mulheres fibromiÃlgicas. Participaram do estudo 30 mulheres com idades entre 20 e 60 anos (mÃdia 46,90Â9,24), selecionadas segundo critÃrios prÃ-definidos, portadoras de fibromialgia, que apresentavam dor de intensidade moderada a grave (Algometria de Fischer <4kg/cm2). As pacientes foram distribuÃdas aleatoriamente em trÃs grupos (n=10) e tratadas com acupuntura (AC) [G-1], eletroacupuntura (EAC) [G-2] e moxabustÃo (MX) [G-3], durante 8 semanas (sessÃes semanais). Agulhas de aÃo inoxidÃvel foram inseridas em acupontos especÃficos bilateralmente (Neiguan/PC-6, Hegu/IG-4, Yanglingquan/VB-34, Sanyinjiao/BP-6 e Taichong/F-3) em todas as pacientes e retidas por 30 minutos. Adicionalmente, foram aplicadas a EAC (G-2) ou a MX (G-3) durante 30 minutos. Para avaliaÃÃo da intensidade da dor foram utilizados o questionÃrio McGill, a Escala de Faces de Wong-Baker e o AlgÃmetro de Fischer. A qualidade de vida foi avaliada utilizando o questionÃrio The Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36), traduzido, adaptado e validado para a lÃngua portuguesa em 1999. Os dados foram tabulados utilizando-se o software Excel para Windows 2007 da Microsoft Corporation (U.S.A.) e analisados pelo programa de anÃlise estatÃstica GraphPad Prism v.5.00 (GraphPad Software, San Diego, CalifÃrnia, U.S.A). Os resultados mostram que nenhum dos trÃs mÃtodos de tratamento utilizados no estudo (AC, EAC, MX) promove reduÃÃo da dor em mulheres fibromiÃlgicas, apÃs 8 semanas de tratamento. Por outro lado, tanto a EAC como a MX melhoram a saÃde mental; a AC promove a melhora da vitalidade nessas pacientes. / Pain is one of the major causes of human suffering, afflicted humanity since the beginning of its existence and, regardless of its acute or chronic character, triggers in man changes in sleep patterns, appetite and libido, irritability, decreased ability to concentrate, in addition to difficulties in family, professional and social activities. Fibromyalgia (FB) is a syndrome characterized by chronic widespread musculoskeletal pain, etiology not yet fully clarified, that occurs predominantly in white individuals, affecting 2.5% of the Brazilian population, with higher incidence in females, in the productive phase (before 50 years of age), and may also affect children and the elderly. In the absence of specific markers, the diagnosis of FB is based on clinical findings according to criteria established by the American College of Rheumatology: widespread pain present in the axial skeleton and in both hemibodies, above and below the waist, presence of 11 or more of the 18 tender points and chronic pain for more than 3 months. FB treatment aims to reduce pain and associated symptoms and improve quality of life. Antidepressants associated with non-pharmacological treatments including low impact aerobic, stretching, strengthening programs, or muscle relaxation, rehabilitation and physical therapy have been used with results not always satisfactory. Other therapies such as balneotherapy, thermotherapy, magnetic therapy, homeopathy, manual handling, dietotherapy, music therapy and acupuncture are recommended for its self-regulatory, analgesic and anti-inflammatory effects. In search of other therapeutic options, this study aims to evaluate the effects of acupuncture, electroacupuncture and moxibu stion on the pain and quality of life in fibromyalgic women. Thirty women aged between 20 and 60 years (mean age 46.90Â9.24), selected according to predefined criteria, with FB, who had pain of moderate to severe intensity (<4kg/cm2) were included in the study. The patients were randomized, distributed in three groups (n=10) and treated with acupuncture (AC) [G-1], electroacupuncture (EAC) [G-2] and moxibustion (MX) [G-3], during 8 weeks (weekly sessions). Stainless steel needles were inserted into specific acupoints bilaterally (Neiguan/PC-6, Hegu/G-4, Yanglingquan/VB-34, Sanyinjiao/BP-6 and Taichong/F-3) in all patients, and retained for 30 minutes. Additionally, EAC (G-2) or MX (G-3) were applied during 30 minutes. To evaluate the intensity of the pain the McGill questionnaire, the Wong-Baker Faces Scale and the Fischer Algometer device were used. The quality of life was assessed using the questionnaire The Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36), translated, adapted and validated for the Portuguese language in 1999.The data was tabulated using the Excel 2007 software for Windows  from Microsoft Corporation (U.S.A). GraphPad Prism  v. 5.00 (GraphPad Software, San Diego, California, U.S.A) program was used for statistical analysis. The results show that none of the three treatment methods used in the study (AC, EAC, MX) promotes reduction of pain in fibromyalgic women, after 8 weeks of treatment. However, both EAC as MX treatments improve the mental health. Additionally, the AC improves vitality in these patients.

Introdução: Pacientes fibromiálgicos freqüentemente referem fadiga e estudos apontam esse sintoma como o segundo mais intenso, podendo limitar as atividades de vida diária, aumentar o estresse a até mesmo a dor. Não há um consenso se as queixas de fadiga correspondem a padrões alterados nos mecanismos de fadiga muscular, já que predominam as avaliações com questionários e escalas. O objetivo deste estudo foi avaliar a fadiga muscular em fibromiálgicos por meio da eletromiografia de superfície durante o teste de sentar e levantar. Métodos: Participaram do estudo 49 sujeitos divididos em dois grupos: Grupo Fibromiálgico (n=34) e Grupo Controle (n=15). Os padrões de fadiga muscular foram avaliados pela análise da freqüência mediana (MDF) do sinal eletromiográfico do terço distal do músculo vasto lateral durante o teste de sentar e levantar. A dor pela Escala Visual Analógica (EVA), os sintomas da fibromialgia pelo Questionário do Impacto da Fibromialgia (QIF) e o desempenho no teste de sentar e levantar pelo tempo total utilizado e número de repetições. Todos os participantes foram instruídos a realizar o teste numa velocidade confortável até a exaustão. A coleta da eletromiografia foi feita em três momentos, simultaneamente ao uso da escala de Borg para avaliação do nível de esforço percebido: início (T1), após um minuto (T2) e na exaustão (T3). Resultados: O grupo fibromiálgico apresentou MDF reduzida em T3 (p=0,04) e relato de esforço percebido mais intenso que o grupo controle em T2 (p=0,00). Foi observada correlação moderada entre MDF em T3 com as variáveis: intensidade da dor (-0,40; p=0,00) e tempo total em segundos (0,43; p=0,00). Conclusão: o grupo fibromiálgico apresentou sinais de fadiga precocemente com diminuição da freqüência mediana e percepção de esforço mais intenso comparado ao grupo controle. / Introduction: Fibromyalgia patients usually report fatigue and this symptom is the second more intense, limiting daily life activities, increasing stress and pain. There is no sense if fatigue complains are related to muscle fatigue altered patterns, since most studies performed questionnaires and scales to quantify this symptom. The aim of this study was to evaluate muscle fatigue patterns by surface electromyography during the sit to stand test. Methods: Participated 49 subjects in two groups: Fibromyalgia Group (n=34) and Control Group (n=15). Electromyography muscle fatigue patterns were evaluated by median frequency analyses (MDF) of the distal third of the vastus lateralis muscle during sit to stand test, pain by Visual Analog Scale (VAS), fibromyalgia symptoms by Fibromyalgia Impact Questionnaire (FIQ) and the test performance by total time spent in test and by number of movements. All subjects performed the sit to stand test in a comfortable velocity until exhaustion. Electromyography recording was performed in tree moments, simultaneously at Borg scale perceived effort evaluation: initial time (T1), after one minute (T2) and at exhaustion (T3). Results: Fibromyalgia group present MDF decrease at T3 (p=0,04) and more intense perceived effort at T2 (p=0,00). There was a moderate correlation for MDF in T3 with pain intensity (-0,40; p=0,00) and total time in sit to stand test in seconds (0,43; p=0,00). Conclusion: Fibromyalgia patients showed early muscle fatigue signs with MDF decrease and more intense perceived effort.

MARTORI, AH. Macroestrutura do sono em pacientes com fibromialgia, antes e após tratamento. 2011. 59 f. Dissertação (Mestrado) Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, 2011. Os objetivos do presente estudo foram: - avaliar a macroestrutura do sono de pacientes com Fibromialgia sem tratamento medicamentoso; - avaliar se há modificações na macroestrutura do sono, após a instituição de tratamento medicamentoso da síndrome com Amitripitilina ou Fluoxetina + Ciclobenzaprina; - avaliar a queixa de dor, através da Escala Analógica Visual (EVA), e de comprometimento do sono, utilizando escala semelhante adaptada para o sono (Escala de Qualidade do Sono EQS), antes e após o tratamento. Vinte pacientes (19 mulheres e 1 homem) foram selecionados do ambulatório de Reumatologia do HCFMRP-USP, entre aqueles com diagnóstico clínico definido de fibromialgia, sem tratamento medicamentoso atual para a síndrome. Os pacientes preencheram a EVA e a EQS, antes e após a introdução do medicamento de escolha, ao mesmo tempo em que foram submetidos a polissonografia (PSG), antes e após tratamento. As alterações da macroestrutura do sono na primeira PSG foram aumento de N1, redução de N3 e aumento do número de microdespertares, o que pode ser, em parte, atribuído a efeito de primeira noite. Após o tratamento, houve aumento significativo na latência de sono REM e na porcentagem de N1, com tendência a aumento na eficiência de sono. Observou-se expressiva frequência de padrão alfa-delta, antes do tratamento (9 de 20 pacientes = 45%), mantendo-se inalterada após o mesmo. Apesar disto, após o tratamento, houve melhora significativa das queixas de dor e da qualidade do sono, segundo os dados das respectivas escalas analógicas. Três pacientes exibiram movimentos periódicos durante o sono a partir do segundo exame, o que foi atribuído ao efeito da medicação, não se repercutindo em redução na qualidade do sono, segundo auto-avaliação do paciente. O distúrbio respiratório não se mostrou como um fator relacionado aos transtornos do sono em fibromiálgicos, tendo sido observada síndrome da apnéia e hipopnéia obstrutivas do sono (SAHOS) em 3 dos 20 pacientes estudados (grau leve, em 2, e moderado em 1) Na segunda PSG, apenas 1 paciente se manteve com diagnóstico de SAOS. Em conclusão, observamos que o paciente com fibromialgia não exibe alterações significativas na macroestrutura do sono, antes de iniciar o tratamento, apesar de sua qualidade comprometida segundo a auto-avaliação do mesmo. A imposição do tratamento não modifica significativamente a macroestrutura do sono, porém, melhora as queixas dolorosas e a auto-avaliação da qualidade do sono. Entretanto, o padrão alfa-delta, sugestivo de sono não-reparador, ocorre em quase metade dos pacientes com fibromialgia, de forma independente do tratamento, e da referida melhora nos sintomas dolorosos e na qualidade subjetiva do sono, sugerindo a possibilidade deste ser um marcador cortical independente, cuja provável relação com a fisiopatologia da doença carece de maiores estudos. Palavras-chave: Fibromialgia. Sono. Polissonografia. Tratamento. / Our goals in the present study were: - to evaluate sleep macrostructure in patients with Fibromyalgia free from medication; - to investigate if there are changes in sleep macrostructure, after the institution of medical treatment either with Amitriptiline or a combination of Fluoxetin and Cyclobenzaprine; - to evaluate the complaint of pain through the Visual Analogical Scale (VAS) and sleep impairment through an analogous scale so called Sleep Quality Scale (SQS), before and after treatment. Twenty patients (19 women and 1 man) were selected from the Rheumatology Outpatient Clinic of Ribeirão Preto University Hospital University of São Paulo, among those classified as suffering from Fibromyalgia without any current medical treatment for the syndrome. They fulfilled VAS and SQS and were submitted to two polysomnographic recordings (PSG), before and after the introduction of either one of medical treatments, chosen by the Rheumatology staff. As a result, we did not find significant changes in sleep macrostructure, before and after treatment, but an expressive frequency of alpha-delta pattern, in the first PSG (9 out of 20 patients = 45%), which remained unchanged after treatment. Even though, after treatment, there was significant improvement in regard to pain and sleep quality, according to the respective analogical scales. There was a significant increase in both REM latency and N1 percentage, as well as a tendency to increase in sleep efficiency, in the second PSG. Three patients showed periodic limb movements in the second exam, which has been attributed to an effect of the medications, without repercussion in sleep quality according to SQS. Respiratory sleep disorders did not appear to be related to sleep disturbances in fibromyalgia patients, as obstructive sleep apnea (OSA) was found in 3 out of 20 patients studied (mild degree, in 2, and moderate, in 1). Only 1 of those patients remained with OSA in the second PSG. In conclusion, we observed that patients with fibromyalgia, before starting medical treatment, do not show significant changes in sleep macrostructure, despite of sleep bad quality as referred by SQS. Medical treatment does not significantly modify sleep macrostructure, although improves complaints of pain and auto-evaluated sleep quality. Alpha-delta pattern, a possible marker of non restorative sleep, occurs in fibromyalgia patients independently from the treatment and from the self-attributed improvement in pain and sleep quality, suggesting its possible role as an independent cortical marker, eventually related to the physiopathology of this syndrome, which demands further studies to be determined.

No description available.

Fibromyalgia is a chronic illness characterized by debilitating symptoms such as unpredictable widespread pain, fatigue and migraines. Social support can be a crucial factor in illness management for individuals living with this medically contested, stigmatized and marginalized illness. For many, social media is a significant aspect of their daily reality and in this social space, new forms of relationships and communities have begun to form. This study explores the ways in which a new form of support community for fibromyalgia develops and maintains itself on the social media platform Instagram. A mixed-method research design incorporating both a content and semiotic analysis of Instagram posts as well as interviews with participants utilizing the app was conducted to shed light on the ways in which the relatively new phenomenon of sharing illness experience and support occur on Instagram. / Graduate

Background: About 2 percent of people in the world suffers from Fibromyalgia, out of them about 80 percent are women. Common symptoms are pain over a long period of time. Why this illness occurs is still unknown. Other characteristic features of this illness is fatigue, soreness and cognitive problems, such as forgetfulness.   Aim: The aim of this literature review was to describe the experience of living with fibromyalgia and to describe the method of data collection in the included articles. Method: Literature review with descriptive design. 13 qualitative articles were included. The articles were acquired through searches in the databases Cinahl and Medline by PubMed.   Main Results: People with fibromyalgia experienced that the pain and fatigue, that their illness caused, changed just about everything in their daily life. Most of them experienced that their psychological well being and social life were affected negatively by the illness. To not be believed or received well by people they met or by healthcare professionals was described as a big problem that happened far too often. This literature review also describe the method of data collection used in the included articles. Eleven out of thirteen articles used interviews as the method for data collection. One article used a questionnaire, and one article used focus group discussion. Conclusions: Descriptions of experiences of living with fibromyalgia has shown that it affects these persons on many levels of their life, both physically, psychologically and socially. The pain and fettique hinders them in their day to day life.  They experience that they are not believed or taken seriously in their daily life, nor in the encounters with healthcare professionals. / Bakgrund: I världen lider cirka 2 procent av befolkningen av fibromyalgi och 80 procent av dessa är kvinnor. De vanligaste symtomen är långvarig smärta med fortfarande okänd orsak till varför sjukdomen uppkommer. Sjukdomen karaktäriseras av onaturlig trötthet, ömhet och kognitiva besvär som att till exempel glömska. Syfte: Syftet med denna litteraturstudie var att beskriva upplevelsen av att leva med fibromyalgi, samt att beskriva de inkluderade artiklarnas datainsamlingsmetod. Metod: En litteraturstudie med deskriptiv design. Tretton kvalitativa artiklar inkluderades, dessa söktes genom databaserna Cinahl och Medline via PubMed. Huvudresultat: Många av personerna med fibromyalgi upplevde att smärtan och orkeslösheten från deras sjukdom förändrade i stort sett allt i deras vardagliga liv. De flesta upplevde att deras psykiska mående samt sociala liv påverkats negativt av sjukdomen. Att inte bli betrodd eller mottagen på ett bra sätt av människor de mötte samt sjukvårdspersonal beskrev personerna i flera av studierna som ett stort problem och allt för vanligt förekommande. Föreliggande litteraturstudie beskrev även vilken datainsamlingsmetod som användes. I elva av de tretton artiklarna användes intervju som datainsamlingsmetod. Av de resterande två använde sig en av ett formulär och den andra fokusgrupp diskussion. Slutsats: Beskrivningar av upplevelser att leva med fibromyalgi, har visat att den påverkar personerna på många plan i livet, både fysiskt, psykiskt och socialt. Smärtan och tröttheten hindrar dem i det dagliga livet och de upplever att de inte blir betrodda eller tagna på allvar både i vardagen, men även i mötet med hälso- och sjukvårdspersonal.

Orientador: José Inácio de Oliveira / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-24T12:35:37Z (GMT). No. of bitstreams: 1 Sousa_LeandroAlbertode_M.pdf: 4798180 bytes, checksum: 495f733ebeb2709e5d7f00c10e9d4f39 (MD5) Previous issue date: 2013 / Resumo: A Amônia Sérica, substrato da degradação proteica no organismo, pode estar relacionada a diferentes sinais e sintomas quando seus níveis estão acima do padronizado, 47 microMol/L, a Hiperamonemia, alguns estudos diziam que entre estes sintomas poderia estar o aumento da dor. A Síndrome Fibromiálgica (SF) ou Fibromialgia tem como principal sintoma o aumento da sensibilidade dolorosa em diferentes segmentos corporais, com uma prevalência média de 2%, a Fibromialgia acomete mais indivíduos do gênero feminino do que masculino - 06 mulheres a cada 10 doentes. Só há um consenso com relação a Fibromialgia: é uma doença multifatorial. Este trabalho teve então como objetivo comparar as diferenças dos níveis de amônia entre os pacientes com dor (fibromiálgicos) e pessoas sem queixas de dores para verificarmos se esta diferença existe. Depois do estudo piloto, comparou-se os níveis do substrato entre dois grupos: um com 17 pacientes fibromiálgicos do Ambulatório de Reumatologia do Hospital das Clínicas da Universidade Estadual de Campinas (UNICAMP), formando o Grupo de Indivíduos Fibromiálgicos (GIF), e 18 funcionários do Hospital das Clínicas da UNICAMP, formando o Grupo de Indivíduos sem Dor (GISD). RESULTADOS: após análise dos exames de sangue, não foi evidenciada diferença significativa (p-value = 0,710) nos níveis de Amônia Sérica entre os dois grupos. Portanto ode-se concluir que neste estudo piloto não se pode afirmar que haja relação entre os níveis de amônia sérica e Fibromialgia. / Abstract: The main symptom of Fibromyalgia is the increase of pain sensibility in distinct areas of the human body. With 2% of prevalence, the syndrome attacks more women than men - 06 women in each 10 patients. There is only one consensus point related with Fibromyalgia: it is a multifactorial disease. The plasmatic ammonia, substratum of protein degradation in body, can be related to different kinds of signs and symptoms when its levels gets up above of standard, 47 microMol/L, the Hyperammonemia. AIM OF THE STUDY: to compare the plasmatic ammonia levels between subjects with no pain and subjects with fibromyalgia. PATIENTS, MATERIALS AND METHODS: it has done a Case-control study with 17 patients of Rheumatology's Clinic of Clinic's Hospital at Universidade Estadual de Campinas (UNICAMP), Group of Fibromyalgics Subjects (GIF), and 18 subjects of Hospital at Universidade Estadual de Campinas (UNICAMP), Group of Subjects with no pain (GISD). RESULTS: after blood's exams analyses, it was no found significant differents (p-value = 0,710) on the plasmatic ammonia levels between two groups. CONCLUSION: there is no relation between plasmatic ammonia's level and Fibromyalgia. / Mestrado / Epidemiologia / Mestre em Saude Coletiva

Chronic pain is common and frequently interferes with people’s regular functioning and reduces quality of life. Though pharmacological approaches are used most frequently to treat pain-related issues, the side effects of these medications often lead to other problems. Group therapy has been used and studied for decades in treating pain though it’s general efficacy for addressing pain is not clear. Objectives: to determine group therapy’s efficacy for patients with pain-related issues and whether the effects are moderated by study, patient, leader, or group characteristics. Method: potential articles were selected from searches completed in major databases based on a set of inclusion criteria. A random effects meta-analysis was conducted, and potential moderators were analyzed. Results: we analyzed 57 studies representing 8,933 patients receiving group therapy for pain which produced a significant, small effect (g = 0.28) for reducing pain intensity. Various secondary outcomes such as pain frequency, interference with activities of daily living, physical functioning, catastrophizing, self-efficacy, anxiety, depression, and quality of life were also found to improve significantly. Four significant moderating variables were found to include pain measure used, gender composition, number of sessions, and presence of pain diagnosis. Discussion: results are discussed and compared to those of past meta-analyses regarding both chronic pain and group therapy. Implications for practice and research are provided.

Pain can have a devastating effect on the quality of life of patients in palliative medicine. Thus far, majority of research has been centered on opioid-based pain management, with a limited empirical evidence for the use of nonopioid medications in palliative care. However, opioid and nonopioid medications such as nonsteroidal anti-inflammatory drugs have their limitations in the clinical use due to risk of adverse effects, therefore, there is a need for more research to be directed to finding an alternative approach to pain management in comfort care setting. The purpose of this article is to discuss a potential new drug that would adequately alleviate pain and enhance quality of life without significant risks of adverse effects that would limit its use. Naltrexone is a reversible competitive antagonist at μ-opioid and κ-opioid receptors, which when used at standard doses of 50 to 150 mg was initially intended for use in opioid and alcohol use disorders. However, it was discovered that its use in low doses follows alternate pharmacodynamic pathways with various effects. When used in doses of 1 to 5 mg it acts as a glial modulator with a neuroprotective effect via inhibition of microglial activation. It binds to Toll-like receptor 4 and acts as an antagonist, therefore inhibiting the downstream cellular signaling pathways that ultimately lead to pro-inflammatory cytokines, therefore reducing inflammatory response. Its other mode of action involves transient opioid receptor blockade ensuing from low-dose use which upregulates opioid signaling resulting in increased levels of endogenous opioid production, known as opioid rebound effect. Low dose naltrexone has gained popularity as an off-label treatment of several autoimmune diseases including multiple sclerosis and inflammatory bowel disease, as well as chronic pain disorders including fibromyalgia, complex regional pain syndrome, and diabetic neuropathy. Low-dose naltrexone (LDN) may also have utility in improving mood disorders and the potential to enhance the quality of life. This article will therefore propose the potential off-label use of LDN in management of nonmalignant pain in the palliative medicine setting.

Fibromyalgia syndrome (FMS), a common chronic pain condition, is often incompletely treated by conventional medical therapies. It can cause disability, psychological distress, work-related absenteeism, increased use of healthcare resources, and result in the inability to carry out the tasks of daily living. The purpose of this quantitative, correlational study was to investigate the potential influence of laughter on affect and pain in individuals with FMS. Laughter produces beneficial effects on acute pain and on chronic pain in general and has been found to improve temporary affective states, but there have been no studies testing the effects of laughter on the pain and affect of fibromyalgia patients. Informing this study were the gate control and neuromatrix theories of pain, as well as the dynamic model of affect theory. The research questions addressed whether laughter frequency is associated with affect and or with perceived chronic pain levels in these individuals. Forty-one adult fibromyalgia patients documented all laughter episodes daily and assessed their pain and affective states 3 times per day for 14 days. Hierarchical regressions revealed that increased overall laughter frequency was significantly associated with decreases in overall pain and increases in overall positive affect but was not associated with measures of negative affect. Also, morning laughter frequency was predictive of increased afternoon and evening positive affect ratings, as well as with decreased afternoon pain ratings, but was not significantly associated with evening pain ratings. The knowledge gained from these results may have positive social change implications at the individual level, within those individuals' larger social networks, and within the research and medical communities.