The purpose of the current study was to develop a manualized treatment for fibromyalgia syndrome (FM) and to examine the efficacy of the treatment in a randomized controlled clinical trial. FM is a chronic musculoskeletal pain disorder characterized by tender points and generalized pain. Depression, chronic fatigue, and sleep disturbance are common. A biopsychosocial model served as a framework for understanding FM by integrating psychological, social, and physical factors. Cognitive-behavioural therapy (CBT), an empirically validated treatment for arthritis, has also been used with FM patients in an attempt to improve pain control, reduce disability, and increase self-efficacy. Overall, the attention/placebo controlled studies employing CBT as a treatment for FM show that it is not superior to a credible attention placebo. The current study attempted to combine the necessary components of CBT with interpersonal therapy to address relational patterns and personality characteristics that can affect ability to cope with chronic pain. One hundred and five women diagnosed with FM by a rheumatologist were randomly assigned to the CBT-interpersonal treatment condition or an attention-control condition. There were 8 treatment groups with a mean of 6-7 participants in each. The treatment consisted of weekly 2-hour sessions over 8 consecutive weeks. Outcome measures included: FM impact, pain, health care utilization, depression, coping, and self-efficacy. An intention-to-treat analysis was conducted. Results showed that the impact of FM symptoms was reduced following treatment compared to the control group and this was statistically and clinically significant, but was not maintained at 3-month follow-up. Significant improvements were also observed in coping strategies, some of which were maintained at follow-up. Importantly, self-efficacy improved significantly following treatment compared to the control group. Self-efficacy beliefs have been related to pain, coping efforts, disability, and psychological functioning. Directions for future research may include a focus on long-term maintenance of treatment gains that may be mediated by improvements in self-efficacy. There is strong evidence that changes in self-efficacy are enduring and affect changes in health behaviours and health status.

The purpose of the current study was to develop a manualized treatment for fibromyalgia syndrome (FM) and to examine the efficacy of the treatment in a randomized controlled clinical trial. FM is a chronic musculoskeletal pain disorder characterized by tender points and generalized pain. Depression, chronic fatigue, and sleep disturbance are common. A biopsychosocial model served as a framework for understanding FM by integrating psychological, social, and physical factors. Cognitive-behavioural therapy (CBT), an empirically validated treatment for arthritis, has also been used with FM patients in an attempt to improve pain control, reduce disability, and increase self-efficacy. Overall, the attention/placebo controlled studies employing CBT as a treatment for FM show that it is not superior to a credible attention placebo. The current study attempted to combine the necessary components of CBT with interpersonal therapy to address relational patterns and personality characteristics that can affect ability to cope with chronic pain. One hundred and five women diagnosed with FM by a rheumatologist were randomly assigned to the CBT-interpersonal treatment condition or an attention-control condition. There were 8 treatment groups with a mean of 6-7 participants in each. The treatment consisted of weekly 2-hour sessions over 8 consecutive weeks. Outcome measures included: FM impact, pain, health care utilization, depression, coping, and self-efficacy. An intention-to-treat analysis was conducted. Results showed that the impact of FM symptoms was reduced following treatment compared to the control group and this was statistically and clinically significant, but was not maintained at 3-month follow-up. Significant improvements were also observed in coping strategies, some of which were maintained at follow-up. Importantly, self-efficacy improved significantly following treatment compared to the control group. Self-efficacy beliefs have been related to pain, coping efforts, disability, and psychological functioning. Directions for future research may include a focus on long-term maintenance of treatment gains that may be mediated by improvements in self-efficacy. There is strong evidence that changes in self-efficacy are enduring and affect changes in health behaviours and health status.

Fibromyalgia Syndrome (FMS) is a disease of unknown etiology that affects up to 3 million Canadians, or 2-10% of the general population (Carruthers & van de Sande, 2005). Acceptance-based behavioural therapy (ABBT) is a relatively recent approach to treating human suffering in general and chronic pain in particular (Hayes, Strosahl, & Wilson, 1999; McCracken, 2005). ABBT treatments have been shown to effectively treat pain, pain-related anxiety, depression, and other behavioural measures of disability (McCracken, 2005; McCracken, Vowles, Gregg, & Almada, 2010; Pear & Simister, 2016, p. 160). In-person treatments can place significant burden on patients and the overall health-care system. Outcomes for online programs can be similar to those for in-person treatment while allowing for increased flexibility for both patients and professionals (Ritterband & Tate, 2009; Strecher, 2007). The current study extended a pilot study (Shay, Tkachuk, Simister, Bailly, & Skrabek, 2011), modifying the previous treatment to a 6 unit program that could be delivered online. Sixty-one participants completed the study, being randomly assigned to an online ABBT plus treatment-as-usual (online ABBT + TAU) group or a treatment-as-usual alone (TAU) group. All participants completed a series of self-report measures at baseline, at post-treatment, and at a 3-month follow-up. Linear mixed modelling supported significant differences between the groups in favour of the ABBT + TAU treatment group on the primary outcome measure (Fibromyalgia Impact Questionnaire-Revised (FIQ-R); F (2, 52.82) = 20.10, p < .0001) following treatment. The online ABBT + TAU group also had significantly greater improvements in depression, pain, acceptance, perceived helplessness, and kinesiophobia. Increased acceptance mediated the effects of treatment on improvements in FMS quality of life and FMS impact, while reduced helplessness mediated the effects of treatment on improvements in level of reported pain. Comments and subjective ratings of improvement were consistent with the quantitative results. Participants rated mindfulness (contact with present moment experience) as the most useful treatment unit. / February 2016

Fibromyalgia syndrome (FMS) is a chronic pain condition with significant societal and personal burdens of illness. Chronic opioid therapy in the treatment of chronic nonmalignant pain has increased drastically over the past decade. This is a worrisome trend in general, but specifically, given the pathophysiologic characteristics seen in fibromyalgia syndrome patients, the use of this class of medication deserves special scrutiny. Although the theoretical case against this therapy choice is strong, little empirical evidence exists. In order to supplement this literature, retrospective analysis methods are utilized to examine the association of state-, provider-, and patient level characteristics with the prevalence of chronic opioid use in this disease state. Data gathered through this analysis is then used to develop a propensity index for the identification of an appropriate control group for fibromyalgia patients, a task that has proven difficult in the literature to date. Using propensity stratification and matching techniques analysis of the impact of fibromyalgia, chronic opioid use, and the interaction of these two variables are undertaken. Several key findings and updates to the understanding of chronic opioid use and fibromyalgia syndrome are reported. Wide geographic variation in chronic opioid utilization between states is seen. The role of diagnosing provider type in the rate of chronic opioid prescribing is significant and can be aggregated at various levels. Demographic characteristics, comorbid conditions, and concurrent medication use are all important associates of chronic opioid use in fibromyalgia syndrome. Additionally, chronic opioid use in fibromyalgia patients, independent of propensity to receive that therapy choice is a significant correlate with healthcare costs. A diagnosis of fibromyalgia is a statistically significant source of healthcare costs, though the clinical significance of its impact when compared to a closely matched control group is minimized. Despite the minimization of the role of this diagnosis the impact of the interaction of chronic opioid use with fibromyalgia, despite control for myriad regressors, is significant both statistically and clinically.

Made available in DSpace on 2015-05-14T12:56:08Z (GMT). No. of bitstreams: 1 arquivototal.pdf: 1472826 bytes, checksum: f09cd3b6bfe357a69915a6aa5c94e6b7 (MD5) Previous issue date: 2009-12-17 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / The aim of this study was to evaluate the presence of Temporomandibular Disorders (TMD) and the involvement of pain, as well as psychological and psychosocial factors, on a population with Fibromyalgia Syndrome (FMS). This is an observational, cross-sectional study with a direct inductive approach. The universe was composed of patients from the Acupuncture and Pain Ambulatory Facility of Hospital das Clínicas of the Federal University of Pernambuco (HC-UFPE) diagnosed with FMS, according to American College of Rheumatology criteria. The following were assessed: the sample variables (sex and age); classification and degree of TMD by the simplified anamnestic index; psychological and psychosocial factors involved using Research Diagnostic Criteria for TMD (RDC/TMD): Axis II and FMS according to the medical chart used in the ambulatory facility of HC-UFPE. The data were analyzed using descriptive and inferential statistical techniques and Pearson s chi-square or Fisher s Exact test. The significance level used was 5% and the intervals were obtained with 95% of confidence. The sample was composed of 50 female patients with mean age of 47.02 years and standard deviation of 10.27 years. Of these, 49 reported the presence of signs and symptoms related to TMD, which was classified as moderate (40.0%), severe (36.0%) and slight (22.0%). Seventy-six percent of the sample needed treatment for TMD. With respect to the signs and symptoms investigated the most frequent items with a positive response were those related to nape of the neck and neck pain (86.0%), self-assessment of tension (76.0%) and headache (60.0%). Most (80.0%) reported facial pain during the 4 weeks; all but 1 patient had chronic pain. Of the activities related to the quality of life of the patients, the items most compromised by facial pain, reported by 80.0% of the individuals, were: Maintaining normal facial expression, without signs of pain or sadness (68.0%); Eating hard food items (64.0%) and Masticating (60.0%). All the participants experienced body pain, mainly in the occipital region (92.0%). The most frequent complaints from body pain were: fatigue (98%), difficulty in concentrating (90%), anxiety (88%), numbness in the hands or feet (84%) and restless sleep (80%). A significant positive correlation was observed between the duration of facial pain and body pain. Mean visual analogue scale values were 5.22 and 8.7 for facial and body pain, respectively. Depression was found in 90.0% of the patients and most had somatization with pain (98.0%) and somatization without pain (96.0%). The degree of TMD showed a significant association (p < 0.05) with the level of depression and with limitations in mandibular function: yawning, speaking and maintaining normal facial expression without signs of pain or sadness. Facial pain showed a significant association (p < 0.05) with the variables: level of TMD, depression, teeth grinding, fatigue muscle pain from masticating, buzzing in the ear and headache. There was a significant correlation between the occurrence of depression and the following limitations: performing physical exercises; eating hard foods; smiling or laughing; sexual activity; speaking and maintaining normal facial expression, with no signs of pain or sadness. It was concluded that the fibromyalgia population studied exhibited a high prevalence of TMD. Depression was statistically associated to TMD, which was more intense in individuals with severe depression. A significant association was also found when the psychosocial factors involved in mandibular function limitations, degree of depression and severity of TMD were reported. / O objetivo deste estudo foi avaliar a presença de Disfunção Temporomandibular (DTM) e envolvimento de dor, fatores psicossociais e psicológicos em uma população com Síndrome Fibromiálgica (SFM). Foi realizado um estudo observacional transversal com abordagem indutiva direta. O universo foi composto por pacientes do Ambulatório de Acupuntura e Dor do Hospital das Clínicas da Universidade Federal de Pernambuco (HC-UFPE) com diagnóstico de SFM segundo os critérios do Colégio Americano de Reumatologia para SFM. Avaliaram-se: as variáveis de caracterização amostral (gênero e idade); classificação e grau da DTM pelo índice Anamnésico Simplificado; fatores psicológicos e psicossociais envolvidos utilizando-se os Critérios Diagnósticos de Pesquisa em DTM (RDC/TMD): Eixo II e a SFM através da ficha clínica utilizada no referido ambulatório do HC-UFPE. Os dados foram analisados através de técnicas de estatística descritiva e inferencial utilizando o teste estatístico Qui-quadrado de Pearson ou o teste Exato de Fisher. O nível de significância utilizado foi de 5% e os intervalos foram obtidos com 95% de confiança. A amostra foi composta por 50 pacientes do gênero feminino com idade média de 47,02 anos e desvio padrão de 10,27 anos, destas 49 relataram a presença de sinais e sintomas relacionados à DTM que foi classificada quanto a sua severidade como moderada (40,0%), severa (36,0%) e leve (22,0%). Desta amostra 76% mostraram-se com necessidade de tratamento para DTM. Quanto aos sinais e sintomas investigados os itens mais freqüentes com resposta positiva foram aqueles relacionados a dor na nuca ou pescoço (86,0%), auto-avaliação de tensão (76,0%) e dor de cabeça (60,0%). A maioria (80,0%) relatou dor na face durante as 4 semanas; com exceção de uma paciente todas tinham dor crônica. Das atividades relacionadas à qualidade de vida das pacientes os itens mais prejudicados pela dor na face, relatada por 80,0% delas, foram: Ficar com o rosto normal, sem aparência de dor ou triste (68,0%); comer alimentos duros (64,0%) e mastigar (60,0%). Todas as participantes apresentavam dor no corpo sendo a região occipital a mais citada (92,0%). As maiores queixas devido a dor no corpo foram: fadiga (98%), dificuldade de concentração (90%), ansiedade (88%), dormência nas mãos ou pés (84%) e sono com vários despertares (80%). Foi observada correlação positiva elevada entre os tempos da dor na face e dor no corpo sendo a média da escala visual analógica 5,22 e 8,7 para dor na face e no corpo, respectivamente. Em 90,0% das pacientes foi encontrado depressão e a maioria tinha somatização com dor (98,0%) e somatização sem dor (96,0%). O grau da DTM mostrou associação significativa (p < 0,05) com o grau da depressão e com as limitações da função mandibular: bocejar, conversar e ficar com o rosto normal sem aparência de dor ou triste. Quanto a associação da dor na face, mostraram-se significativas (p < 0,05) as variáveis: grau da DTM, depressão, bruxismo, cansaço ou dor muscular ao mastigar, zumbidos no ouvido e dor de cabeça. Houve associação significativa entre ocorrência de depressão com as limitações: fazer exercícios físicos ou fazer ginástica; comer alimentos duros; sorrir ou gargalhar; atividade sexual; conversar e ficar com o rosto normal, sem aparência de dor ou triste. Conclui-se que há uma alta prevalência de DTM na população fibromiálgica estudada. A depressão foi estatisticamente associada à DTM que mostrou-se mais intensa nos indivíduos com maior severidade de depressão. Associação significativa também foi encontrada quando os fatores psicossociais envolvidos nas limitações da função mandibular, grau de depressão e severidade da DTM foram relacionados.

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Ma thèse doctorale vise à analyser la fibromyalgie en tant qu’entité prise en charge et traitée par des savoirs et des pratiques biomédicales contemporaines et localisées. Tout en prenant en considération une vision biomédicale transnationale du syndrome, mon terrain de recherche est situé dans le contexte italien. La première partie de la thèse est consacrée à l’analyse de la vision médicale de la douleur chronique sans lésion, également entendue comme la « douleur-maladie » ; elle propose aussi une analyse de la manière dont les formes douloureuses chroniques complexes sont encadrées au niveau législatif et politique dans le contexte national italien. La deuxième partie se concentre sur la fibromyalgie en tant que catégorie médicale. Un premier chapitre analyse comment en biomédecine le syndrome est encadré par un savoir scientifique transnational ; un deuxième chapitre se focalise sur les données collectées pendant la recherche ethnographique. La troisième partie de la thèse examine la construction médicale de la fibromyalgie en tant que syndrome féminin. Elle propose également, dans un deuxième chapitre, le témoignage de Marzia, une femme atteinte de fibromyalgie qui à travers son historie, en s’opposant à une interprétation purement biomédicale de la maladie, définit le syndrome en mode contrastif, changeant et imprévisible. / My PhD thesis aims to analyse the fibromyalgia syndrome understood as an entity defined by contemporary and located biomedical knowledge and practices. While a transnational biomedical vision of the syndrome is analysed, the ethnographic research field is located within the Italian context. The first chapter is focussed on biomedical theories which analyse chronic pain without organic lesions, also framed here by the concept of pain as a disease; it ends by analysing how complex chronic painful states are considered at one legislative and political level in the Italian national context. The second chapter analyses fibromyalgia syndrome seen as a biomedical category. A first section examines how the syndrome is framed by transnational biomedical scientific knowledge; the second section focuses on data collected during the ethnographic research. The third chapter is dedicated to an investigation of the medical reasons that outline fibromyalgia as a female syndrome. It also proposes, in its second section, the testimony of Marzia, a woman affected by fibromyalgia; beyond a purely biomedical interpretation of the disease, through Marzia’s story the syndrome emerges in contrastive, opposite and unpredictable ways. / La mia tesi di dottorato analizza la sindrome fibromialgica intesa come entità presa in carico e trattata da saperi e pratiche biomediche contemporanee e localizzate. Pur focalizzandomi sulla visione biomedica transnazionale della sindrome, il mio terreno di ricerca è situato all’interno del contesto nazionale italiano. La prima parte della tesi è centrata sull’analisi della visione biomedica del dolore cronico senza lesione, inquadrato qui anche nei termini di “dolore-malattia”. Essa propone anche una osservazione di come sono inquadrate nella contemporaneità forme dolorose croniche complesse a un livello più propriamente legislativo e politico all’interno del contesto italiano. La seconda parte della tesi si concentra sulla fibromialgia intesa nei termini di categoria medica. Un primo capitolo analizza come attualmente la sindrome è inquadrata attraverso un sapere scientifico transazionale; un secondo capitolo è focalizzato sui dati raccolti durante la ricerca etnografica. La terza parte della tesi esamina la costruzione medica della fibromialgia nei termini di una sindrome femminile. Propone infine la testimonianza di Marzia, una donna colpita da fibromialgia che, attraverso la sua storia e opponendosi a un’interpretazione puramente biomedica della malattia, definisce la sindrome in modo contrastante, mutevole e imprevedibile.