Fibromialgia é caracterizada por dor crônica músculo-esquelética difusa, distúrbio do sono, fadiga e humor depressivo ou ansiedade. Cinqüenta e oito mulheres com fibromialgia foram alocadas aleatoriamente e divididas em dois grupos: o primeiro (n=34), tratadas duas vezes por semana com acupuntura perfazendo total de 20 sessões, medicadas com antidepressivos tricíclico e utilizando caminhada, exercícios e relaxamento 2 vezes por semana. O segundo grupo (n=24) recebeu o mesmo tratamento exceto a acupuntura. A avaliação da dor foi realizada através da escala visual analógica (EVA), número de pontos dolorosos (NPD), do índice miálgico (IM) e um questionário SF36 para a qualidade de vida. As avaliações foram feitas antes, após, seis meses, um ano e dois anos depois da primeira avaliação. Foram realizadas por profissionais que desconheciam o grupo ao qual a paciente pertencia. No final das vinte sessões, as pacientes que receberam a acupuntura apresentaram melhora significante nas medidas de dor (EVA, NPD e IM) e em cinco sub-escalas do SF36 em relação ao grupo controle. Após seis meses o grupo de acupuntura apresentou resultado melhor do que o controle em relação ao NPD e ao IM e em uma sub-escala do SF36. Após um ano o grupo de acupuntura mostrou melhora sobre o grupo controle somente em uma sub-escala do SF36. Depois de dois anos do início do tratamento com acupuntura não houve diferença significativa entre os dois grupos em todas as medidas pesquisadas. A associação da acupuntura ao tratamento usual para fibromialgia mostrou-se benéfica para dor e qualidade de vida, mas somente por três meses após o tratamento. / Fibromyalgia is characterized by chronic widespread pain, disturbed sleep, fatigue and psychological distress. The aim of this study was to evaluate the effect of acupuncture as a treatment for this condition. Fifty-eight women diagnosed with fibromyalgia were randomly allocated to two groups. One group received acupuncture (n=34) twice a week for 20 sessions in addition to tricyclic antidepressants and exercises. The control group (n=24) received only tricyclic antidepressants and exercises. Patients rated their pain intensity using a visual analogue scale (VAS). A blinded assessor evaluated the number of fibromyalgia tender points (TePsN) and the pressure pain threshold over the 18 fibromyalgia tender points (PPT18). The same assessor also evaluated quality of life (QoL) using SF-36. These evaluations were done prior to treatments, at the end of the 20 sessions, and again at six months, one year and two years after the first evaluation. At the end of the 20 sessions, patients who had received acupuncture were significantly better than those who had not in all measures of pain (VAS, TePsN, PPT18) and in five subscales of SF-36. After six months, the acupuncture group was significantly better than the control group in some measures of pain (TePsN and PPT18) and in one subscale of SF-36. After one year, the acupuncture group showed significant advantage in only one subscale of SF-36; at two years there were no significant differences between the two groups on all outcome measures. The addition of acupuncture to usual treatment for fibromyalgia is beneficial for pain and quality of life, but only in the first six months.

Made available in DSpace on 2016-08-19T18:16:00Z (GMT). No. of bitstreams: 1 JOSE MAURO CARNEIRO FERNANDES.pdf: 2722865 bytes, checksum: 93282d8b85068c8a3abc440c86dc410e (MD5) Previous issue date: 2010-04-28 / Fibromyalgia is a syndrome whose causes are as yet unknown. It is characterized by widespread chronic musculoskeletal pain as well as by the presence of painful areas called tender points, especially in the axial skeleton. According to the origins of symptoms, fibromyalgia can be classified as traumatic or non-traumatic, being the former considered when there is evidence of trauma as a triggering factor of the symptoms. Given that the impact of this disease on patients and relatives' quality of life is an important aspect to be taken into account, this paper aims at investigating the impact on the well-being of women suffering from both traumatic and non-traumatic fibromyalgia. Women suffering from fibromyalgia were selected to the study and divided in two groups: sufferers from traumaticinduced fibromyalgia (group I) and sufferers from non-traumatic fibromyalgia (group II). An structured questionnaire was used for the research, from which the counting of tender points has been analyzed and the pain intensity has been evaluated (through the Visual Analog Scale - VAS), in addition to the demographic data; the Fibromyalgia Impact Questionnaire (FIQ) has been used to assess the quality of life and, to the statistic analysis, the Mann-Whitney test was used. 72 patients have been analyzed, being 34 from group I and 38 from group II. The main symptoms triggering factors - here understood as traumatic factors were divorce (23.5% of cases) and loss of family members (23.5% of cases); no difference between groups was found concerning age group, number of children, family income, education level, or marital status; the main symptoms reported by the patients, besides widespread pain, were fatigue, sleep disturbance, weakness and paresthesias, with no difference between groups; amongst the associated symptoms, headache was more prevalent in group I (p=0.0006); the counting of tender points and the pain intensity measurement were similar in both groups; as for the FIQ for quality of life evaluation, it has been worse within group I (p<0,0001). As a conclusion, a stronger impact on the quality of life of women suffering from traumatic fibromyalgia has been observed in this study. / A fibromialgia é uma síndrome de origem desconhecida, caracterizada por dor músculoesqulética difusa e crônica, e presença de múltiplas regiões dolorosas, denominadas tender points (pontos dolorosos), especialmente no esqueleto axial. De acordo com a origem dos sintomas, a fibromialgia pode ser classificada em traumática e não-traumática, sendo a primeira quando existe evidência de um trauma como fator desencadeante dos sintomas. Um aspecto importante quando se estuda fibromialgia é seu impacto na qualidade de vida em pacientes e familiares. Este trabalho tem por objetivo investigar o impacto na qualidade de vida em mulheres portadoras de fibromialgia de origem traumática e não-traumática. Mulheres portadoras de fibromialgia foram selecionadas para o estudo e divididas em dois grupos: portadoras de fibromialgia de origem traumática (grupo I) e portadoras de fibromialgia de origem não-traumática (grupo II). Foi utilizado um questionário estruturado para a pesquisa, onde além dos dados demográficos, analisamos a contagem de pontos dolorosos e avaliamos a intensidade da dor através da Escala Analógica Visual; o Questionário sobre o Impacto da Fibromialgia (QIF) foi usado para avaliar a qualidade de vida e para a análise estatística utilizou-se o teste de Mann-Whitney. Foram analisadas 72 pacientes, sendo 34 no grupo I e 38 no grupo II. Os principais fatores desencadeantes dos sintomas, considerados fatores traumáticos foram divórcio (23,5% dos casos) e perda familiar (23,5% dos casos); não houve diferença entre os grupos no que diz respeito a idade, número de filhos, renda familiar, escolaridade e estado civil; os principais sintomas apresentados pelas pacientes, além de dor difusa, foram sono não-reparador, fraqueza, fadiga e parestesias, sem diferença entre os dois grupos; entre os sintomas associados, a cefaléia teve uma prevalência maior no grupo I (p=0,0006); a contagem de pontos dolorosos e a avaliação da intensidade da dor foram semelhantes entre os dois grupos; já a avaliação da qualidade de vida pelo QIF foi pior no grupo I (p<0,0001). Concluindo, neste estudo observou-se um maior impacto na qualidade de vida de mulheres portadoras de fibromialgia de origem traumática.

Made available in DSpace on 2016-08-19T18:16:01Z (GMT). No. of bitstreams: 1 NELBE MARIA FERREIRA DE AMORIM.pdf: 1748880 bytes, checksum: b3cf56a7fa26b5258bd484dc8612f2d1 (MD5) Previous issue date: 2009-10-28 / FUNDAÇÃO DE AMPARO À PESQUISA E AO DESENVOLVIMENTO CIENTIFICO E TECNOLÓGICO DO MARANHÃO / Fibromyalgia is a complex multifactorial disorder characterized by chronic pain associated with fatigue, depression, anxiety, alterations in sleep patterns and cognition. Aerobic exercise and training of progressive strength are proposed as treatments of the symptoms. The Pilates method is proposed to improve the flexibility of the body, to emphasize the strengthening of the trunk of the body and posture. The aim of this clinical assay was to evaluate the Pilates method on the daily activities of patients with fibromyalgia, on pain, on the number of tender points and on the amplitude of movement of the shoulders and hips, measured respectively by a Fibromyalgia Impact Questionnaire (FIQ), by the Visual Analogical Scale (VAS), by fingerpressure and by photogrammetry. Thirty eight women with a diagnosis of fibromyalgia were randomly distributed into two groups. Group 01 (G1 n=19) were submitted to a program of Pilates based-exercise, two times per week for 8 consecutive weeks with each session lasting sixty minutes and there was also an educational program. Group 2 (G2 n=19) the control group, were only submitted to the educational program. The evaluations were made in both groups at the beginning and at the end of the program. Statistical significance were found in the fibromyalgia impact on daily life (p=0,014), on pain (p=0,0004), on the number of tender points (p=0,012). The amplitude of movements of the shoulders and hips had no significant results. It s therefore concluded that in this study, the Pilates method was efficient in reducing the fibromyalgia impact on daily life, on the pain intensity and in the number of tenders points, and it was not efficient in gaining amplitude of movement in the shoulders and hips. / Fibromialgia é uma desordem multifatorial complexa, caracterizada por dor crônica associada à fadiga, depressão, ansiedade, alterações do sono e da cognição. Exercícios aeróbicos e de treinamento de força são propostos como tratamentos dos sintomas. O método Pilates propõe melhora da flexibilidade do corpo, do fortalecimento do tronco e da postura. Este estudo é um ensaio clínico e teve como objetivo avaliar em pacientes com fibromialgia, os efeitos do método Pilates nas atividades de vida diária (AVD S), na dor, no número dos tender points e na amplitude de movimento (ADM) dos ombros e quadris, mensurados respectivamente pelo Questionário do Impacto da Fibromialgia (QIF), pela escala analógica visual (EAV), pela dígito-pressão e pela biofotogrametria. Foram avaliadas trinta e oito mulheres com o diagnóstico de fibromialgia e distribuídas aleatoriamente em dois grupos. O grupo 01 (G1 n=17) foi submetido a um programa de exercício baseado no método Pilates, duas vezes por semana, durante 8 semanas consecutivas, tendo cada sessão uma duração de 60 minutos, além de um programa educacional. O grupo 2 (G2 n=17) controle, foi submetido apenas ao programa educacional. As avaliações foram feitas em ambos os grupos no início e no final do programa. Foram encontradas diminuições estatisticamente significantes no impacto da fibromialgia na vida diária (p=0,014), na dor (p=0,0004), no número dos tenders points (p=0,012). Na amplitude de movimento dos ombros e quadris, não foram encontrados resultados significantes. Concluiu-se, que neste estudo, o método Pilates foi eficaz na diminuição do impacto da fibromialgia na vida diária, na intensidade da dor e no número dos tenders points, e não foi eficiente para o ganho da ADM da flexão dos ombros e dos quadris.

Made available in DSpace on 2016-08-19T18:16:01Z (GMT). No. of bitstreams: 1 JOSE MAURO CARNEIRO FERNANDES.pdf: 2722853 bytes, checksum: 80b569b07583bcf987407fd8ed61225d (MD5) Previous issue date: 2010-04-28 / Fibromyalgia is a syndrome whose causes are as yet unknown. It is characterized by widespread chronic musculoskeletal pain as well as by the presence of painful areas called tender points, especially in the axial skeleton. According to the origins of symptoms, fibromyalgia can be classified as traumatic or non-traumatic, being the former considered when there is evidence of trauma as a triggering factor of the symptoms. Given that the impact of this disease on patients and relatives' quality of life is an important aspect to be taken into account, this paper aims at investigating the impact on the well-being of women suffering from both traumatic and non-traumatic fibromyalgia. Women suffering from fibromyalgia were selected to the study and divided in two groups: sufferers from traumaticinduced fibromyalgia (group I) and sufferers from non-traumatic fibromyalgia (group II). An structured questionnaire was used for the research, from which the counting of tender points has been analyzed and the pain intensity has been evaluated (through the Visual Analog Scale - VAS), in addition to the demographic data; the Fibromyalgia Impact Questionnaire (FIQ) has been used to assess the quality of life and, to the statistic analysis, the Mann-Whitney test was used. 72 patients have been analyzed, being 34 from group I and 38 from group II. The main symptoms triggering factors - here understood as traumatic factors were divorce (23.5% of cases) and loss of family members (23.5% of cases); no difference between groups was found concerning age group, number of children, family income, education level, or marital status; the main symptoms reported by the patients, besides widespread pain, were fatigue, sleep disturbance, weakness and paresthesias, with no difference between groups; amongst the associated symptoms, headache was more prevalent in group I (p=0.0006); the counting of tender points and the pain intensity measurement were similar in both groups; as for the FIQ for quality of life evaluation, it has been worse within group I (p<0,0001). As a conclusion, a stronger impact on the quality of life of women suffering from traumatic fibromyalgia has been observed in this study. / A fibromialgia é uma síndrome de origem desconhecida, caracterizada por dor músculoesqulética difusa e crônica, e presença de múltiplas regiões dolorosas, denominadas tender points (pontos dolorosos), especialmente no esqueleto axial. De acordo com a origem dos sintomas, a fibromialgia pode ser classificada em traumática e não-traumática, sendo a primeira quando existe evidência de um trauma como fator desencadeante dos sintomas. Um aspecto importante quando se estuda fibromialgia é seu impacto na qualidade de vida em pacientes e familiares. Este trabalho tem por objetivo investigar o impacto na qualidade de vida em mulheres portadoras de fibromialgia de origem traumática e não-traumática. Mulheres portadoras de fibromialgia foram selecionadas para o estudo e divididas em dois grupos: portadoras de fibromialgia de origem traumática (grupo I) e portadoras de fibromialgia de origem não-traumática (grupo II). Foi utilizado um questionário estruturado para a pesquisa, onde além dos dados demográficos, analisamos a contagem de pontos dolorosos e avaliamos a intensidade da dor através da Escala Analógica Visual; o Questionário sobre o Impacto da Fibromialgia (QIF) foi usado para avaliar a qualidade de vida e para a análise estatística utilizou-se o teste de Mann-Whitney. Foram analisadas 72 pacientes, sendo 34 no grupo I e 38 no grupo II. Os principais fatores desencadeantes dos sintomas, considerados fatores traumáticos foram divórcio (23,5% dos casos) e perda familiar (23,5% dos casos); não houve diferença entre os grupos no que diz respeito a idade, número de filhos, renda familiar, escolaridade e estado civil; os principais sintomas apresentados pelas pacientes, além de dor difusa, foram sono não-reparador, fraqueza, fadiga e parestesias, sem diferença entre os dois grupos; entre os sintomas associados, a cefaléia teve uma prevalência maior no grupo I (p=0,0006); a contagem de pontos dolorosos e a avaliação da intensidade da dor foram semelhantes entre os dois grupos; já a avaliação da qualidade de vida pelo QIF foi pior no grupo I (p<0,0001). Concluindo, neste estudo observou-se um maior impacto na qualidade de vida de mulheres portadoras de fibromialgia de origem traumática.

INTRODUÇÃO: Pacientes com fibromialgia (FM) apresentam distúrbios no sistema de resposta ao estresse, o qual é composto pelo eixo hipotalâmico-pituitário-adrenal (HPA) e pelo sistema nervoso autônomo. Recentemente, tem havido muito interesse na possível função do sistema nervoso autônomo na patogênese da FM. O objetivo deste estudo foi avaliar a interação entre os sistemas simpático e parassimpático, em mulheres com FM e mulheres saudáveis, utilizando a análise da variabilidade da freqüência cardíaca (VFC). MÉTODOS: Foram estudadas 20 mulheres com FM com idades entre 35 e 55 anos, e 20 controles saudáveis pareados pela idade, gênero e índice de massa corporal. A VFC foi analisada sobre gravações eletrocardiográficas, obtidas através da monitorização eletrocardiográfica ambulatorial (Holter) de 24 horas, e avaliada pelos índices da VFC no domínio do tempo (SDNN, SDANN, SDNNi, RMSSD e pNN50) e no domínio da freqüência (LF, HF, WF e LF/HF). A VFC foi analisada durante o período de 24 horas e também durante o período noturno, entre 01:00 e 04:00 h AM, consideradas como horas de sono. O equilíbrio simpato-vagal foi analisado através da razão LF/HF, sendo as faixas de freqüências da LF (0,04-0,15 Hz) considerada como predominantemente simpática, e da HF (0,15-0,50 Hz) considerada como predominantemente parassimpática. RESULTADOS: Não houve diferença de idade entre pacientes com FM e o grupo controle (44,40 ± 5,01 e 44,65 ± 5,32 anos, respectivamente; p=0,879). Os índices que refletem o sistema nervoso parassimpático, mostraram um comportamento similar entre pacientes com FM, mas revelaram atividade significativamente diminuída quando comparado ao grupo controle, ambos durante o período noturno e durante o período de 24 horas (p<0,05). Não houveram diferenças entre os índices que refletem o sistema simpático entre os grupo FM e controle (p>0,05), assim como não mostraram hiperatividade simpática. Contudo, a razão LF/HF foi significativamente maior em pacientes com FM, quando comparado ao grupo controle, ambos durante o período de sono (p=0,015) como durante o período de 24 horas (p=0,025), sugerindo predominância simpática em indivíduos com FM. CONCLUSÃO: Nossos resultados sugerem que pacientes com FM apresentam predominância da atividade simpática, associado ao tônus parassimpático diminuído. Sob condições basais não foi detectada hiperatividade simpática, uma vez que a atividade simpática não mostrou alterações significantes. / INTRODUCTION: Patients with fibromyalgia (FM) exhibit disturbances of the stress-response system, which is composed by hypothalamic-pituitary-adrenal axis (HPA) and autonomic nervous system. Recently, much interest has been expressed in the possible role of the autonomic nervous system in the pathogenesis of FM. The aim of this study was to assess the interation between sympathetic and parasympathetic systems, in FM and health women, using heart hate variability (HRV) analysis. METHODS: It was studied 20 women with FM aged between 35 and 55 years-old, and 20 healthy controls matched for age, sex and body mass index. HRV was assessed over electrocardiographic recordings, obtained by 24-hours ambulatory electrocardiography monitoring (Holter), and evaluated by time domain indexes (SDNN, SDANN, SDNNi, RMSSD e pNN50) and frequency domain indexes (LF, HF, WF e LF/HF). HRV was analyzed over the 24-hours period and also over the night period, between 01:00 and 04:00 AM, considered as sleep hours. Sympathovagal balance was analysed by LF/HF ratio, with LF band (0.04-0.15 Hz) considered as sympathetic predominance, and HF band (0.15-0.50 Hz) considered as parasympathetic predominance. RESULTS: There was no age difference between FM patients and control group (44.40 ± 5.01 and 44.65 ± 5.32 years, respectively; p=0.879). The indexes that reflect parasympathetic nervous system, showed a similar behavior among FM patients, but revealed a significantly decreased activity when compared to control group, both during the nocturnal period as well during the 24h period (p<0.05). There was no difference between the indexes that reflect sympathetic system in FM patients and controls (p>0.05), as did not show sympathetic hyperactivity. However, the ratio LH/HF was significantly higher in FM patients, when compared to control group, both during the sleep period (p=0.015) as well as over the 24h period (p=0.025), suggesting a sympathetic predominance in FM subjects. CONCLUSION: Our data suggest that FM patients present a predominance of sympathetic activity, associated with a reduced parasympathetic tonus. Under basal conditions sympathetic hyperactivity was not detected, since sympathetic activity did not show significant alterations.

Fibromyalgia, a chronic illness characterized by widespread muscle pain, tenderness, joint stiffness, and fatigue, affects 3-6% of the world’s population. Symptoms of fibromyalgia impact the ability to complete daily activities, such as cooking, cleaning or employment, possibly leading to greater perceived stress and, in turn, to engagement in suicidal behavior. For persons with fibromyalgia, pressure to complete previous routines, and emergence of frustration at the inability to do so, may result in the experience of being overwhelmed by stressors. Further, persons with fibromyalgia are at greater risk for both mental health difficulties and suicidal behavior than persons in the general population; for example, depressive symptoms, including self-blame, are three times more common. However, not all individuals with fibromyalgia experience overwhelming distress or engage in suicidal behaviors, perhaps due to the presence of individual-level protective factors. One such factor is self-compassion, which is composed of self-kindness, common humanity, and mindfulness. Positive emotions directed toward the self may buffer against illness-related stressors and feelings of inadequacy and loss associated with impact of disease and functional impairment, thereby decreasing suicide risk. At the bivariate level, we hypothesized that fibromyalgia impact would be positively related to stress and suicidal behaviors, and that self-compassion would be negatively related to all of these variables. At the multivariate level, we hypothesized that stress would mediate the relation between fibromyalgia impact and suicidal behaviors, and that self-compassion would moderate this mediation effect such that greater self-compassion would weaken the linkages between impairment and stress, impairment and suicidal behavior, and stress and suicidal behavior. Our sample of individuals with fibromyalgia (N=508) were primarily White (91.8%; n=383) and female (95.7%; n=401), and completed self-report measures including: Fibromyalgia Impact Questionnaire-Revised, Depression Anxiety Stress Scales, Self-Compassion Scale-Short Form, and Suicide Behaviors Questionnaire-Revised. Bivariate correlations and multivariate analyses, per Hayes (2013), were conducted covarying age, sex, and ethnicity. In bivariate correlations, fibromyalgia impact was positively related to stress and suicidal behaviors and negatively related to self-compassion (p Supporting hypotheses, our results suggest that self-compassion may protect against the development of stress related to fibromyalgia impact and subsequent risk for suicidal behaviors, and may have clinical implications. Therapeutic interventions focused on alleviating stress (e.g., meditation, stress inoculation therapy) and promoting self-compassion (e.g. mindful self-compassion training, positive self-talk) could ameliorate the perceived impact of fibromyalgia-related stressors and, thus, risk for engagement in suicidal behaviors.

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Purpose: Despite a growing literature on the benefits of gratitude for adjustment to chronic illness, little is known about gratitude in medical populations compared to healthy populations, or the degree to which potential deficits in gratitude might impact quality of life. The purpose of the present study was to (1) examine levels of gratitude and quality of life in fibromyalgia patients and healthy controls and (2) consider the role of gratitude in explaining quality of life differences between fibromyalgia patients and healthy controls. Methods: Participants were 173 fibromyalgia patients and 81 healthy controls. All participants completed measures of gratitude, quality of life, and socio-demographics. Results: Although gratitude was positively associated with quality of life, levels of gratitude and quality of life were lower in the fibromyalgia sample relative to the healthy controls. This difference in gratitude partially mediated differences in quality of life between the two groups after controlling for socio-demographic variables. Conclusions: Our findings suggest that gratitude is a valuable positive psychological trait for quality of life in people with fibromyalgia. Interventions to improve gratitude in this patient population may also bring enhancement in quality of life.

The Stress and Coping Cyclical Amplification Model of Perfectionism in Illness posits, that in the context of a chronic illness, both perfectionistic strivings and concerns contribute to poor health outcomes. Similarly, person-centred models, such as the tripartite model of perfectionism, claim that high levels of both perfectionism concerns and strivings reflect an “unhealthy” perfectionism that takes a toll on well-being. To date there are few comparative tests of these models for physical and mental health outcomes in healthy versus chronically ill individuals. The aim of the current study was to investigate the implications of perfectionism for health by testing how within-person combinations of perfectionism varied in relation to health outcomes, and between fibromyalgia patients (n = 89) and healthy controls (n = 123). Supporting both models, within-person combinations of high perfectionistic strivings and concerns were associated with high stress and poor mental and physical health compared to other within-person combinations. These links were more robust for fibromyalgia patients compared to controls, and stress mediated the association with physical health outcomes only for the fibromyalgia patients. Findings support the value of taking a person-centred approach for understanding how perfectionistic strivings contributes to poor health in the context of chronic illness.