Most Fibromyalgia Treatments Not Supported by High-Quality Evidence

NEW YORK (Reuters Health) – Most therapies now available for fibromyalgia are not backed by high-quality evidence for their effectiveness in reducing pain or improving quality of life (QOL), according to a new research review.

“Out of 65 different therapies included in our review, we only found high-quality evidence supporting the effectiveness of cognitive-behavioral therapies, antidepressants and central nervous system depressants,” Dr. Vinicius Cunha Oliveira of the Universidade Federal dos Vales do Jequitinhonha e Mucuri in Diamantina, Brazil, told Reuters Health by email.

“Although the certainty about the effectiveness of these therapies is high, their effect sizes may not be clinically meaningful to patients,” he added. “It should be considered by clinicians in the decision-making process and discussed with their patients.”

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October 22, 2020October 31, 2020

Foam Rolling for Fibromyalgia

The first thing to know about foam rolling is that there are a lot of nonsensical and made up claims for it with a lot of pseudoscience. The warning is be careful what you read about the use of foam rolling by the gurus and pseudo experts. The claims that get made for the use of foam rolling are not backed up by the scientific research on it. Having said that, it is useful. Athletes use it as part of a warm-up and recovery routines. It can help for some specific conditions such as self-massage for plantar fasciitis.

It does not loosen fascia, that is impossible. Its does not release toxins – that is a claim often made by the scientifically illiterate…. and so on. Do not believe the hype.

Given the muscle pain and trigger points in fibromyalgia, can it actually help beyond the hype and personal anecdotes that surrounds its use? While the research does show some benefits in athletes and muscle aches, there is an extraordinary lack of research on its use in fibromyalgia. There is this study (in Italian) that showed that in people with fibromyalgia that the group that used the foam roller did better than the control group on measures of depression, pain, anxiety and sleep quality. So that is a good finding and does support the use of foam rolling in fibromyalgia.

By all means, please try the foam roller. It does appear that it can help. Just do not fall for the hype, marketing and pseudoscience that gets claimed for it.

All you need to do is buy a foam roller (online or at the local sports shop) and find a program (online, in books, or get a personal trainer).

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October 18, 2020October 22, 2020

Fibromyalgia and the role of brain connectivity in pain inhibition

Brain Connectivity is the essential peer-reviewed journal covering groundbreaking findings in the rapidly advancing field of connectivity research at the systems and network levels. Published 10 times per year in print and online, the Journal is under the leadership of Founding and Co-Editors-in-Chief Christopher Pawela, PhD, Assistant Professor, Medical College of Wisconsin, and Bharat Biswal, PhD, Chair of Biomedical Engineering, New Jersey Institute of Technology. It includes original peer-reviewed papers, review articles, point-counterpoint discussions on controversies in the field, and a product/technology review section. To ensure that scientific findings are rapidly disseminated, articles are published Instant Online within 72 hours of acceptance, with fully typeset, fast-track publication within 4 weeks. Tables of content and a sample issue may be viewed on the Brain Connectivity website.

Press Release:

New Rochelle, NY, October 1, 2014–The cause of fibromyalgia, a chronic pain syndrome is not known. However, the results of a new study that compares brain activity in individuals with and without fibromyalgia indicate that decreased connectivity between pain-related and sensorimotor brain areas could contribute to deficient pain regulation in fibromyalgia, according to an article published in Brain Connectivity, a peer-reviewed journal from Mary Ann Liebert, Inc., publishers. The article is available free on the Brain Connectivity website at http://online.liebertpub.com/doi/full/10.1089/brain.2014.0274 until November 1, 2014.

The new study by Pär Flodin and coauthors from Karolinska Institutet (Stockholm, Sweden) builds on previous findings in fibromyalgia that showed abnormal neuronal activity in the brain associated with poor pain inhibition. In the current study, “Fibromyalgia is Associated with Decreased Connectivity between Pain- and Sensorimotor Brain Areas”, the researchers report a pattern of “functional decoupling” between pain-related areas of the brain that process pain signals and other areas of the brain, such as those that control sensorimotor activity in fibromyalgia patients compared to healthy patients, in the absence of any external pain stimulus. As a result, normal pain perception may be impaired.

“Fibromyalgia is an understudied condition with an unknown cause that can only be diagnosed by its symptoms,” says Christopher Pawela, PhD, Co-Editor-in-Chief of Brain Connectivity and Assistant Professor, Medical College of Wisconsin. “This study by Flodin et al is an important first step in the understanding of how the brain is involved in the widespread pain perception that is characteristic of the disorder.”

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About the Journal

Brain Connectivity is the essential peer-reviewed journal covering groundbreaking findings in the rapidly advancing field of connectivity research at the systems and network levels. Published 10 times per year in print and online, the Journal is under the leadership of Founding and Co-Editors-in-Chief Christopher Pawela, PhD, Assistant Professor, Medical College of Wisconsin, and Bharat Biswal, PhD, Chair of Biomedical Engineering, New Jersey Institute of Technology. It includes original peer-reviewed papers, review articles, point-counterpoint discussions on controversies in the field, and a product/technology review section. To ensure that scientific findings are rapidly disseminated, articles are published Instant Online within 72 hours of acceptance, with fully typeset, fast-track publication within 4 weeks. Tables of content and a sample issue may be viewed on the Brain Connectivity website at http://www.liebertpub.com/brain.

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Mayo Clinic Guide to Fibromyalgia: Strategies to Take Back Your Life

Abril M.D., Andy (Author)
English (Publication Language)
272 Pages - 09/24/2019 (Publication Date) - Mayo Clinic Press (Publisher)

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October 18, 2020October 18, 2020

Foot Pain in Fibromyalgia

Like any painful problem in fibromyalgia, any pain in the foot is probably going to be more painful. What might just be a not-so-bad problem foot problem in those without fibromyalgia, in those with fibromyalgia it is a more painful problem. The reason for that is the central sensitization of the nervous system in those with fibromyalgia that amplifies the pain.

Probably the most common musculoskeletal problem of the foot is plantar fasciitis which typically causes pain under the heel that is commonly worse when getting out of bed in the morning. The cause is to much load on the plantar fascia which is a strong ligament like structure that supports the arch of the foot. Heel pain in fibromyalgia is particularly problematic, not just because of the plantar fasciitis, but also because they are susceptible to trigger or tender spots in the muscles under the arch of the foot. This probably means that the management of these sorts of problems is going to be more difficult than the typical case of plantar fasciitis.

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Mayo Clinic Guide to Fibromyalgia: Strategies to Take Back Your Life

Abril M.D., Andy (Author)
English (Publication Language)
272 Pages - 09/24/2019 (Publication Date) - Mayo Clinic Press (Publisher)

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If you have any problems related to the foot, then it is probably best to see a podiatrist for advice on which are the best options to manage the problem.

October 15, 2020October 15, 2020

Aerobic exercise and fibromyalgia

There is no doubt about this. The evidence and science is really clear on this: aerobic exercise is helpful in those with fibromyalgia and leads to significant improvements in the quality of life. There is no doubt on this and we all probably should be doing it anyway.

The nature of the aerobic exercise probably does not matter. There are plenty of options such a cycling, swimming, walking or running. Running or jogging is often the easiest as there are no constraints on when or where that you can do it. It is also the cheapest, as all you need is a good pair of running shoes. It is often best to start out with a slow walk, then as that is comfortable a fast walk, and then when that is comfortable, alternate a slow jog with walking. Only as your body get used to it should you up how fast you jog and how far you jog. The important thing is to increase distances and speed slowly and gradually.

It is also probably advisable to get advice from a physician or exercise physiologist if it has been a while since you have participated in any form of exercise.

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Mayo Clinic Guide to Fibromyalgia: Strategies to Take Back Your Life

Abril M.D., Andy (Author)
English (Publication Language)
272 Pages - 09/24/2019 (Publication Date) - Mayo Clinic Press (Publisher)

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October 13, 2020October 14, 2020

Is it gout or a fibromyalgia flare up?

The first thing you need to know about gout is that is really hurts, I mean really really hurts. A gout attack is very painful. Gout also typically and mostly affect the big toe joint of the foot. It also comes on suddenly. So if the pain you are experiencing is really bad, comes on suddenly and affects the big toe joint, then it probably gout. If it is not those things, then it is probably not gout. That does not mean that it is or is not, but its really one of probabilities, so it is probably best to get checked out by a physician if you experience this.

The flare ups that can occur in fibromyalgia do not have the same characteristics as those of gout. That does not mean that you do not have gout and if 3% of the general population have gout, then by chance 3% of those with fibromyalgia are probably going to have gout by chance. There is no evidence that gout is more common in those with fibromyalgia.

If you do have gout, then the diet is just as important as the diet for those with fibromyalgia should be. Higher urate levels are a problem in those with out. Its best to avoid foods that raise the urate levels ( eg beer, liquor, wine, potato, poultry, soft drinks, and meat) and consume more of the foods that reduce urate levels (eg eggs, peanuts, cold cereal, skimmed milk, cheese, brown bread, margarine, and non-citrus fruits).

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Mayo Clinic Guide to Fibromyalgia: Strategies to Take Back Your Life

Abril M.D., Andy (Author)
English (Publication Language)
272 Pages - 09/24/2019 (Publication Date) - Mayo Clinic Press (Publisher)

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October 10, 2020October 22, 2020

Where does the pain in fibromyalgia come from?

Those who have fibromyalgia syndrome could have an increased intramuscular pressure, which could represent a new diagnostic aid in fibromyalgia syndrome and be a target for therapy to lessen muscle pressure, based on a study just published in The Journal of Rheumatology.

“This study directs attention to a peripheral target for both diagnosis and treatment that is not routinely monitored in clinical practice; intramuscular pressure, and hopefully provides a revised roadmap for a better understanding of pain in fibromyalgia syndrome,” wrote the authors, led by Robert S. Katz M.D., of the Rush Medical College from Chicago, Illinois.

People with fibromyalgia syndrome experience chronic pain, that is thought to come about via disordered central processing. The initial drugs for this chronic pain include things like pregabalin, duloxetine and milnacipran, that are useful to relieve the assumed central nervous system effect on widespread musculoskeletal pain. In the research, they question the common model of pain in fibromyalgia syndrome, looking to demonstrate that pain over the muscles is connected to increased intramuscular pressure.

The research included 108 people who met the American College of Rheumatology (ACR) requirements for fibromyalgia syndrome and 30 people who met the ACR criteria for a different rheumatic condition. Trapezius muscle pressure was assessed and participants had dolorimetry testing, digital palpation, and documented their pain scores.

The degree of pressure within the trapezius muscle of people with fibromyalgia syndrome resting was nearly 22 mm Hg higher than the pressure of the controls, with a mean pressure of 33.48 mm Hg versus 12.23 mm Hg, respectively. In 98 % of people with fibromyalgia syndrome, a pressure reading of 23 mm Hg or higher was recorded, which is greater when compared to a normal resting value of around 8 mm Hg.

People with fibromyalgia syndrome had been more tender than controls according to both dolorimetry and digital palpation (p<0.001 for both). The average pain rating in people with fibromyalgia syndrome and people with another rheumatic disease was 6.68 and 1.43, respectively (p<0.001). The researchers mentioned that these results are in line with prior evidence showing that pain and tenderness are frequent in the trapezius muscle of people with fibromyalgia syndrome, however they recommended that this pain/pressure connection needs more research.

“This is the first evidence of an abnormality in muscle pressure in fibromyalgia syndrome,” the researchers wrote. “Methods to reduce intramuscular pressure may be therapeutic.”

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Mayo Clinic Guide to Fibromyalgia: Strategies to Take Back Your Life

Abril M.D., Andy (Author)
English (Publication Language)
272 Pages - 09/24/2019 (Publication Date) - Mayo Clinic Press (Publisher)

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August 23, 2020October 14, 2020

Study Finds a High Rate of Restless Legs Syndrome in Adults with Fibromyalgia

Press release:

DARIEN, IL – A study in the Oct. 15 issue of the Journal of Clinical Sleep Medicine found that adults with fibromyalgia had a much higher prevalence and risk of restless legs syndrome than healthy controls.

The study suggests that treating RLS may improve sleep and quality of life in people with fibromyalgia. Results show that the prevalence of restless legs syndrome was about 10 times higher in the fibromyalgia group (33 percent) than among controls (3.1 percent). After statistical adjustments for potential confounders such as age, gender and ethnicity, participants with fibromyalgia were 11 times more likely than controls to have RLS (odds ratio = 11.2). As expected, considerable sleep disruption was reported by participants with fibromyalgia using the Pittsburgh Sleep Quality Index, Insomnia Severity Index and Epworth Sleepiness Scale. In the fibromyalgia group these sleep problems were more severe among people who also had RLS. “Sleep disruption is common in fibromyalgia, and often difficult to treat,” said contributing author Dr. Nathaniel F. Watson, associate professor of neurology at the University of Washington in Seattle, Wash. “It is apparent from our study that a substantial portion of sleep disruption in fibromyalgia is due to restless legs syndrome.” The research team led by Dr. Watson and lead author Dr. Mari Viola-Saltzman of Loyola University Medical Center in Maywood, Illinois, studied 172 people with fibromyalgia who had a mean age of 50 years; 93 percent were female. They were compared with 63 healthy controls who had a mean age of 41 years.

Fibromyalgia was identified by self-report or review of the medical records, and it was confirmed on examination according to published guidelines regarding the presence of pain that is chronic and widespread. Pain was assessed by subjective report and by objective measurement with a dolorimeter, a spring-loaded gauge that is used to apply standardized rates of pressure to tender points on the arms and legs. According to the National Institute of Arthritis and Musculoskeletal and Skin Diseases, fibromyalgia can cause significant pain and fatigue. It is estimated to affect 5 million Americans age 18 or older, and between 80 and 90 percent of those diagnosed with fibromyalgia are women. The causes of fibromyalgia remain unknown.

Restless legs syndrome was diagnosed using a self-administered, validated questionnaire. RLS is a sleep-related movement disorder that involves an urge to move the legs that is usually accompanied or caused by uncomfortable and unpleasant sensations in the legs. This urge begins or worsens during periods of rest or inactivity, is partially or totally resolved by movement, and worsens or only occurs at night. RLS occurs 1.5 to two times more commonly in women than in men. Watson noted that treating restless legs syndrome may be one of the keys to reducing fatigue and improving quality of life in people with fibromyalgia. RLS often can be successfully treated with a medication such as pramipexole or ropinirole. “Since restless legs syndrome is a treatable condition, diagnosing and treating RLS in fibromyalgia patients has the potential to improve their sleep,” Watson said.

According to the authors, the cross-sectional nature of the study did not allow for an examination of causality. However, several aspects of the two syndromes suggest a logical overlap. Both disorders involve sensory abnormalities, and a similar pathophysiology of the system that regulates the neurotransmitter dopamine has been proposed for both syndromes. Furthermore, restless legs syndrome may be induced by antidepressants, which are a common treatment for pain and depression in fibromyalgia. Also, exercise has been shown to improve the symptoms of both syndromes. The study was supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases of the National Institutes of Health and by the National Fibromyalgia Research Association.

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Mayo Clinic Guide to Fibromyalgia: Strategies to Take Back Your Life

Abril M.D., Andy (Author)
English (Publication Language)
272 Pages - 09/24/2019 (Publication Date) - Mayo Clinic Press (Publisher)

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August 15, 2020October 9, 2020

Foods that might trigger Fibromyalgia

The following foods may worsen symptoms of fibromyalgia by increasing inflammation:

Sugar. Lowering or removing sugar can have a significant influence on wellness for two reasons. Initially, the clinical literature has actually shown that consuming foods high in sugar is linked to boosted fibromyalgia discomfort.

Second, limiting sugar assists control weight. Being obese puts added stress on the body, contributing to fatigue, and also kept fat might bring about inflammation in some cases. Sugar is a popular active ingredient in sweet as well as soft drinks, but is additionally in foods thought about to be healthy and balanced– such as yogurt. When inspecting nourishment tags, it is helpful to recognize that glucose, fructose, and sucrose are various other names for sugar.

Carbohydrates. Fine-tuned carbs such as cookies, several breads, breads, as well as white rice are absorbed quickly, creating blood sugar level levels to surge. The effect does not last, nonetheless, and also blood glucose quickly goes down, making the specific starving once more. These changes can make the fatigue and discomfort of fibromyalgia worse as well as contribute to overeating.

When eating carbohydrates, entire wheat resources ought to be selected. Entire wheat foods absorb a lot more slowly, preventing the highs and lows that accompany various other carbs.

One little research study focused on ladies identified with fibromyalgia that likewise had irritable digestive tract syndrome (IBS) and also a food intolerance. (Many individuals with fibromyalgia also have irritable bowel syndrome.).

When the ladies reduced on consuming a certain group of carbs, they reported a 50% reduction in short-tempered bowel signs and symptoms and a 22% decline in other signs, consisting of pain. The restricted carbohydrates were a type not well soaked up in the small intestine. Such carbohydrates include lactose (a component in milk and also other dairy products foods), fructose (in some vegetables and fruits, honey, and also various other sugar), as well as grains.

Processed foods. Sugar as well as harmful fats, which boost inflammation, are a big part of numerous processed foods. Flavors and preservatives typically utilized in processed foods likewise may set off food sensitivities.

Unhealthy fats. Veggie oils, such as corn oil, safflower oil, as well as peanut oil, have an inflammatory impact, especially when utilized to fry food. The clinical literature has actually linked deep-fried foods to aggravating of fibromyalgia signs. Harmful oils are an usual ingredient in numerous refined foods, such as cookies, doughnuts, and crackers. Pizza and cheese are additionally major resources of undesirable fats.

Alcohol. While some research study has located moderate alcohol use can reduce symptoms, some people with fibromyalgia report alcohol triggers signs to flare. Consuming alcohol while taking specific medicines prescribed for fibromyalgia– such as anti-convulsants, antidepressants, as well as acetaminophen (a component in several drugs) can create damaging interactions.

The above is not a comprehensive list of foods that may trigger symptoms. Other foods and ingredients that may trigger symptoms for some include, but are not limited to:

Gluten
Red meat
Some fruits and vegetables
Dairy products
Eggs
Caffeine

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Mayo Clinic Guide to Fibromyalgia: Strategies to Take Back Your Life

Abril M.D., Andy (Author)
English (Publication Language)
272 Pages - 09/24/2019 (Publication Date) - Mayo Clinic Press (Publisher)

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August 1, 2020October 9, 2020

Research teams find widespread inflammation in the brains of fibromyalgia patients

A study by Massachusetts General Hospital (MGH) researchers – collaborating with a team at the Karolinska Institutet in Sweden – has documented for the first time widespread inflammation in the brains of patients with the poorly understood condition called fibromyalgia. Their report has been published online in the journal Brain, Behavior and Immunity.

“We don’t have good treatment options for fibromyalgia, so identifying a potential treatment target could lead to the development of innovative, more effective therapies,” says Marco Loggia, PhD, of the MGH-based Martinos Center for Biomedical Imaging, co-senior author of the report. “And finding objective neurochemical changes in the brains of patients with fibromyalgia should help reduce the persistent stigma that many patients face, often being told their symptoms are imaginary and there’s nothing really wrong with them.”

Characterized by symptoms including chronic widespread pain, sleep problems, fatigue, and problems with thinking and memory, fibromyalgia affects around 4 million adults in the U.S., according to the Centers for Disease Control and Prevention. Previous research from the Karolinska group led by Eva Kosek, MD, PhD, co-senior author of the current study, suggested a potential role for neuroinflammation in the condition – including elevated levels of inflammatory proteins in the cerebrospinal fluid – but no previous study has directly visualized neuroinflammation in fibromyalgia patients.

A 2015 study by Loggia’s team used combined MR/PET scanning to document neuroinflammation – specifically activation of glial cells – in the brains of patients with chronic back pain. Hypothesizing that similar glial activation might be found in fibromyalgia patients as well, his team used the same PET radiopharmaceutical, which binds to the translocator protein (TSPO) that is overexpressed by activated glial cells, in their study enrolling 20 fibromyalgia patients and 14 control volunteers.

At the same time, Kosek’s team at Karolinska had enrolled a group of 11 patients and an equal number of control participants for a similar study with the TSPO-binding PET tracer. Since that radiopharmaceutical binds to two types of glial cells – microglia and astrocytes – they also imaged 11 patients, 6 who had the TSPO imaging and 5 others, and another 11 controls with a PET tracer that is thought to bind preferentially to astrocytes and not to microglia. At both centers, participants with fibromyalgia completed questionnaires to assess their symptoms. When the MGH team became aware of the similar investigation the Karolinska group had underway, the teams decided to combine their data into a single study.

The results from both centers found that glial activation in several regions of the brains of fibromyalgia patients was significantly greater than it was in control participants. Compared to the MGH team’s chronic back pain study, TSPO elevations were more widespread throughout the brain, which Loggia indicates corresponds to the more complex symptom patterns of fibromyalgia. TSPO levels in a structure called the cingulate gyrus – an area associated with emotional processing where neuroinflammation has been reported in patients with chronic fatigue syndrome – corresponded with patients reported levels of fatigue. The Karolinska team’s studies with the astrocyte-binding tracer found little difference between patients and controls, suggesting that microglia were primarily responsible for the increased neuro-inflammation in fibromyalgia patients.

“The activation of glial cells we observed in our studies releases inflammatory mediators that are thought to sensitize pain pathways and contribute to symptoms such as fatigue,” says Loggia, an assistant professor of Radiology at Harvard Medical School. “The ability to join forces with our colleagues at Karolinska was fantastic, because combining our data and seeing similar results at both sites gives confidence to the reliability of our results.”

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Mayo Clinic Guide to Fibromyalgia: Strategies to Take Back Your Life

Abril M.D., Andy (Author)
English (Publication Language)
272 Pages - 09/24/2019 (Publication Date) - Mayo Clinic Press (Publisher)

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Fibromyalgia Latest

Posts

Most Fibromyalgia Treatments Not Supported by High-Quality Evidence

Foam Rolling for Fibromyalgia

Fibromyalgia and the role of brain connectivity in pain inhibition

Foot Pain in Fibromyalgia

Aerobic exercise and fibromyalgia

Is it gout or a fibromyalgia flare up?

Where does the pain in fibromyalgia come from?

Study Finds a High Rate of Restless Legs Syndrome in Adults with Fibromyalgia

Foods that might trigger Fibromyalgia

Research teams find widespread inflammation in the brains of fibromyalgia patients