Fibromyalgia Impact Questionnaire (FIQ) References with Abstracts from 1991 to 2006

       (1)    Havermark AM, Langius-Eklof A. Long-term follow up of a physical therapy programme for patients with fibromyalgia syndrome. Scand J Caring Sci 2006; 20(3):315-322.
Abstract: The purpose of this study was to evaluate, in a long-term perspective, the impact of a physical therapy-based educational programme on patients with fibromyalgia syndrome (FMS). The programme includes information about the syndrome, information about pain and muscle physiology, training in warm water, stretching, body awareness therapy and relaxation in groups of 15 patients twice weekly, 2 hours during 10 weeks. A total of 240 patients with FMS participated in the study before and immediately after the programme and at a follow up with a mean of 35 months after the programme. Health status as measured with the Fibromyalgia Impact Questionnaire was answered by the patients at all three measurement points. Questionnaires concerning self-care, self-motivation and sense of coherence (SOC) were distributed at the follow up. The results showed a significant improvement on several symptoms when comparing before and after the programme, and at the time of follow up the patients' rated well-being was still improved. The results also showed that the patients' pretreatment perception of symptoms, well-being and SOC are predictors to the perception of general health at the follow up of a physical therapy programme. The conclusion is that a physical therapy programme for patients with FMS may have a positive impact on patients' general well-being but not on other symptoms

       (2)    Birtane M, Uzunca K, Tastekin N, Tuna H. The evaluation of quality of life in fibromyalgia syndrome: a comparison with rheumatoid arthritis by using SF-36 Health Survey. Clin Rheumatol 2006; .
Abstract: Musculoskeletal disorders are the most common causes of deterioration in quality of life (QOL). We in this study aimed to assess (1) the impact of fibromyalgia syndrome (FS) on QOL comparing with that of rheumatoid arthritis (RA) patients and control subjects and (2) the impact of these two musculoskeletal disorders on various components of QOL using SF-36 Health Survey. Thirty-five patients with RA, 30 patients with FS, and 30 voluntary control subjects were included in the study. The groups were comparable in terms of demographic characteristics. QOL was evaluated by using Short-Form (SF)-36 Health Survey in all study participants, and Fibromyalgia Impact Questionnaire (FIQ), which is a specific health-status instrument for FS, was used in FS patients. Physical functioning, physical role, social functioning, bodily pain, general health, vitality, emotional role, and mental health scores were significantly lower in RA and FS patients than in control subjects (p<0.05). The between-groups comparisons revealed that FS patients had significantly lower mental health scores than RA patients (49.87 vs 62.51, respectively), (p<0.001). Total  FIQ score correlated significantly with physical functioning, physical role, and bodily pain in FS patients. All parameters of SF-36 Health Survey except for social functioning correlated significantly with some of the variables of FIQ. FS has a negative impact on QOL, like RA. Furthermore, mental health was more severely affected in FS patients when compared with RA patients

       (3)    Eksioglu E, Yazar D, Bal A, Usan HD, Cakci A. Effects of Stanger bath therapy on fibromyalgia. Clin Rheumatol 2006; .
Abstract: The purpose of this study was to assess the effectiveness of Stanger bath on the treatment of fibromyalgia (FM). Fifty women with FM were randomly divided into two groups. The first group (n=25) was treated with amitriptyline, 10 mg/day for 8 weeks, and Stanger bath, 20 min daily for ten sessions. The second group (n=25) only had amitriptyline, 10 mg/day for 8 weeks. In the first group the assessment parameters were measured before (t1), at the end (t2), and 2 months after the hydrotherapy (t3). In the second group these parameters were examined before (T1) and 2 months after the treatment (T2). Patients were evaluated by number of tender points and Fibromyalgia Impact Questionnaire (FIQ) scores. There was significant improvement in number of tender points between t1 and t2 (P<0.01) and t1 and t3 (P<0.001) in the Stanger bath group. In addition, there was significant improvement in FIQ scores between t1 and t2 (P<0.001) and t1 and t3 (P<0.01) in the Stanger bath group. In the second group we observed significant improvement in FIQ scores and tender point numbers between T1 and T2 (P=0.00). We did not find any difference between groups in tender point number percent change (p=0.074). However, we observed statistically significant improvement in percent change of FIQ scores in Stanger bath group (-30+/-16.7) when compared to group 2 (-19.3+/-13) (p=0.016). We conclude that Stanger bath therapy when combined with amitriptyline has a long lasting effect and better outcome in FM patients

       (4)    Lee SS, Yoon HJ, Park YW. Antipolymer antibody is not associated with fibromyalgia in Korean female patients. Rheumatol Int 2006; .
Abstract: To examine the levels of antipolymer antibody (APA) in Korean female patients with fibromyalgia (FM) and to determine whether the levels of APA correlate with FM severity. Serum samples from patients with FM (n = 69), patients with rheumatoid arthritis (RA) (n = 71), and controls (n = 75) were assayed for APA. All of the subjects were female, and the controls were age-matched healthy volunteers. FM tender point counts and scores were examined, and FM patients were asked to complete a Korean version of the Fibromyalgia Impact Questionnaire (FIQ), the State-Trait Anxiety Inventory (STAI), and the Beck Depression Inventory (BDI). APA-positive samples were detected in five (7.2%) of the 69 FM patients, seven (9.9%) of the 71 RA patients, and four (5.3%) of the 75 controls. The prevalence of seropositivity and the level of APA in FM patients did not differ from those in RA patients and controls. The proportion positive for APA was not higher for FM patients with severe symptoms than for FM patients with mild symptoms. There was a negative association between the APA level and age. The APA level in FM patients was not correlated with age at diagnosis, age at symptom onset, disease duration, education, tender point counts and scores, FIQ, STAI, or BDI. The prevalence of APA in Korean FM patients was quite low. Owing to the low prevalence of APA in this study, the APA assay did not distinguish FM patients with severe symptoms from those with mild symptoms

       (5)    Hidalgo J, Rico-Villademoros F, Calandre EP. An open-label study of quetiapine in the treatment of fibromyalgia. Prog Neuropsychopharmacol Biol Psychiatry 2006; .
Abstract: The aim of this exploratory study was to systematically assess the potential effectiveness and tolerability of quetiapine, an atypical antipsychotic, for the treatment of patients with fibromyalgia. This was a unicentre, open-label study conducted in thirty-five outpatients, 18 years or older, who met the ACR criteria for fibromyalgia and who had not satisfactorily responded to their previous fibromyalgia treatment. Quetiapine, flexibly dosed (25-100 mg/day), was added to their original treatment regimen for 12 weeks. The primary outcome measure was the mean change from baseline to endpoint in the Fibromyalgia Impact Questionnaire (FIQ) total score. Secondary efficacy measures included mean changes from baseline to endpoint in the scores of the Clinical Global Impression (CGI) of Severity scale, Pittsburgh Sleep Quality Index (PSQI), Beck Depression Inventory (BDI), State-Trait Anxiety Inventory (STAI), 12-Item Short Form Health Survey (SF-12), and individual items of the FIQ. Thirty (85.7%) patients (mean age 47+/-7.9, 93.3% females) had a postbaseline evaluation and constituted the intent-to-treat efficacy sample. Mean FIQ total score decreased significantly by 10.2 points from a baseline of 63.2 to 53.0 at study endpoint (p<0.001). A statistically significant reduction was observed in FIQ stiffness and FIQ fatigue subscores but not in FIQ pain subscore. Large effect sizes were observed for the FIQ total (1.04), CGI-severity (1.00) and PSQI (1.07), while moderate effect sizes (i.e.>/=0.50) were encountered in the FIQ fatigue, FIQ stiffness and SF-12 mental component summary. Quetiapine was safely administered and well tolerated. Despite the lack of effect on pain, the significant and relevant improvement in overall efficacy measures and quality of life suggests that quetiapine may be a valuable drug for treatment of patients with fibromyalgia that should be further tested in double-blind, placebo-controlled trials

       (6)    Wennemer HK, Borg-Stein J, Gomba L, Delaney B, Rothmund A, Barlow D et al. Functionally oriented rehabilitation program for patients with fibromyalgia: preliminary results. Am J Phys Med Rehabil 2006; 85(8):659-666.
Abstract: OBJECTIVE: To evaluate function and disability in patients with fibromyalgia before and after participation in a functionally oriented, multidisciplinary, 8-wk treatment program. DESIGN: A total of 23 patients who met American College of Rheumatology criteria for the diagnosis of fibromyalgia were enrolled in the study. Outcome measures included: range of motion, 6-min walk test, a modified Fibromyalgia Impact Questionnaire, a modified SF-36 Physical Functioning Scale, and the Fibromyalgia Health Assessment Questionnaire. Pretreatment and posttreatment scores were analyzed using paired t tests. RESULTS: All subjects completed the program, and there were no reported injuries. Three subjects failed to complete the survey instruments at the conclusion of the study. Intention to treat analysis including these subjects was carried out but did not significantly change results. For the remaining subjects (n = 20), a significant improvement was found on the Physical Functioning Scale (P = 0.01). Trends toward improvement on the Fibromyalgia Impact Questionnaire (P = 0.40) and Fibromyalgia Health Assessment Questionnaire (P = 0.14) were seen but did not achieve statistical significance. Range of motion testing revealed significant improvements in lumbar spine extension (P < 0.001), straight-leg raise (P < 0.001), cervical spine flexion (P < 0.01), cervical spine rotation (P < 0.05), and cervical spine side bending (P < 0.05). Distance traveled during the 6-min walk test increased significantly (P < 0.01), whereas perceived exertion as measured by the Borg scale did not change. There were no injuries or other adverse consequences of the program. CONCLUSIONS: This study utilized multiple functional outcome measures to demonstrate improved function and decreased disability in patients with fibromyalgia. Our patients reported significantly improved physical function after participation in the 8-wk intensive multidisciplinary treatment program. This progressive, functionally based exercise training program was well tolerated by all participants and outlines an effective exercise prescription for patients with fibromyalgia. Fibromyalgia patients in this study responded favorably to a treatment program that focused on function instead of pain

       (7)    Armstrong DJ, Meenagh GK, Bickle I, Lee AS, Curran ES, Finch MB. Vitamin D deficiency is associated with anxiety and depression in fibromyalgia. Clin Rheumatol 2006; %19;.
Abstract: Fibromyalgia is a complex problem in which symptoms of anxiety and depression feature prominently. Low levels of vitamin D have been frequently reported in fibromyalgia, but no relationship was demonstrated with anxiety and depression. Seventy-five Caucasian patients who fulfilled the ACR criteria for fibromyalgia had serum vitamin D levels measured and completed the Fibromyalgia Impact Questionnaire (FIQ) and Hospital Anxiety and Depression Score (HADS). Deficient levels of vitamin D was found in 13.3% of the patients, while 56.0% had insufficient levels and 30.7% had normal levels. Patients with vitamin D deficiency (<25 nmol/l) had higher HADS [median, IQR, 31.0 (23.8-36.8] than patients with insufficient levels [25-50 nmol/l; HADS 22.5 (17.0-26.0)] or than patients with normal levels [50 nmol/l or greater; HADS 23.5 (19.0-27.5); Kruskal-Wallis ANOVA on ranks p<0.05]. There was no relationship with global measures of disease impact or musculoskeletal symptoms. Vitamin D deficiency is common in fibromyalgia and occurs more frequently in patients with anxiety and depression. The nature and direction of the causal relationship remains unclear, but there are definite implications for long-term bone health

       (8)    Schley M, Legler A, Skopp G, Schmelz M, Konrad C, Rukwied R. Delta-9-THC based monotherapy in fibromyalgia patients on experimentally induced pain, axon reflex flare, and pain relief. Curr Med Res Opin 2006; 22(7):1269-1276.
Abstract: OBJECTIVE: Fibromyalgia (FM) is a chronic pain syndrome characterized by a distinct mechanical hyperalgesia and chronic pain. Recently, cannabinoids have been demonstrated as providing anti-nociceptive and anti-hyperalgesic effects in animal and human studies. Here, we explored in nine FM patients the efficacy of orally administered delta-9-tetrahydrocannabinol (THC) on electrically induced pain, axon reflex flare, and psychometric variables. RESEARCH DESIGN AND METHods: Patients received a daily dose of 2.5-15 mg of delta-9-THC, with a weekly increase of 2.5 mg, as long as no side effects were reported. Psychometric variables were assessed each week by means of the West Haven-Yale Multidimensional Pain Inventory (MPI), Pittsburgh Sleep Quality Index (PSQI), Medical outcome survey-short form (MOS SF-36), the Pain Disability Index (PDI), and the Fibromyalgia Impact Questionnaire (FIQ). In addition, patients recorded daily, in a diary, their overall pain intensity on a numeric scale. Each week, pain and axon reflex flare was evoked experimentally by administration of high intensity constant current pulses (1 Hz, pulse width 0.2 ms, current increase stepwise from 2.5-12.5 mA every 3 minutes) delivered via small surface electrodes, attached to the volar forearm skin. MAIN OUTCOME MEASURES: Daily pain recordings by the patient, experimentally induced pain, and axon reflex flare recorded by a laser Doppler scanner. RESULTS: Five of nine FM patients withdrew during the study due to adverse side effects. Delta-9-THC had no effect on the axon reflex flare, whereas electrically induced pain was significantly attenuated after doses of 10-15 mg delta-9-THC (p < 0.05). Daily-recorded pain of the FM patients was significantly reduced (p < 0.01). CONCLUSIONS: This pilot study demonstrated that a generalized statement that delta-9-THC is an analgetic drug cannot be made. However, a sub-population of FM patients reported significant benefit from the delta-9-THC monotherapy. The unaffected electrically induced axon reflex flare, but decreased pain perception, suggests a central mode of action of the cannabinoid

       (9)    Bazzichi L, Giannaccini G, Betti L, Mascia G, Fabbrini L, Italiani P et al. Alteration of serotonin transporter density and activity in fibromyalgia. Arthritis Res Ther 2006; 8(4):R99.
Abstract: ABSTRACT : The aim of the study was to evaluate the kinetic parameters of a specific serotonin transporter (SERT) and serotonin uptake in a mentally healthy subset of patients with fibromyalgia. Platelets were obtained from 40 patients and 38 healthy controls. SERT expression and functionality were evaluated through the measurement of [3H]paroxetine binding and the [3H]serotonin uptake itself. The values of maximal membrane binding capacity (Bmax) were statistically lower in the patients than in the healthy volunteers, whereas the dissociation constant (Kd) did not show any statistically significant variations. Moreover, a decrease in the maximal uptake rate of SERT (Vmax) was demonstrated in the platelets of patients, whereas the Michaelis constant (Km) did not show any statistically significant variations. Symptom severity score (tiredness, tender points index and Fibromyalgia Impact Questionnaire) were negatively correlated with Bmax and with Vmax, and positively correlated with Km. A change in SERT seems to occur in fibromyalgic patients, and it seems to be related to the severity of fibromyalgic symptoms

     (10)    Martin DP, Sletten CD, Williams BA, Berger IH. Improvement in fibromyalgia symptoms with acupuncture: results of a randomized controlled trial. Mayo Clin Proc 2006; 81(6):749-757.
Abstract: OBJECTIVE: To test the hypothesis that acupuncture improves symptoms of fibromyalgia. PATIENTS AND METHODS: We conducted a prospective, partially blinded, controlled, randomized clinical trial of patients receiving true acupuncture compared with a control group of patients who received simulated acupuncture. All patients met American College of Rheumatology criteria for fibromyalgia and had tried conservative symptomatic treatments other than acupuncture. We measured symptoms with the Fibromyalgia Impact Questionnaire (FIQ) and the Multidimensional Pain Inventory at baseline, immediately after treatment, and at 1 month and 7 months after treatment. The trial was conducted from May 28, 2002, to August 18, 2003. RESULTS: Fifty patients participated in the study: 25 in the acupuncture group and 25 in the control group. Total fibromyalgia symptoms, as measured by the FIQ, were significantly improved in the acupuncture group compared with the control group during the study period (P = .01). The largest difference in mean FIQ total scores was observed at 1 month (42.2 vs 34.8 in the control and acupuncture groups, respectively; P = .007). Fatigue and anxiety were the most significantly improved symptoms during the follow-up period. However, activity and physical function levels did not change. Acupuncture was well tolerated, with minimal adverse effects. CONCLUSION: This study paradigm allows for controlled and blinded clinical trials of acupuncture. We found that acupuncture significantly improved symptoms of fibromyalgia. Symptomatic improvement was not restricted to pain relief and was most significant for fatigue and anxiety

     (11)    Zijlstra TR, Taal E, van de Laar MA, Rasker JJ. Validation of a Dutch translation of the fibromyalgia impact questionnaire. Rheumatology (Oxford) 2006; .
Abstract: Objectives. To validate a Dutch translation of the fibromyalgia impact questionnaire (FIQ). Materials and methods. Data were taken from two randomized clinical trials on Spa treatment and venlafaxine in fibromyalgia (FM). Participants completed the Dutch FIQ and a set of validated questionnaires for general health (RAND-36), depression (Beck depression inventory, BDI), pain (McGill pain questionnaire, MPQ) and fatigue (checklist individual strength, CIS). Internal consistency within the FIQ item 'physical functioning' was studied using Cronbach's alpha. Test-retest reliability was studied with intra-class-correlation (ICC) in a subsample of 76 control subjects over a 3 month period without specific intervention. Construct validity was evaluated by correlating the FIQ to other questionnaires. Sensitivity to change was studied using standardized response means (SRM). Results. The study sample consisted of 213 women and 11 men (mean age 47 yrs, mean disease duration 11 yrs). Cronbach's alpha for the item 'physical functioning' was 0.91, indicating high internal consistency. Test-retest reliability was acceptable, with ICC ranging from 0.45 for 'morning tiredness' to 0.71 for 'physical function'. FIQ correlated significantly with the RAND-36, with Spearman's rho ranging from -0.60 to -0.70 for items measuring the same concept. Similar patterns of correlation were seen with MPQ, BDI and CIS. Sensitivity to change was sufficient, with SRM after Spa treatment ranging from 0.3 for 'work days missed' to 0.9 for 'days felt good'. Similar SRM were found in the venlafaxine trial for patients reporting general improvement. Conclusion. The Dutch FIQ is a valid instrument for measuring health status in FM, showing sufficient reliability, construct validity and responsiveness

     (12)    Fengler RK, Jacobs JW, Bac M, van Wijck AJ, van Meeteren NL. Action potential simulation (APS) in patients with fibromyalgia syndrome (FMS): a controlled single subject experimental design. Clin Rheumatol 2006; .
Abstract: OBJECTIVES: Action potential simulation (APS) is becoming a popular method of pain reduction. Nevertheless, little is known about the efficacy of this relatively new treatment. The aim of this study was to investigate whether APS helps to reduce pain, improves patients' perception of daily functioning and social participation in patients with fibromyalgia syndrome (FMS). MATERIALS AND METHODS: Ten patients with FMS according to the American College of Rheumatology (ACR) criteria entered this double blind crossover single-case study. In a period of 20 weeks, the patients underwent two treatment periods of 4 weeks, one with verum and one with placebo, at random, in a double blind fashion. Outcome measures were evaluated on a weekly basis. Primary outcome measure was pain measured with the Fibromyalgia Impact Questionnaire (FIQ) questions 4 and 5, the number of tender points and the total tender point pain intensity score. Both visual inspection and statistical analysis were done to analyse the data from this single-subject design. RESULTS: Performing visual inspection and statistical analysis, no positive results of the APS treatment were found in this study. Remarkable is the fact that placebo APS had significantly better results than verum APS. CONCLUSIONS: In this single-case study with ten patients (all female), APS was not a helpful method to reduce pain, to improve patients' perception of daily functioning and social participation in patients with FMS

     (13)    Unlu E, Ulas UH, Gurcay E, Tuncay R, Berber S, Cakci A et al. Genital sympathetic skin responses in fibromyalgia syndrome. Rheumatol Int 2006; %20;.
Abstract: The study was designed to investigate the autonomic dysfunction in fibromyalgia syndrome (FMS) by recording sympathetic skin response (SSR) from palmar, plantar and genital regions. The second aim was to evaluate the relation between sexual problems and autonomic dysfunction in FMS. SSR potential was recorded from palmar, plantar and genital regions in 28 married, female FMS patients and 18 married, healthy females. Fibromyalgia Impact Questionnaire (FIQ) was used to show the clinical severity and functional disability in FMS patients. Glombok Rust Inventory of Sexual Satisfaction (GRISS), a 28-item questionnaire, was used to assess the existence and severity of sexual problems. Beck test was used to evaluate anxiety and depression. The amplitude of SSR recorded from palmar, plantar and genital regions was lower than in the control subjects (P < 0.05). GRISS (total and subscale), Beck test and FIQ scores of FMS patients were higher than in the control subjects (P < 0.05). No correlation was found between the SSR potential and GRISS scores. The results of our study reveal that abnormality in SSR recorded from palmar, plantar and genital regions reflects the abnormality in the autonomic nervous system (ANS) of FMS patients. These patients have more sexual problems than healthy subjects, and we think this finding is related to increased anxiety and depression in these patients

     (14)    Singh BB, Wu WS, Hwang SH, Khorsan R, Der-Martirosian C, Vinjamury SP et al. Effectiveness of acupuncture in the treatment of fibromyalgia. Altern Ther Health Med 2006; 12(2):34-41.
Abstract: CONTEXT: Fibromyalgia syndrome (FMS) is a prevalent musculoskeletal disorder associated with pain, mood state alteration, and disability. A structured and effective treatment plan for palliative care has not been established. The genesis of FMS is not clear. FMS occurs primarily in adult women. DESIGN: Using a quasi-experimental clinical design and following the criteria of the American College of Rheumatology (ACR), for FMS, 21 participants completed the study. The mean age was 53.6 years. The data were collected at baseline and at 1 and 2 months. Acupuncture treatments included 17 points for FMS symptoms, and 8 outcome measures were collected. RESULTS: The Fibromyalgia Impact Questionnaire (FIQ) showed significant differences at 1 and 2 months. For the SF-12, 3 subscales showed significant differences between baseline and 2 months. Four of 6 items were significantly changed. The mean number of general health symptoms was significantly decreased by 2 months. For the Catastrophe Index, significant differences were found for baseline vs 2 months. Pain threshold scores were significantly different at end of treatment for 5 bilateral tender points. There was significant improvement in Beck Depression items for both 1- and 2-month periods. In a multivariate regression model, 5 covariates were included--age, number of weeks in treatment, number of doctors treating, number of general symptoms, and baseline FIQ score. The results indicated significant age effect. This analysis showed that the higher the FIQ score, the more positive the change experienced by study participants. Number of weeks in treatment, number of doctors who treated, and total number of general health symptoms did not have a significant effect on outcomes. CONCLUSIONS: Significant improvement was experienced by participants at 8 weeks of treatment. Acupuncture treatment as delivered was effective at reducing FMS symptoms in this outcome study

     (15)    Pamuk ON, Cakir N. The frequency of thyroid antibodies in fibromyalgia patients and their relationship with symptoms. Clin Rheumatol 2006; .
Abstract: We determined the frequency of thyroid autoantibodies in fibromyalgia (FM) patients and the relationship between FM symptoms and these antibodies. Euthyroid 128 FM patients, 64 rheumatoid arthritis (RA) patients, and 64 healthy control subjects were included in the study. The sociodemographic features and the clinical features of FM patients were determined. By using a visual analog scale, patients were questioned about the severity of FM-related symptoms. All patients were administered with Duke-Anxiety Depression (Duke-AD) scale, the physical function items of the fibromyalgia impact questionnaire scale. Thyroid autoimmunity was defined as the presence of detectable antithyroglobulin (TgAb) and/or antithyroid peroxidase (TPOAb) antibodies by the immunometric methods. Patients with a connective tissue disorder, hypo- or hyperthyroidism, and patients who had psychiatric treatment within the last 6 months were not included into the study. The frequencies of thyroid autoimmunity in FM (34.4%) and RA (29.7%) patients were significantly higher than controls (18.8%) (p<0.05). Twenty-six (20.3%) FM patients had positive TgAb and 31 (24.2%) had positive TPOAb. When patients with thyroid autoimmunity were compared to others, it was seen that the mean age, the percentage of postmenopausal patients, the frequency of dryness of the mouth, and the percentage of patients with a previous psychiatric treatment were higher in this group (p<0.05). FM patients had thyroid autoimmunity similar to the frequency in RA and higher than controls. Age and postmenopausal status seemed to be associated with thyroid autoimmunity in FM patients. The presence of thyroid autoimmunity had no relationship with the depression scores of FM patients

     (16)    Garcia-Campayo J, Pascual A, Alda M, Marzo J, Magallon R, Fortes S. The Spanish version of the FibroFatigue Scale: validation of a questionnaire for the observer's assessment of fibromyalgia and chronic fatigue syndrome. Gen Hosp Psychiatry 2006; 28(2):154-160.
Abstract: OBJECTIVE: To examine some of the psychometric properties of the Spanish version of the FibroFatigue Scale (FFS). METHODS: FFS was administered to 120 patients diagnosed with fibromyalgia and chronic fatigue syndrome. Internal consistency was evaluated by using Cronbach's alpha, test-retest reliability with weighted kappa and construct validity by correlations among FFS, the Fibromyalgia Impact Questionnaire (FIQ), the EuroQol 5D (EQ-5D) and the Hospital Anxiety and Depression Scale (HADS). The interrater reliability was tested using analysis of variance with patients and raters as independent factors. RESULTS: Internal consistency (alpha) was .88, test-retest reliability was .91, and interrater reliability was .93. Significant correlations were obtained between overall FFS and the FIQ (.55, P<.01), the EQ-5D (-.48, P<.01) and the HADS depression subscale (.25, P<.01), but not with the HADS anxiety subscale. CONCLUSION: These results support the reliability and validity of the data obtained with the Spanish version of the FSS

     (17)    Menzies V, Taylor AG, Bourguignon C. Effects of guided imagery on outcomes of pain, functional status, and self-efficacy in persons diagnosed with fibromyalgia. J Altern Complement Med 2006; 12(1):23-30.
Abstract: OBJECTIVES: (1) To investigate the effects of a 6-week intervention of guided imagery on pain level, functional status, and self-efficacy in persons with fibromyalgia (FM); and (2) to explore the dose-response effect of imagery use on outcomes. DESIGN: Longitudinal, prospective, two-group, randomized, controlled clinical trial. SETTING AND SUBJECTS: The sample included 48 persons with FM recruited from physicians' offices and clinics in the mid-Atlantic region. INTERVENTION: Participants randomized to Guided Imagery (GI) plus Usual Care intervention group received a set of three audiotaped guided imagery scripts and were instructed to use at least one tape daily for 6 weeks and report weekly frequency of use (dosage). Participants assigned to the Usual Care alone group submitted weekly report forms on usual care. MEASURES: All participants completed the Short-Form McGill Pain Questionnaire (SF-MPQ), Arthritis Self- Efficacy Scale (ASES), and Fibromyalgia Impact Questionnaire (FIQ), at baseline, 6, and 10 weeks, and submitted frequency of use report forms. RESULTS: FIQ scores decreased over time in the GI group compared to the Usual Care group (p = 0.03). Ratings of self-efficacy for managing pain (p = 0.03) and other symptoms of FM also increased significantly over time (p = < 0.01) in the GI group compared to the Usual Care group. Pain as measured by the SF-MPQ did not change over time or by group. Imagery dosage was not significant. CONCLUSIONS: This study demonstrated the effectiveness of guided imagery in improving functional status and sense of self-efficacy for managing pain and other symptoms of FM. However, participants' reports of pain did not change. Further studies investigating the effects of mind-body interventions as adjunctive self-care modalities are warranted in the fibromyalgia patient population

     (18)    Assis MR, Silva LE, Alves AM, Pessanha AP, Valim V, Feldman D et al. A randomized controlled trial of deep water running: clinical effectiveness of aquatic exercise to treat fibromyalgia. Arthritis Rheum 2006; 55(1):57-65.
Abstract: OBJECTIVE: To compare the clinical effectiveness of aerobic exercise in the water with walking/jogging for women with fibromyalgia (FM). METHODS: Sixty sedentary women with FM, ages 18-60 years, were randomly assigned to either deep water running (DWR) or land-based exercises (LBE). Patients were trained for 15 weeks at their anaerobic threshold. Visual analog scale of pain, Fibromyalgia Impact Questionnaire (FIQ), Beck Depression Inventory, Short Form 36 Health Survey (SF-36), and a patient's global assessment of response to therapy (PGART) were measured at baseline, week 8, and week 15. Statistical analysis included all patients. RESULTS: Four patients dropped out from each group. Both groups improved significantly at week 15 compared with baseline, with an average 36% reduction in pain intensity. For PGART, 40% of the DWR group and 30% of the LBE group answered "much better" at posttreatment. FIQ total score and FIQ depression improvements in the DWR group were faster (week 8) than the LBE group and kept improving (week 15; P < 0.05). Only the DWR group showed improvements in SF-36 role emotional (P = 0.006). No significant between-group differences were observed for peak oxygen uptake and other outcomes. CONCLUSION: DWR is a safe exercise that has been shown to be as effective as LBE regarding pain. However, it has been shown to bring more advantages related to emotional aspects. Aerobic gain was similar for both groups, regardless of symptom improvement. Therefore, DWR could be studied as an exercise option for patients with FM who have problems adapting to LBE or lower limbs limitations

     (19)    Mannerkorpi K, Svantesson U, Broberg C. Relationships between performance-based tests and patients' ratings of activity limitations, self-efficacy, and pain in fibromyalgia. Arch Phys Med Rehabil 2006; 87(2):259-264.
Abstract: OBJECTIVE: To investigate the relationship between performance-based tests, ratings of activity limitations, self-efficacy, and pain in fibromyalgia. DESIGN: Descriptive. SETTING: University hospital. PARTICIPANTS: Sixty-nine women with fibromyalgia (mean age, 45+/-7.8y). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The patients completed 4 performance-based tests focusing on muscle power function and 3 unloaded arm movements. The patients rated their activity limitations by means of the subscales of physical function (PF) and pain on the Fibromyalgia Impact Questionnaire (FIQ), the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36), and the Arthritis Self-Efficacy Scale (ASES). Spearman correlation coefficient (rho) and multivariate regression analysis were conducted. RESULTS: The highest correlations were found between the 6-minute walk test (6MWT) (rho range, -.48 to .68) and the activity limitations and between hand grip strength (rho range, -.34 to .57) and the activity limitations. The regression analysis indicated that hand grip strength explained 25% of the variation in the SF-36 PF scale. The 6MWT plus endurance of the shoulder muscles explained 24% of the variation in the FIQ PF scale and the 6MWT plus active abduction of the shoulder explained 48% of the variation in the ASES function scale. Correlations between the performance-based tests and the activity limitations tended to be higher than those between performance and pain. CONCLUSIONS: The majority of the performance-based tests and the patients' subjective ratings of activity limitations showed significant relationships. The 6MWT and hand grip strength, reflecting activity limitations in the SF-36, FIQ, and ASES, are recommended for use in clinical research and in the clinical examination when planning treatment for patients with fibromyalgia

     (20)    Gordon C, Emiliozzi C, Zartarian M. Use of a mechanical massage technique in the treatment of fibromyalgia: a preliminary study. Arch Phys Med Rehabil 2006; 87(1):145-147.
Abstract: OBJECTIVE: To investigate how a mechanical massage technique (LPG technique) could contribute to the treatment of fibromyalgia. DESIGN: Feasibility study. SETTING: A single center. PARTICIPANTS: Ten women having a preexisting diagnosis of fibromyalgia based on American College of Rheumatology criteria were enrolled. INTERVENTION: Subjects received a total of 15 sessions of mechanical massage administered by a physical therapist once a week. MAIN OUTCOME MEASURES: The Fibromyalgia Impact Questionnaire and a physical examination scoring tender points (number, pain intensity). Evaluations were conducted at the screening visit, after 7 sessions (V7), and after completion of 15 sessions (V15). RESULTS: Most of the parameters (pain intensity, physical function, number of tender points) showed a significant improvement at V15 compared with screening. CONCLUSIONS: The findings suggest the possibility that the studied intervention might be associated with positive outcomes in women with fibromyalgia, and support the need for a controlled clinical trial to determine its efficacy

     (21)    Arnold LM, Rosen A, Pritchett YL, D'Souza DN, Goldstein DJ, Iyengar S et al. A randomized, double-blind, placebo-controlled trial of duloxetine in the treatment of women with fibromyalgia with or without major depressive disorder. Pain 2005; 119(1-3):5-15.
Abstract: This was a 12-week, randomized, double-blind, placebo-controlled trial to assess the efficacy and safety of duloxetine, a selective serotonin and norepinephrine reuptake inhibitor, in 354 female patients with primary fibromyalgia, with or without current major depressive disorder. Patients (90% Caucasian; mean age, 49.6 years; 26% with current major depressive disorder) received duloxetine 60 mg once daily (QD) (N=118), duloxetine 60 mg twice daily (BID) (N=116), or placebo (N=120). The primary outcome was the Brief Pain Inventory average pain severity score. Response to treatment was defined as >or=30% reduction in this score. Compared with placebo, both duloxetine-treated groups improved significantly more (P<0.001) on the Brief Pain Inventory average pain severity score. A significantly higher percentage of duloxetine-treated patients had a decrease of >or=30% in this score (duloxetine 60 mg QD (55%; P<0.001); duloxetine 60 mg BID (54%; P=0.002); placebo (33%)). The treatment effect of duloxetine on pain reduction was independent of the effect on mood and the presence of major depressive disorder. Compared with patients on placebo, patients treated with duloxetine 60 mg QD or duloxetine 60 mg BID had significantly greater improvement in remaining Brief Pain Inventory pain severity and interference scores, Fibromyalgia Impact Questionnaire, Clinical Global Impression of Severity, Patient Global Impression of Improvement, and several quality-of-life measures. Both doses of duloxetine were safely administered and well tolerated. In conclusion, both duloxetine 60 mg QD and duloxetine 60 mg BID were effective and safe in the treatment of fibromyalgia in female patients with or without major depressive disorder

     (22)    Brautbar A, Elstein D, Pines B, Krienen N, Hemmer J, Buskila D et al. Fibromyalgia and Gaucher's disease. QJM 2006; 99(2):103-107.
Abstract: BACKGROUND: Patients with symptomatic Gaucher's disease sometimes have non-specific symptoms (such as general malaise with widespread musculoskeletal pains) that respond poorly to enzyme replacement treatment. These may indicate fibromyalgia syndrome; if so, other therapeutic options might be more appropriate. AIM: To identify patients with Gaucher's disease for whom fibromyalgia-specific therapy may be therapeutic. DESIGN: Questionnaire-based survey. METHODS: Adult patients (n = 109) with non-neuronopathic Gaucher's disease and adult healthy controls (n = 108) completed health-related questionnaires including the Fibromyalgia Impact Questionnaire, and underwent testing with a dolorimeter to ascertain sensitivity at 22 tender points. RESULTS: Six patients, but no controls, met the criteria for fibromyalgia. Patients with fibromyalgia had a significantly greater incidence of co-morbidities (p = 0.014) relative to other patients with Gaucher's disease; four suffered from bone involvement and were receiving enzyme therapy, but two were untreated. DISCUSSION: The presence of fibromyalgia-specific trigger points may result from multiple aetiologies, or may be an independently-sorting predisposition. Our findings cannot distinguish between these possibilities, but if fibromyalgia were the cause, enzyme replacement therapy would be expensive and inappropriate

     (23)    Ozgocmen S, Ozyurt H, Sogut S, Akyol O, Ardicoglu O, Yildizhan H. Antioxidant status, lipid peroxidation and nitric oxide in fibromyalgia: etiologic and therapeutic concerns. Rheumatol Int 2006; 26(7):598-603.
Abstract: We proposed to assess the oxidant/antioxidant status, lipid peroxidation and nitric oxide (NO) in untreated fibromyalgia (FM) patients and controls. The effect of amitriptyline (A, 20 mg daily) and sertraline (S, 100 mg daily) treatment on patients' superoxide dismutase (SOD), xanthine oxidase (XO), adenosine deaminase (ADA) enzyme activities, thiobarbituric acid reactive substances (TBARS) and NO levels was investigated. Thirty female patients with primary FM and age-matched 16 healthy female controls were included. Patients received an 8-week course of treatment with either A or S. FM patients had higher serum levels of TBARS (particularly malondialdehyde) and lower levels of nitrite compared to controls whereas enzyme activities were similar. A and S significantly improved Fibromyalgia Impact Questionnaire (FIQ) pain scores, Hamilton anxiety and depression rating scales. But neither A nor S had significant effects on measured oxidative stress parameters, except SOD activity that was significantly reduced after S treatment. Total myalgic scores negatively correlated with XO activity, and depression scales negatively correlated with levels of TBARS. Our results indicate that patients with FM are under oxidative stress. These findings represent a rationale for further research assessing the effect of free radical scavengers or antioxidant agents like vitamins and omega-3 fatty acids on peripheral and central mechanisms in FM

     (24)    Bennett R. The Fibromyalgia Impact Questionnaire (FIQ): a review of its development, current version, operating characteristics and uses. Clin Exp Rheumatol 2005; 23(5 Suppl 39):S154-S162.
Abstract: The Fibromyalgia Impact Questionnaire (FIQ) was developed in the late 1980s by clinicians at Oregon Health & Science University in an attempt to capture the total spectrum of problems related to fibromyalgia and the responses to therapy. It was first published in 1991 and since that time has been extensively used as an index of therapeutic efficacy. Overall, it has been shown to have a credible construct validity, reliable test-retest characteristics and a good sensitivity in demonstrating therapeutic change. The original questionnaire was modified in 1997 and 2002, to reflect ongoing experience with the instrument and to clarify the scoring system. The latest version of the FIQ can be found at the web site of the Oregon Fibromyalgia Foundation (www.myalgia.com/FIQ/FIQ). The FIQ has now been translated into eight languages, and the translated versions have shown operating characteristics similar to the English version

     (25)    Lee SS, Yoon HJ, Chang HK, Park KS. Fibromyalgia in Behcet's disease is associated with anxiety and depression, and not with disease activity. Clin Exp Rheumatol 2005; 23(4 Suppl 38):S15-S19.
Abstract: OBJECTIVE: To determine the prevalence of fibromyalgia (FM) in Korean patients with Behcet's disease (BD) and to evaluate the association between FM and clinical and psychological variables. METHODS: Seventy patients with BD were examined for FM tender points and asked to complete a Korean version of the Fibromyalgia Impact Questionnaire (FIQ). Disease activity was measured using the erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and a clinical activity score, which was calculated by summing the clinical manifestations. The State-Trait Anxiety Inventory (STAI) and Beck Depression Inventory (BDI) were used for psychometric scoring. RESULTS: Twenty-six BD patients (37.1%) met the American College of Rheumatology criteria for FM. The patients who met the criteria for FM were more frequently female, less frequently employed, and less well educated. Age, disease duration, clinical manifestations, medication, and measures of disease activity did not differ between BD patients with and without FM. Nevertheless, BD patients with FM had higher STAI and BDI scores than did patients without FM (all p < 0.05). FM tender points were significantly correlated with the STAI and BDI, and not with disease activity variables. The FIQ scores were also strongly correlated with the STAI and BDI scores, and not with disease activity. CONCLUSION: FM was very common among BD patients and was associated with the presence of anxiety and depression, and not with disease activity

     (26)    Wood PB, Kablinger AS, Caldito GS. Open trial of pindolol in the treatment of fibromyalgia. Ann Pharmacother 2005; 39(11):1812-1816.
Abstract: BACKGROUND: Evidence suggests that fibromyalgia is related to both chronic sympathetic hyperactivity and decreased levels of serotonin. OBJECTIVE: To examine the efficacy of pindolol, a mixed serotonin (5-HT)(1A) presynaptic autoreceptor/beta-adrenergic receptor antagonist, in the treatment of fibromyalgia. METHODS: An open trial was conducted using 20 female patients who met the American College of Rheumatology criteria for fibromyalgia. Treatment was initiated with pindolol 7.5 mg/day and titrated to a maximum dose of 15 mg/day for a total of 90 days. Primary outcome measures were tender point analysis and the Fibromyalgia Impact Questionnaire (FIQ). Anxiety and depression were measured with the Hamilton Depression and Anxiety Scales and Beck Depression Inventory. RESULTS: There was significant improvement in primary outcome measures, including Tender Point Count (mean +/- SD, 16.3 +/- 2.2 vs 12.3 +/- 5.0; F = 8.9; p < 0.001), Tender Point Score (24.4 +/- 5.7 vs 17.5 +/- 9.4; F = 7.8; p < 0.001), and FIQ (45.3 +/- 10.8 vs 35.0 +/- 15.0; F = 5.6; p < 0.005). The depression and anxiety scores did not change significantly among women who completed the study, while the impact on cardiovascular parameters was clinically insignificant. CONCLUSIONS: While the current results are encouraging, further studies are needed to determine whether pindolol might be effective in the treatment of fibromyalgia. Limitations of this study include small group size and lack of placebo control

     (27)    Dobkin PL, Abrahamowicz M, Fitzcharles MA, Dritsa M, da CD. Maintenance of exercise in women with fibromyalgia. Arthritis Rheum 2005; 53(5):724-731.
Abstract: OBJECTIVE: To identify predictors of maintenance of exercise for women with fibromyalgia (FM). METHODS: Women with FM who had been randomized to the exercise arm of a clinical trial were studied prospectively during and 3 months following treatment. Subjects completed exercise logs weekly and returned the data via postal mail. Outcome variables were duration of aerobic and stretching exercises. Two separate multivariate models for longitudinal data were built with adjustment for in-treatment adherence and time. Pretreatment characteristics (self efficacy, pain, disability, stress, exercise barriers and benefits, and age) and changes during treatment (pain, disability, stress, and exercise barriers and benefits) were considered potential predictors of exercise maintenance. RESULTS: Stretching significantly decreased in the 3 months following treatment. High stress at baseline and increases in stress during treatment were associated with poor maintenance of stretching. Disability at baseline (measured with the Fibromyalgia Impact Questionnaire), an increase in barriers to exercise during treatment, and increases in upper-body pain during treatment were associated with worse maintenance of aerobic exercise in the 3 months following treatment. CONCLUSION: The maintenance of an exercise program in women with FM appears to be contingent on being able to deal with stress, pain, barriers to exercise, and disability

     (28)    Bennett RM, Schein J, Kosinski MR, Hewitt DJ, Jordan DM, Rosenthal NR. Impact of fibromyalgia pain on health-related quality of life before and after treatment with tramadol/acetaminophen. Arthritis Rheum 2005; 53(4):519-527.
Abstract: OBJECTIVE: To assess health-related quality of life (HRQOL) in patients with moderate-to-severe fibromyalgia pain compared with the general population, and to assess the relationship between pain severity and HRQOL before and after treatment with an analgesic. METHODS: Data were obtained from a randomized, double-blind study of patients with moderate-to-severe fibromyalgia pain. Patients received either tramadol/acetaminophen or placebo 4 times/day as needed for 91 days. HRQOL was measured with the Short Form 36 Health Survey (SF-36) and the Fibromyalgia Impact Questionnaire (FIQ). Baseline HRQOL scores were compared with a national sample of noninstitutionalized adults and a sample of patients with impaired HRQOL due to congestive heart failure. Patients with fibromyalgia were divided into tertiles by change in pain severity, and SF-36 scores were compared across the tertiles. Mean changes in SF-36 and FIQ scores were compared between treatment groups. RESULTS: Patients with fibromyalgia scored lower than the US norm on all SF-36 scales (P < 0.0001) and lower than patients with congestive heart failure on most scales. More severe pain was associated with greater impairment of HRQOL compared with less severe pain (P < 0.0001). Patients in the highest tertile for improved pain severity had greater improvement in HRQOL scores than patients in the lower tertiles. Compared with patients who received placebo (n = 157), patients treated with tramadol/acetaminophen (n = 156) showed greater improvement on SF-36 physical functioning, role physical, bodily pain, and physical summary scales, as well as FIQ scales for ability to do job, pain, and stiffness (P < 0.01). CONCLUSION: Moderate-to-severe fibromyalgia pain significantly impairs HRQOL, and effective pain relief in these patients significantly increases HRQOL

     (29)    Holman AJ, Myers RR. A randomized, double-blind, placebo-controlled trial of pramipexole, a dopamine agonist, in patients with fibromyalgia receiving concomitant medications. Arthritis Rheum 2005; 52(8):2495-2505.
Abstract: OBJECTIVE: To assess the efficacy and safety of pramipexole, a dopamine 3 receptor agonist, in patients with fibromyalgia. METHODS: In this 14-week, single-center, double-blind, placebo-controlled, parallel-group, escalating-dose trial, 60 patients with fibromyalgia were randomized 2:1 (pramipexole:placebo) to receive 4.5 mg of pramipexole or placebo orally every evening. The primary outcome was improvement in the pain score (10-cm visual analog scale [VAS]) at 14 weeks. Secondary outcome measures were the Fibromyalgia Impact Questionnaire (FIQ), the Multidimensional Health Assessment Questionnaire (MDHAQ), the pain improvement scale, the tender point score, the 17-question Hamilton Depression Inventory (HAM-d), and the Beck Anxiety Index (BAI). Patients with comorbidities and disability were not excluded. Stable dosages of concomitant medications, including analgesics, were allowed. RESULTS: Compared with the placebo group, patients receiving pramipexole experienced gradual and more significant improvement in measures of pain, fatigue, function, and global status. At 14 weeks, the VAS pain score decreased 36% in the pramipexole arm and 9% in the placebo arm (treatment difference -1.77 cm). Forty-two percent of patients receiving pramipexole and 14% of those receiving placebo achieved > or =50% decrease in pain. Secondary outcomes favoring pramipexole over placebo included the total FIQ score (treatment difference -9.57) and the percentages of improvement in function (22% versus 0%), fatigue (29% versus 7%), and global (38% versus 3%) scores on the MDHAQ. Compared with baseline, some outcomes showed a better trend for pramipexole treatment than for placebo, but failed to reach statistical significance, including improvement in the tender point score (51% versus 36%) and decreases in the MDHAQ psychiatric score (37% versus 28%), the BAI score (39% versus 27%), and the HAM-d score (29% versus 9%). No end points showed a better trend for the placebo arm. The most common adverse events associated with pramipexole were transient anxiety and weight loss. No patient withdrew from the study because of inefficacy or an adverse event related to pramipexole. CONCLUSION: In a subset of patients with fibromyalgia, approximately 50% of whom required narcotic analgesia and/or were disabled, treatment with pramipexole improved scores on assessments of pain, fatigue, function, and global status, and was safe and well-tolerated

     (30)    Yuceturk TE, Yucel AE, Yuceturk H, Kart-Koseoglu H, Unuvar R, Ozdemir FN et al. Fibromyalgia: its prevalence in haemodialysis patients and its relationships with clinical and laboratory parameters. Nephrol Dial Transplant 2005; 20(11):2485-2488.
Abstract: OBJECTIVE: Our aim was to determine the prevalence of fibromyalgia syndrome (FS) in chronic haemodialysis (HD) patients and to identify possible links between FS and various clinical and laboratory parameters. METHODS: We studied 122 chronic HD patients and 89 healthy age- and sex-matched controls, classified according to the American College of Rheumatology (ACR) classification criteria for FS. Age, sex, causes of renal failure, length of time on dialysis and marital status were recorded, and questions were asked about symptoms related to FS. All subjects completed the Fibromyalgia Impact Questionnaire (FIQ). Laboratory data obtained in the preceding 6 months were re-evaluated. RESULTS: Nine (7.4%) of the 122 HD patients and four of the 89 control subjects (4.5%) fulfilled the ACR criteria for definite FS (P = 0.56). The mean ages of the subjects who had definite FS and those who did not were similar. Most of the subjects diagnosed with definite FS were female (11 out of 13). The HD patients had higher FIQ scores than the controls, regardless of FS diagnosis. Among the HD patients, those with definite FS had a significantly higher mean FIQ score than all the other HD patients combined. In the all HD patients group, fatigue, irritable bowel syndrome and personal histories of depression were correlated with FS, whereas duration of HD, aetiology of renal failure, laboratory parameters and hepatitis B or C virus infection were not. CONCLUSION: The prevalence of FS appeared to be similar in chronic HD patients and the general population; also, FS-related symptoms appear to be similar in HD patients and the general population who have FS. No laboratory parameter was correlated with frequency of FS

     (31)    da CD, Abrahamowicz M, Lowensteyn I, Bernatsky S, Dritsa M, Fitzcharles MA et al. A randomized clinical trial of an individualized home-based exercise programme for women with fibromyalgia. Rheumatology (Oxford) 2005; 44(11):1422-1427.
Abstract: OBJECTIVE: To determine the efficacy of a 12-week individualized home-based exercise programme on physical functioning, pain severity and psychological distress for women with fibromyalgia (FM). METHODS: Seventy-nine women with a primary diagnosis of FM were randomized to a 12-week individualized home-based moderate-intensity exercise programme or to a usual care control group. Outcomes were functional capacity (Fibromyalgia Impact Questionnaire), pain severity and psychological distress. Outcomes were measured at study entry, at the end of the 12-week intervention, and at 3 and 9 months following completion of the intervention. RESULTS: On the basis of intention-to-treat analyses, a significant improvement in functional capacity at 3 and 9 months following treatment for participants in the exercise group who were more functionally disabled at study entry was observed. At both 3 and 9 months post-treatment, the mean estimated benefit of the intervention was more than 10 points [-12.3 (95% CI, -21.9 to -2.8); -10.8 (95% CI, -21.5 to -0.2)]. Compared with the control group, statistically significant improvements in upper body pain were evident in the exercise group at post-treatment. These between-group differences in upper body pain were maintained at 3 and 9 months post-treatment. No statistically significant group differences on lower body pain and psychological distress were found. CONCLUSIONS: Home-based exercise, a relatively low-cost treatment modality, has the potential to improve important health outcomes in FM

     (32)    Tikiz C, Muezzinoglu T, Pirildar T, Taskn EO, Frat A, Tuzun C. Sexual dysfunction in female subjects with fibromyalgia. J Urol 2005; 174(2):620-623.
Abstract: PURPOSE: We investigated sexual function in females with fibromyalgia (FM) and evaluate whether coexistent major depression (MD) has an additional negative effect on sexual function. MATERIALS AND METHODS: A total of 100 female subjects were enrolled in the study, including 40 with FM only, 27 with FM plus MD and 33 healthy volunteers as a control group. The diagnosis of MD was made according to Structured Clinical Interview for Diagnostic and Statistical Manual-IV interview and the Hamilton Depression Rate Scale was used to grade depression. Widespread pain and quality of life were assessed with the Lattinen Pain Scale and Fibromyalgia Impact Questionnaire, respectively. The Female Sexual Function Index (FSFI) was used to assess sexual dysfunction. RESULTS: All subjects were comparable in age, occupation and education. Mean FSFI total score +/- SD was significantly decreased in the FM and FM plus MD groups compared with that in healthy controls (21.83 +/- 5.84 and 22.43 +/- 7.0 vs 28.10 +/- 6.52, respectively, p = 0.001). However, the FSFI score was not significantly different between patients with FM only and FM plus MD (p >0.05). Correlation analysis revealed a negative moderate correlation between total Lattinen pain score and FSFI score in the FM only and FM plus MD groups (r = -0.366, p = 0.047 and r = -0.403, p = 0.018, respectively). FSFI score did not correlate with FIQ and HDRS scores (p >0.05). CONCLUSIONS: This study demonstrates that female patients with FM have distinct sexual dysfunction compared with healthy controls and coexistent MD has no additional negative effect on sexual function. Thus, female subjects with FM should be evaluated in terms of sexual function to provide better quality of life

     (33)    Donmez A, Karagulle MZ, Tercan N, Dinler M, Issever H, Karagulle M et al. SPA therapy in fibromyalgia: a randomised controlled clinic study. Rheumatol Int 2005; 26(2):168-172.
Abstract: OBJECTIVE: The aim of the present study is to evaluate the effectiveness of spa therapy in the management of fibromyalgia. METHODS: Thirty women with fibromyalgia were randomly assigned to either a spa therapy group or a control group. The spa therapy group (n = 16) had spa treatment for 2 weeks in addition to their medical treatment. The control group (n = 14) continued to have their medical treatment and/or daily exercises. An investigator who was blinded for the intervention assessed all the patients for 9 months. Improvements in Fibromyalgia Impact Questionnaire (FIQ), pain and number of tender points were primary outcomes. Secondary outcome measures were improvement in sleep disturbance, fatigue, gastrointestinal symptoms, anxiety, Beck Depression Inventory and patient's global evaluation. RESULTS: the spa group was found to be superior to the control group at the end of intervention in terms of FIQ, pain, tender point count, fatigue and patients' global assessment. This superiority remained for 6 months in FIQ, 1 month in pain and tender point count. CONCLUSION: It was concluded that the addition of spa therapy to medical therapy has both short- and long-term beneficial effects in female patients with fibromyalgia

     (34)    Burckhardt CS, Jones KD. Effects of chronic widespread pain on the health status and quality of life of women after breast cancer surgery. Health Qual Life Outcomes 2005; 3:30.:30.
Abstract: BACKGROUND: Most research and treatment of post-breast cancer chronic pain has focused on local or regional pain problems in the operated area. The purpose of this pilot study was to compare and contrast the pain characteristics, symptom impact, health status, and quality of life of post-breast cancer surgery women with regional chronic pain versus those with widespread chronic pain. METHODS: A cross-sectional, descriptive design compared two groups of women with chronic pain that began after surgery: regional pain (n = 11) and widespread pain (n = 12). Demographics, characteristics of the surgery, as well as standardized questionnaires that measured pain (Brief Pain Inventory (BPI), Short Form McGill Pain Questionnaire (MPQ-SF)), disease impact (Fibromyalgia Impact Questionnaire (FIQ), Functional Assessment of Cancer Therapy-Breast (FACT-B)), health status (Medical Outcomes Short Form (SF-36)) and quality of life (Quality of Life Scale (QOLS)) were gathered. RESULTS: There were no significant differences between the groups on any demographic or type of surgery variable. A majority of both groups described their pain as aching, tender, and sharp on the MPQ-SF. On the BPI, intensity of pain and pain interference were significantly higher in the widespread pain group. Differences between the two groups reached statistical significance on the FIQ total score as well as the FACT-B physical well-being, emotional well-being and breast concerns subscales. The SF-36 physical function, physical role, and body pain subscales were significantly lower in the widespread pain group. QOLS scores were lower in the widespread pain group, but did not reach statistical significance. CONCLUSION: This preliminary work suggests that the women in this study who experienced widespread pain after breast cancer surgery had significantly more severity of pain, pain impact and lower physical health status than those with regional pain

     (35)    Mannerkorpi K, Arndorw M. Efficacy and feasibility of a combination of body awareness therapy and qigong in patients with fibromyalgia: a pilot study. J Rehabil Med 2004; 36(6):279-281.
Abstract: OBJECTIVE: To evaluate the effects of body awareness therapy combined with qigong for patients with fibromyalgia. DESIGN: A controlled randomized pilot study. SUBJECTS: Thirty-six female patients with fibromyalgia were randomized to either qigong plus body awareness therapy (n = 19) or a control group (n = 17). METHODS: The programme was conducted once a week over a period of 3 months. The outcome measures were an observational method called the Body Awareness Rating Scale, the Fibromyalgia Impact Questionnaire and 2 tests of physical function. An interview was conducted with the patients in the treatment group. RESULTS: Seven patients in each group (39%) were lost to the post-test examination. The inter-group analysis revealed a significant improvement in movement harmony for the treatment group (p = 0.03), while no differences were found in the Fibromyalgia Impact Questionnaire or the functional tests. The intra-group analysis revealed an improvement in movement harmony for the treatment group (p = 0.01), while the total score of the Fibromyalgia Impact Questionnaire deteriorated (p = 0.04) in the control group. The interviews indicated that several patients had experienced exacerbation of symptoms while standing still, and/or difficulty in concentrating on the movements. CONCLUSIONS: Although improvement in movement harmony occurred in the patients completing the treatment programme, no improvement was found for fibromyalgia symptoms or physical function

     (36)    Zijlstra TR, van de Laar MA, Bernelot Moens HJ, Taal E, Zakraoui L, Rasker JJ. Spa treatment for primary fibromyalgia syndrome: a combination of thalassotherapy, exercise and patient education improves symptoms and quality of life. Rheumatology (Oxford) 2005; 44(4):539-546.
Abstract: OBJECTIVES: To study the effect of a combination of thalassotherapy, exercise and patient education in people with fibromyalgia. METHODS: Patients with fibromyalgia, selected from a rheumatology out-patient department and from members of the Dutch fibromyalgia patient association, were pre-randomized to receive either 2(1/2) weeks of treatment in a Tunisian spa resort, including thalassotherapy, supervised exercise and group education (active treatment) or treatment as usual (control treatment). Primary outcome measure was health-related quality of life, measured with the RAND-36 questionnaire. Secondary measures included the Fibromyalgia Impact Questionnaire, the McGill Pain Questionnaire, the Beck Depression Inventory, tender point score and a 6-min treadmill walk test. RESULTS: Fifty-eight participants receiving the active treatment reported significant improvement on RAND-36 physical and mental component summary scales. For physical health, differences from the 76 controls were statistically significant after 3 months, but not after 6 and 12 months. A similar pattern of temporary improvement was seen in the self-reported secondary measures. Tender point scores and treadmill walk tests improved more after active treatment, but did not reach significant between-group differences, except for walk tests after 12 months. CONCLUSIONS: A combination of thalassotherapy, exercise and patient education may temporarily improve fibromyalgia symptoms and health-related quality of life

     (37)    Marques AP, Ferreira EA, Matsutani LA, Pereira CA, Assumpcao A. Quantifying pain threshold and quality of life of fibromyalgia patients. Clin Rheumatol 2005; 24(3):266-271.
Abstract: The most typical symptom of fibromyalgia (FM) is diffuse pain, and pain at specific points-tender points-is crucial for its diagnosis. By comparing healthy individuals and FM patients, this study was aimed at assessing pain and quality of life of Brazilian females with FM, while seeking for a correlation between pain threshold and quality of life. A total of 178 women were evaluated: 124 were FM patients and 54 were healthy women. Pain threshold at tender points was quantified by dolorimetry, and diffuse pain by means of the visual analogue scale (VAS); the Fibromyalgia Impact Questionnaire (FIQ) was used to evaluate quality of life. Statistical treatment of the data allowed for proposing two indexes: a pain threshold index (PT) and a quality of life one (QOL). PT is the lowest value among all pain thresholds measured at the 18 tender points; QOL is the mean of responses to the FIQ and VAS. Both indexes were tested and showed significant differences between the test and control groups. By pairing pain threshold values of each tender point in the test and control groups, it was found that the most sensitive points matched between the two groups, that is, the most sensitive anatomic spots in a healthy individual are also likely to be the most sensitive points in a person with FM. This suggests that a stimulus that provokes slight discomfort to a healthy person may produce more pain in FM patients--which may bear implications for FM clinical treatment. In this sample of Brazilian women, FM patients had both lower pain threshold and worse quality of life than healthy women

     (38)    Gowans SE, Dehueck A, Voss S, Silaj A, Abbey SE. Six-month and one-year followup of 23 weeks of aerobic exercise for individuals with fibromyalgia. Arthritis Rheum 2004; 51(6):890-898.
Abstract: OBJECTIVE: To measure mood and physical function of individuals with fibromyalgia, 6 and 12 months following 23 weeks of supervised aerobic exercise. METHODS: This is a followup report of individuals who were previously enrolled in 23 weeks of land-based and water-based aerobic exercise classes. Outcomes included the 6-minute walk test, Beck Depression Inventory (BDI), State-Trait Anxiety Inventory, Arthritis Self-Efficacy Scale (ASES), Fibromyalgia Impact Questionnaire (FIQ), tender point count, patient global assessment score, and exercise compliance. Outcomes were measured at the start and end of the exercise classes and 6 and 12 months later. RESULTS: Analyses were conducted on 29 (intent-to-treat) or 18 (efficacy) subjects. Six-minute walk distances and BDI total scores were improved at followup (all analyses). BDI cognitive/affective scores were improved at the end of 23 weeks of exercise (both analyses) and at the 12-month followup (efficacy analysis only). BDI somatic scores were improved at 6-month (both analyses) and 12-month followup (intent-to-treat only). FIQ and ASES function were improved at all followup points. ASES pain was improved in efficacy analyses only (all followup points). Tender points were unchanged after 23 weeks of exercise and at followup. Exercise duration at followup (total minutes of aerobic plus anaerobic exercise in the preceding week) was related to gains in physical function (6- and 12-month followup) and mood (6-month followup). CONCLUSION: Exercise can improve physical function, mood, symptom severity, and aspects of self efficacy for at least 12 months. Exercising at followup was related to improvements in physical function and perhaps mood

     (39)    Friedberg F. Eye movement desensitization in fibromyalgia: a pilot study. Complement Ther Nurs Midwifery 2004; 10(4):245-249.
Abstract: The purpose of this study was to investigate the effectiveness of eye movement desensitization (EMD) for the relief of pain, fatigue and anxiety and depression in fibromyalgia patients. Six Caucasian female patients (mean age=43.2 yr) participated in two treatment sessions. Outcome assessments included the Fibromyalgia Impact Questionnaire, Fatigue Scale, Beck Anxiety Inventory, and Beck Depression Inventory. In-session process measures included thermal biofeedback monitoring and subjective units of discomfort ratings of pain, stress, and fatigue. Four out of six subjects were considered treatment responders. Thermal biofeedback monitoring revealed an average increase in hand temperature of 5.4 degrees indicating a relaxation effect. At treatment termination, average scores decreased on the measures of anxiety (28.6%), depression (29.9%), fibromyalgia impact (12.6%), and fatigue (11.5%). At the 3-month follow-up assessment, total reductions in average scores from pre-treatment baseline reflected further improvements on measures of anxiety (45.8%), depression (31.6%), fibromyalgia impact (19.2%), and fatigue (26.7%). Because EMD produced a somewhat automatic relaxation response with minimal patient participation, it may be especially useful when standard relaxation techniques fail

     (40)    Rivera J, Gonzalez T. The Fibromyalgia Impact Questionnaire: a validated Spanish version to assess the health status in women with fibromyalgia. Clin Exp Rheumatol 2004; 22(5):554-560.
Abstract: OBJECTIVE: To translate, adapt, validate and assess the sensitivity to change of a Spanish version of the Fibromyalgia Impact Questionnaire (FIQ-S). METHODS: The FIQ-S was adapted following the translation and back-translation methodology. Female patients with fibromyalgia (FM) were invited to participate. Reliability was analyzed by the Spearman correlation coefficient between test and retest. Internal consistency was checked by the Cronbach's alpha coefficient. Construct validity was analyzed comparing FIQ-S with: HAQ, FHAQ, SF-36, SCL90-R, and the visual analogue scale for pain. Sensitivity to change was assessed in an 8-week randomized trial of exercise therapy. Feasibility was analyzed by the time taken in completing the FIQ-S and the proportion of patients able to complete the questionnaire. RESULTS: Translation was concordant. Adaptation affected at 4 sub-items of physical function. One-hundred and two FM patients completed the protocol. Mean age was 48.7 years with a mean of 9.2 years of evolution. Test-retest correlations were between 0.61-0.85 (p < 0.0001). Internal consistency showed alpha = 0.82 for all items and alpha = 0.86 for the sub-items of physical function. Significant correlations (p < 0.0001) were found between the FIQ-S items and HAQ, FHAQ, SF-36 and SCL90-R. For patients treated with the exercise program, the pre-treatment FIQ-S score was 52.0 +/- 11.5 and the post-treatment score was 40.8 +/- 13.7 (p < 0.003). Mean time for completing FIQ-S was 3.3 minutes. In 4% of the patients external help was needed. CONCLUSION: The FIQ-S is a reliable, valid and responsive to changes questionnaire for measuring health status and physical function in Spanish speaking FM patients

     (41)    Arnold LM, Lu Y, Crofford LJ, Wohlreich M, Detke MJ, Iyengar S et al. A double-blind, multicenter trial comparing duloxetine with placebo in the treatment of fibromyalgia patients with or without major depressive disorder. Arthritis Rheum 2004; 50(9):2974-2984.
Abstract: OBJECTIVE: To assess the efficacy and safety of duloxetine, a serotonin and norepinephrine reuptake inhibitor, in subjects with primary fibromyalgia, with or without current major depressive disorder. METHODS: This study was a randomized, double-blind, placebo-controlled trial conducted in 18 outpatient research centers in the US. A total of 207 subjects meeting the American College of Rheumatology criteria for primary fibromyalgia were enrolled (89% female, 87% white, mean age 49 years, 38% with current major depressive disorder). After single-blind placebo treatment for 1 week, subjects were randomly assigned to receive duloxetine 60 mg twice a day (n = 104) or placebo (n = 103) for 12 weeks. Co-primary outcome measures were the Fibromyalgia Impact Questionnaire (FIQ) total score (score range 0-80, with 0 indicating no impact) and FIQ pain score (score range 0-10). Secondary outcome measures included mean tender point pain threshold, number of tender points, FIQ fatigue, tiredness on awakening, and stiffness scores, Clinical Global Impression of Severity (CGI-Severity) scale, Patient Global Impression of Improvement (PGI-Improvement) scale, Brief Pain Inventory (short form), Medical Outcomes Study Short Form 36, Quality of Life in Depression Scale, and Sheehan Disability Scale. RESULTS: Compared with placebo-treated subjects, duloxetine-treated subjects improved significantly more (P = 0.027) on the FIQ total score, with a treatment difference of -5.53 (95% confidence interval -10.43, -0.63), but not significantly more on the FIQ pain score (P = 0.130). Compared with placebo-treated subjects, duloxetine-treated subjects had significantly greater reductions in Brief Pain Inventory average pain severity score (P = 0.008), Brief Pain Inventory average interference from pain score (P = 0.004), number of tender points (P = 0.002), and FIQ stiffness score (P = 0.048), and had significantly greater improvement in mean tender point pain threshold (P = 0.002), CGI-Severity (P = 0.048), PGI-Improvement (P = 0.033), and several quality-of-life measures. Duloxetine treatment improved fibromyalgia symptoms and pain severity regardless of baseline status of major depressive disorder. Compared with placebo-treated female subjects (n = 92), duloxetine-treated female subjects (n = 92) demonstrated significantly greater improvement on most efficacy measures, while duloxetine-treated male subjects (n = 12) failed to improve significantly on any efficacy measure. The treatment effect on significant pain reduction in female subjects was independent of the effect on mood or anxiety. Duloxetine was safely administered and well tolerated. CONCLUSION: In this randomized, controlled, 12-week trial (with a 1-week placebo lead-in phase), duloxetine was an effective and safe treatment for many of the symptoms associated with fibromyalgia in subjects with or without major depressive disorder, particularly for women, who had significant improvement across most outcome measures

     (42)    Gulec H, Sayar K, Topbas M, Karkucak M, Ak I. [Alexithymia and anger in women with fibromyalgia syndrome]. Turk Psikiyatri Derg 2004; 15(3):191-198.
Abstract: OBJECTIVE: Fibromyalgia syndrome is characterized by both somatic and psychic symptoms and it is suggested that psychic factors contribute to the clinical presentation of this syndrome. This study was planned to have a better understanding of fibromyalgia through elaborating the role of alexithymia and anger in the pathogenesis of this illness. METHOD: The study was carried out in the Physical Therapy and Rehabilitation outpatient clinic with 101 women with fibromyalgia syndrome, 30 women with rheumatoid arthritis and 59 healthy women with no current or past medical history. The subjects were evaluated by the Visual Analog Scale, Toronto Alexithymia Scale-20 items, Spielberger State-Trait Anger Inventory, Beck Depression Scale, Fibromyalgia Impact Questionnaire and a sociodemographic data form. RESULTS: All these groups were similar to each other in means of age, years of education, marital and economical status. In the fibromyalgia syndrome group, the scores of anxiety and anger-in were calculated significantly higher than other groups. The depression and alexithymia scores were found higher than healthy group. DISCUSSION: These findings suggest that fibromyalgia patients suffer more anxiety and anger toward oneself, which is anger-in, than rheumatoid arthritis patients. Though the patient groups were more alexithymic than the healthy group, alexitimia scores of the two patient groups were not different. This situation suggest that anger-in, which is suppressed and unexpressed anger style is a part of the fibromyalgia syndrome together as well as high anxiety

     (43)    Blacker CV, Greenwood DT, Wesnes KA, Wilson R, Woodward C, Howe I et al. Effect of galantamine hydrobromide in chronic fatigue syndrome: a randomized controlled trial. JAMA 2004; 292(10):1195-1204.
Abstract: CONTEXT: There is no established pharmacological treatment for the core symptoms of chronic fatigue syndrome (CFS). Galantamine hydrobromide, an acetyl cholesterone inhibitor, has pharmacological properties that might benefit patients with CFS. OBJECTIVE: To compare the efficacy and tolerability of galantamine hydrobromide in patients with CFS. DESIGN, SETTING, AND PATIENTS: Randomized, double-blind trial conducted June 1997 through July 1999 at 35 outpatient centers in the United Kingdom (n = 17), United States (n = 14), the Netherlands (n = 2), Sweden (n = 1), and Belgium (n = 1) involving 434 patients with a clinical diagnosis of CFS (modified US Centers for Disease Control and Prevention criteria). INTERVENTIONS: A total of 89 patients were randomly assigned to receive 2.5 mg of galantamine hydrobromide; 86 patients, 5.0 mg; 91 patients, 7.5 mg; and 86 patients, 10 mg (these patients received medicine in the tablet form 3 times per day); a total of 82 patients received matching placebo tablets 3 times per day. MAIN OUTCOME MEASURES: The primary efficacy variable was the global change on the Clinician Global Impression Scale after 4, 8, 12, and 16 weeks of treatment. Secondary outcomes were changes in core symptoms of CFS on the Chalder Fatigue Rating Scale, the Fibromyalgia Impact Questionnaire, and the Pittsburgh Sleep Quality Index; changes in quality of life on the Nottingham Health Profile; and assessment of plasma-free cortisol levels and cognitive performance on a computer-based battery of tests. RESULTS: After 16 weeks, there were no statistically significant differences between any of the galantamine or placebo groups in clinical condition on the Clinician Global Impression Scale, or for any of the secondary end points. Exploratory regression analysis failed to detect any consistent prognostic factor that might have influenced the primary or any secondary outcome measures. CONCLUSION: This trial did not demonstrate any benefit of galantamine over placebo in the treatment of patients with CFS

     (44)    Huuhka MJ, Haanpaa ML, Leinonen EV. Electroconvulsive therapy in patients with depression and fibromyalgia. Eur J Pain 2004; 8(4):371-376.
Abstract: The effect of electroconvulsive therapy (ECT) on depression and other symptoms of fibromyalgia was studied in a prospective 3-month trial in 13 patients with fibromyalgia and concomitant depression. All the patients met the DSM-IV diagnostic criteria for Major Depressive Disorder and fulfilled the American College of Rheumatology diagnostic criteria for fibromyalgia. The Montgomery and Asberg Depression Rating Scale (MADRS) and the clinical global impression scale (CGI) were used to assess the severity of depression and the clinical change of the patients. The fibromyalgia impact questionnaire (FIQ) was used to evaluate the severity of the fibromyalgia symptoms. The intensity of pain was evaluated using a 6-point scale (0=no pain, 5=very severe pain), and tender point palpation. All assessments were performed at baseline and at follow-up visits, which took place one week, one month and three months after ECT. There was a significant improvement in depression after ECT according to MADRS. Using CGI, six patients were much or very much improved, while four patients were minimally improved and three patients had no change. There was significant improvement in four out of ten FIQ item scores, "feel good", "fatigue", "anxiety" and "depression". No significant change was found in the FIQ item scores "physical function", "pain", "stiffness" and "morning tiredness" or number of tender points and self-reported pain. We conclude that ECT is a safe and effective treatment for depression in fibromyalgia patients, but has no effect on the pain or other physical symptoms of these patients

     (45)    Picavet HS, Hoeymans N. Health related quality of life in multiple musculoskeletal diseases: SF-36 and EQ-5D in the DMC3 study. Ann Rheum Dis 2004; 63(6):723-729.
Abstract: OBJECTIVE: To examine the health related quality of life of persons with one or more self reported musculoskeletal diseases, as measured by the short form 36 item health status survey (SF-36) and the Euroqol questionnaire (EQ-5D). METHODS: A sample of Dutch inhabitants aged 25 years or more (n = 3664) participated in a questionnaire survey. Twelve lay descriptions of common musculoskeletal diseases were presented and the subjects were asked whether they had ever been told by a physician that they had any of these. Their responses were used to assess the prevalence of these conditions. Commonly used scores of SF-36 and descriptive scores from EQ-5D are presented, along with standardised differences between disease groups and the general population. RESULTS: SUBJECTS: with musculoskeletal diseases had significantly lower scores on all SF-36 dimensions than those without musculoskeletal disease, especially for physical functioning (SF-36 score (SE), 75.2 (0.5) v 87.8 (0.5)); role limitations caused by physical problems (67.1 (0.9) v 85.8 (0.8)); and bodily pain (68.5 (0.5) v 84.1 (0.5)). The worst health related quality of life patterns were found for osteoarthritis of the hip, osteoporosis, rheumatoid arthritis, and fibromyalgia. Those with multiple musculoskeletal diseases had the poorest health related quality of life. Similar results were found for EQ-5D. CONCLUSIONS: All musculoskeletal diseases involve pain and reduced physical function. The coexistence of musculoskeletal diseases should be taken into account in research and clinical practice because of its high prevalence and its substantial impact on health related quality of life

     (46)    Bae SC, Lee JH. Cross-cultural adaptation and validation of the Korean fibromyalgia impact questionnaire in women patients with fibromyalgia for clinical research. Qual Life Res 2004; 13(4):857-861.
Abstract: Our aim was to translate and cross-culturally adapt the fibromyalgia impact questionnaire into Korean (KFIQ), and then evaluate its reliability and validity. The FIQ was translated into Korean by three translators and then independently translated back into English by three different translators. A total of 62 women patients with fibromyalgia (FM) were studied for the psychometric properties of the KFIQ. The mean age of the patients was 47.1 (25-73) years, and all were female. The mean KFIQ score was 48.3 (17-91), and the mean Korean health assessment questionnaire (KHAQ) score was 0.4 (0-1.7). The test-retest reliability of the KFIQ yielded an intraclass correlation coefficient of 0.85 (0.53-0.96). For the construct validity, the Spearman rank correlations of KFIQ with patient global assessments using visual analog scale (pain, 0.58; morning stiffness, 0.45; fatigue, 0.48; depression, 0.43; anxiety, 0.56; global well-being, 0.46; disease severity, 0.49; impact on life, 0.51), KHAQ (0.44), and tender points (0.60) were high and statistically significant. The KFIQ might be a reliable and valid instrument for measuring health status and physical functioning in Korean women patients with FM, but needs further study

     (47)    Kendall SA, Schaadt ML, Graff LB, Wittrup I, Malmskov H, Krogsgaard K et al. No effect of antiviral (valacyclovir) treatment in fibromyalgia: a double blind, randomized study. J Rheumatol 2004; 31(4):783-784.
Abstract: OBJECTIVE: To investigate the effect of an antiviral compound, valacyclovir, on pain and tenderness in patients with the fibromyalgia (FM) syndrome. METHODS: Sixty patients were randomized into a double blind, placebo controlled 6 week trial. Primary outcome was pain intensity change (on visual analog scale). Secondary outcome measures were tender points (myalgic score) and Fibromyalgia Impact Questionnaire (FIQ). RESULTS: Fifty-two patients completed the study. The numbers of dropouts due to adverse events were equal in valacyclovir (2) and placebo (2) groups. The effect of valacyclovir on pain and tenderness and FIQ did not differ from placebo. CONCLUSION: Valacyclovir cannot be recommended as a therapy for FM at this point

     (48)    Redondo JR, Justo CM, Moraleda FV, Velayos YG, Puche JJ, Zubero JR et al. Long-term efficacy of therapy in patients with fibromyalgia: a physical exercise-based program and a cognitive-behavioral approach. Arthritis Rheum 2004; 51(2):184-192.
Abstract: OBJECTIVE: To analyze the long-term efficacy of 2 interventions for female fibromyalgia (FM) patients: 1) cognitive-behavioral therapy (CBT), and 2) a physical exercise (PE)-based strategy. METHODS: We conducted a prospective, long-term, randomized, parallel clinical trial. The outcome variables are physical activity, aerobic capacity, and results of the Fibromyalgia Impact Questionnaire (FIQ), Short Form 36, Beck Anxiety and Depression Inventory, Chronic Pain Self-Efficacy Scale, and Chronic Pain Coping Inventory. All were measured at baseline, posttreatment, 6 months, and 1 year. The duration of both treatments was 8 weeks. RESULTS: Some items of the FIQ and some strategies to cope with pain improved significantly in both groups after treatment. All variables measuring functional capacity improved significantly in the PE group, whereas only physical activity of the vertebral column improved in the CBT group. There were no differences in anxiety, depression, and self efficacy after treatment in either group. After 1 year of followup, most of the parameters had returned to baseline values in both groups. However, in the PE group, functional capacity remained significantly better. CONCLUSIONS: PE and CBT improve clinical manifestations in FM patients only for short periods of time. Improvement in self efficacy and physical fitness are not associated with improvement in clinical manifestations

     (49)    Sverdrup B. Use less cosmetics--suffer less from fibromyalgia? J Womens Health (Larchmt ) 2004; 13(2):187-194.
Abstract: BACKGROUND: Widespread muscular pain, tenderness, unrefreshing sleep, and fatigue all constitute the fibromyalgia syndrome (FMS), which is often seen in both general and rheumatology practice, primarily in women. The etiology is unknown. The FMS patient usually looks normal. The cardinal finding is the presence of focal areas of hyperalgesia, that is, tender points. My clinical impression was that FMS patients often complained of dry skin. My hypothesis was that overambitious cleaning, resulting in dry skin, and regular use of cosmetics as moisturizers could contribute to their symptoms. METHODS: A prospective, randomized, controlled trial of 48 women with FMS (some of whom had a rheumatic condition) who were regular users of cosmetics was carried out to investigate if a reduced use of cosmetics would reduce the symptoms. The intervention group received special instructions on skin care, with reinforcement when needed. RESULTS: After 2 years, there was significant improvement in pain (p < 0.02), sleep (p < 0.01), and stiffness (p < 0.02), together with better physical function (p < 0.01) and improved wellbeing (p < 0.01) in the experimental group, as measured by the Fibromyalgia Impact Questionnaire (FIQ). CONCLUSIONS: The results should motivate further studies on the possible adverse effects of cosmetic use in FMS and perhaps other conditions

     (50)    Sarzi-Puttini P, Atzeni F, Turiel M, Furlan R, Vulpio L, Carrabba M et al. The Italian version of the Fibrofatigue Scale, a reliable tool for the evaluation of fibromyalgia symptoms. J Psychosom Res 2004; 56(2):213-216.
Abstract: Objective: To validate a translated Italian version of the Fibrofatigue Scale (FFS). Methods: The Italian version of FFS was administered to 60 patients affected by fibromyalgia (FM) (57 patients were interviewed again 10 days later) together with the Italian version of the Fibromyalgia Impact Questionnaire (FIQ), the Stanford Health Assessment Questionnaire (HAQ) and the Medical Outcome Survey Short Form-36 (SF-36). All patients were asked about the severity of pain today (10-cm visual analogue scale) and the duration of symptoms. Test-retest reliability was assessed using Spearman correlations. Internal consistency was evaluated with Cronbach's alpha of reliability. Construct validity of the FFS was evaluated by correlations among the FFS, the FIQ and the subscales of the SF-36. Results: Mean duration of symptoms was 7.6 years, and mean age of participants was 56.3 years. Test-retest reliability was between 0.70 and 0.95 for the single items as well as for the total FFS and other components. Internal consistency was 0.90 for the overall FFS. Significant correlations were obtained between the FFS items and the SF-36. Conclusions: The Italian FFS is a reliable and valid instrument for detecting and measuring functional disability and symptoms severity in Italian patients with FM

     (51)    Cedraschi C, Desmeules J, Rapiti E, Baumgartner E, Cohen P, Finckh A et al. Fibromyalgia: a randomised, controlled trial of a treatment programme based on self management. Ann Rheum Dis 2004; 63(3):290-296.
Abstract: OBJECTIVE: To evaluate the efficacy of a treatment programme for patients with fibromyalgia (FM) based on self management, using pool exercises and education. METHODS: Randomised controlled trial with a 6 month follow up to evaluate an outpatient multidisciplinary programme; 164 patients with FM were allocated to an immediate 6 week programme (n = 84) or to a waiting list control group (n = 80). The main outcomes were changes in quality of life, functional consequences, patient satisfaction and pain, using a combination of patient questionnaires and clinical examinations. The questionnaires included the Fibromyalgia Impact Questionnaire (FIQ), Psychological General Well-Being (PGWB) index, regional pain score diagrams, and patient satisfaction measures. RESULTS: 61 participants in the treatment group and 68 controls completed the programme and 6 month follow up examinations. Six months after programme completion, significant improvements in quality of life and functional consequences of FM were seen in the treatment group as compared with the controls and as measured by scores on both the FIQ (total score p = 0.025; fatigue p = 0.003; depression p = 0.031) and PGWB (total score p = 0.032; anxiety p = 0.011; vitality p = 0.013,). All four major areas of patient satisfaction showed greater improvement in the treatment than the control groups; between-group differences were statistically significant for "control of symptoms", "psychosocial factors", and "physical therapy" No change in pain was seen. CONCLUSION: A 6 week self management based programme of pool exercises and education can improve the quality of life of patients with FM and their satisfaction with treatment. These improvements are sustained for at least 6 months after programme completion

     (52)    Bellamy N, Sothern RB, Campbell J. Aspects of diurnal rhythmicity in pain, stiffness, and fatigue in patients with fibromyalgia. J Rheumatol 2004; 31(2):379-389.
Abstract: OBJECTIVE: To determine diurnal rhythm characteristics of pain, stiffness, and fatigue in self-ratings performed by patients with fibromyalgia (FM). METHODS: Twenty-one women with FM made self-measurements of pain, stiffness, and fatigue on 100 mm horizontal visual analog scales at 6 prespecified timepoints at home for 10 consecutive days. Linear and multiple regressions were performed on the original data and the 24-hour means vs FM classifiers (age, disease duration, tender points, dolorimetry score, Fibromyalgia Impact Questionnaire score), respectively. Data were analyzed for 24-hour and 7-day time-effects by ANOVA and for diurnal and weekly rhythms by the cosinor technique. RESULTS: Individual ratings for pain, stiffness, and fatigue correlated highly with each other throughout the day and over the days of the week. Of the FM classifiers, dolorimetry score was found to be inversely related to the pain, stiffness, and fatigue scores. For the group of subjects with a low dolorimetry score (< 2.25 kg), a significant diurnal rhythm was found in each self-rated variable, with greater pain, stiffness, and fatigue observed in the morning and least in the late afternoon. No rhythm in pain or stiffness was observed in those subjects with a higher threshold for pain (dolorimetry score > 2.25 kg), while fatigue showed the same significant diurnal pattern as in the first group. For the group as a whole, the possible presence of a weekly variation was found with ratings for pain, stiffness, and fatigue higher on Sunday and Monday and lower on Friday. CONCLUSION: Ratings of pain, stiffness, and fatigue in FM are significantly correlated, and show diurnal and possibly weekly rhythmicity, especially when pain threshold is low (dolorimetry score < 2.25 kg), and are thus predictive of each other over these time spans. This has important implications for scheduling activities of daily living, for measurement in clinical trials, and possibly for timing the administration of medications

     (53)    Kendall SA, Brolin-Magnusson K, Soren B, Gerdle B, Henriksson KG. A pilot study of body awareness programs in the treatment of fibromyalgia syndrome. Arthritis Care Res 2000; 13(5):304-311.
Abstract: OBJECTIVE: To compare in a pilot study the effect of two physical therapies, the Mensendieck system (MS) and body awareness therapy (BAT) according to Roxendal, in fibromyalgia patients and to investigate differences in effect between the two interventions. METHODS: Twenty female patients were randomized to either MS or BAT in a program lasting 20 weeks. Evaluations were tender point examination and questionnaires, including visual analog scales (pain intensity at worst site, muscular stiffness, evening fatigue, and global health), Fibromyalgia Impact Questionnaire (FIQ), Coping Strategies Questionnaire, Quality of Life Scales, Arthritis Self-Efficacy Scale (ASES), and disability before, immediately after, and at 6 and 18 months follow-up. RESULTS: The BAT group had improved global health at 18 months follow-up, but lower results than the MS group. The MS group had improved FIQ, ASES other symptoms, and pain at worst site at 18 months follow-up. CONCLUSION: In the present pilot study, MS was associated with more positive changes than BAT

     (54)    Creamer P, Singh BB, Hochberg MC, Berman BM. Sustained improvement produced by nonpharmacologic intervention in fibromyalgia: results of a pilot study. Arthritis Care Res 2000; 13(4):198-204.
Abstract: OBJECTIVE: The aim of this pilot study was to examine the practicality of delivering a package of nonpharmacologic, behavioral-based treatment, previously found to be effective in chronic back pain, to patients with fibromyalgia (FM) and to assess the efficacy of the intervention using a range of outcome measures up to 4 months posttreatment. METHODS: Participants with FM (n = 28) formed a single group for 8 sessions at weekly intervals. Each session comprised an education/cognitive-behavioral component, formal relaxation/meditation training, and instruction in a Chinese movement therapy (Qi Gong). RESULTS: Twenty of 28 subjects completed at least 5 of the 8 sessions. Significant improvement was seen in the Fibromyalgia Impact Questionnaire and a range of other outcome measures including tender points and pain threshold. Improvement was sustained 4 months after the end of the intervention. CONCLUSION: A simple behavioral intervention using large groups can be administered to subjects with FM and appears to produce sustained benefit in a range of outcomes. Controlled trials are currently being planned

     (55)    Taggart HM, Arslanian CL, Bae S, Singh K. Effects of T'ai Chi exercise on fibromyalgia symptoms and health-related quality of life. Orthop Nurs 2003; 22(5):353-360.
Abstract: BACKGROUND: Fibromyalgia (FM), one of the most common musculoskeletal disorders, is associated with high levels of impaired health and inadequate or limited symptom relief. The cause of this complex syndrome is unknown, and there is no known cure. Numerous research results indicate that a combination of physical exercise and mind-body therapy is effective in symptom management. T'ai Chi, an ancient Chinese exercise, combines physical exercise with mindbody therapy. PURPOSE: To investigate the effects of T'ai Chi exercise on FM symptoms and health-related quality of life. DESIGN: Pilot study, one group pre-to-post posttest design. METHODS: Participants with FM (n = 39) formed a single group for 6 weeks of 1-hour, twice weekly T'ai Chi exercise classes. FM symptoms and health-related quality of life were measured before and after exercise. FINDINGS: Twenty-one participants completed at least 10 of the 12 exercise sessions. Although the dropout rate was higher than expected, measurements on both the Fibromyalgia Impact Questionnaire (FIQ) (Buckhardt, Clark, & Bennett, 1991) and the Short Form-36 (SE-36) (Ware & Sherbourne, 1992) revealed statistically significant improvement in symptom management and health-related quality of life. IMPLICATIONS FOR NURSING RESEARCH: Knowledge of interventions to enhance health for the patient with musculoskeletal problems is a National Association of Orthopaedic Nurses priority. Tai Chi is potentially beneficial to patients with FM. Further research is needed to support evidence-based practice

     (56)    Sayar K, Aksu G, Ak I, Tosun M. Venlafaxine treatment of fibromyalgia. Ann Pharmacother 2003; 37(11):1561-1565.
Abstract: BACKGROUND: Although the pathophysiology of fibromyalgia is unknown, central monoaminergic transmission may play a role. Antidepressants have proved to be successful in alleviating symptoms of fibromyalgia. Medications that act on multiple neurotransmitters may be more effective in symptom management. OBJECTIVE: To assess the efficacy of venlafaxine, a potent inhibitor of both norepinephrine and serotonin reuptake, in the treatment of patients with fibromyalgia. METHODS: Fifteen patients with fibromyalgia were assessed prior to and after treatment with fixed-dose venlafaxine 75 mg/d. Before initiation of pharmacotherapy, patients were interviewed with the Structured Clinical Interview for Axis I disorders in the Diagnostic and Statistical Manual of Mental Disorders, 4th edition. The study lasted for 12 weeks, and patients were evaluated in weeks 6 and 12. The primary outcome measures were the Fibromyalgia Impact Questionnaire (FIQ) total score and pain score. The anxiety and depression levels of the patients were measured with the Beck Depression, the Beck Anxiety, the Hamilton Anxiety, and the Hamilton Depression scales. RESULTS: There was a significant improvement in the mean intensity of pain (F = 14.3; p = 0.0001) and in the disability caused by fibromyalgia (F = 42.7; p = 0.0001) from baseline to week 12 of treatment. The depression and anxiety scores also decreased significantly from baseline to week 12. The improvement in the FIQ scores did not correlate with the decrease of scores in both patient- and physician-rated depression and anxiety inventories. Change in pain scores also was not correlated with the change in depression and anxiety scores. CONCLUSIONS: Venlafaxine was quite promising in alleviating the pain and disability associated with fibromyalgia. This effect seems to be independent of its anxiolytic and antidepressant properties. Blockade of both norepinephrine and serotonin reuptake might be more effective than blockade of either neurotransmitter alone in the treatment of fibromyalgia

     (57)    Astin JA, Berman BM, Bausell B, Lee WL, Hochberg M, Forys KL. The efficacy of mindfulness meditation plus Qigong movement therapy in the treatment of fibromyalgia: a randomized controlled trial. J Rheumatol 2003; 30(10):2257-2262.
Abstract: OBJECTIVE: To test the short and longterm benefits of an 8 week mind-body intervention that combined training in mindfulness meditation with Qigong movement therapy for individuals with fibromyalgia syndrome (FM). METHODS: A total of 128 individuals with FM were randomly assigned to the mind-body training program or an education support group that served as the control. Outcome measures were pain, disability (Fibromyalgia Impact Questionnaire), depression, myalgic score (number and severity of tender points), 6 minute walk time, and coping strategies, which were assessed at baseline and at 8, 16, and 24 weeks. RESULTS: Both groups registered statistically significant improvements across time for the Fibromyalgia Impact Questionnaire, Total Myalgic Score, Pain, and Depression, and no improvement in the number of feet traversed in the 6 minute walk. However, there was no difference in either the rate or magnitude of these changes between the mind-body training group and the education control group. Salutary changes occurring by the eighth week (which corresponded to the end of the mind-body and education control group sessions) were largely maintained by both groups throughout the 6 month followup period. CONCLUSION: While both groups showed improvement on a number of outcome variables, there was no evidence that the multimodal mind-body intervention for FM was superior to education and support as a treatment option. Additional randomized controlled trials are needed before interventions of this kind can be recommended for treatment of FM

     (58)    Altan L, Bingol U, Aykac M, Koc Z, Yurtkuran M. Investigation of the effects of pool-based exercise on fibromyalgia syndrome. Rheumatol Int 2004; 24(5):272-277.
Abstract: OBJECTIVE: The aim of this study was to compare pool-based exercise and balneotherapy in fibromyalgia syndrome (FMS) patients. METHODS: Fifty female patients diagnosed with FMS according to the American College of Rheumatism (ACR) criteria were randomly assigned to two groups: group 1 (n=25) with pool-based exercise, and in group 2 (n=25) balneotherapy was applied in the same pool without any exercise for 35 min three times a week for 12 weeks. In both groups, pre- (week 0) and post-treatment (weeks 12 and 24) evaluation was performed by one of the authors, who was blind to the patient group. Evaluation parameters included pain, morning stiffness, sleep, tender points, global evaluation by the patient and the physician, fibromyalgia impact questionnaire, chair test, and Beck depression inventory. Statistical analysis was done on data collected from three evaluation stages. RESULTS: Twenty-four exercise and 22 balneotherapy patients completed the study. Pretreatment (week 0) measurements did not show any difference between the groups. In group 1, statistically significant improvement was observed in all parameters ( P<0.01) except for the chair test at both weeks 12 and 24. In group 2, week 12 measurements showed significant improvement in all parameters ( P<0.01) except for the chair test and Beck depression inventory. Week 24 evaluation results in group 2 showed significant improvements in pain and fatigue according to visual analogue scale (VAS), 5-point scale, number of tender points, algometric and myalgic scores, and patient and physician global evaluation (P<0.01 and P<0.05, respectively), while improvements were nonsignificant in morning stiffness, sleep, fibromyalgia impact questionnaire (FIQ), chair test, and Beck depression inventory parameters in this group. Comparison of the two groups based on the post-treatment (weeks 12 and 24) percent changes and difference scores relative to pretreatment (week 0) values failed to show a significant difference between the groups for any parameter except Beck depression inventory (P<0.01). CONCLUSION: The results of our study showed that pool-based exercise had a longer-lasting effect on some of the FMS symptoms, but statistical analysis failed to show a significant superiority of pool-based exercise over balneotherapy without exercise. While we believe that exercise is a gold standard in FMS treatment, we also suggest in light of our results that balneotherapy is among the valid treatment options in FMS, and further research regarding the type and duration of the exercise programs is necessary

     (59)    Sarzi-Puttini P, Atzeni F, Fiorini T, Panni B, Randisi G, Turiel M et al. Validation of an Italian version of the Fibromyalgia Impact Questionnaire (FIQ-I). Clin Exp Rheumatol 2003; 21(4):459-464.
Abstract: OBJECTIVE: To validate a translated Italian version of the Fibromyalgia Impact Questionnaire (FIQ). METHODS: The Italian version of the FIQ was administered to 50 patients affected by fibromyalgia (FM) (48 patients filled out the questionnaire again 10 days later) together with the Italian version of the Stanford Health Assessment Questionnaire (HAQ), the Medical Outcomes Survey Short Form-36 (SF-36), and a tender point count (TPC) obtained by summing the score (0-3) of each tender point tested by thumb palpation. All patients were asked about the severity of pain today (10 cm visual analog scale) and the duration of symptoms. Test-retest reliability was assessed using Spearman correlations. Internal consistency was evaluated with Cronbach's alpha of reliability. Construct validity of the FIQ was evaluated by correlations between the HAQ and subscales of the SF-36 as well as the TPC. RESULTS: The mean duration of symptoms was 6.5 years and the mean age of the participants was 57.4 years. Test-retest reliability was between 0.74 and 0.95 for physical functioning as well as for the total FIQ and other components. Internal consistency was 0.90 for the overall FIQ. Significant correlations were obtained between the FIQ items, the HAQ and the SF-36. CONCLUSIONS: The Italian FIQ is a reliable and valid instrument for detecting and measuring functional disability and health status in Italian patients with FM

     (60)    Jensen B, Wittrup IH, Bliddal H, nneskiold-Samsoe B, Faber J. Bone mineral density in fibromyalgia patients--correlation to disease activity. Scand J Rheumatol 2003; 32(3):146-150.
Abstract: OBJECTIVE: To compare bone mass (BMD) in women with fibromyalgia (FM) with healthy females, and to evaluate whether self-reported pain and lack of functional capacity correlate to reduced BMD in FM patients. METHODS: Thirty-one FM patients (20 pre- and 11 postmenopausal) and fourty-one healthy women (30 pre- and 10 postmenopausal) were enrolled in the study. BMD of the lumbar spine and the femoral neck was measured by a DEXA (Norland) scanner. Self reported pain was measured on a Visual Analog Scale (VAS). The Activity of Daily Living (ADL) component of the Fibromyalgia Impact Questionnaire (FIQ-ADL) was used as measure for physical capacity. RESULTS: BMD-lumbar spine and BMD-femoral neck did not differ significantly between FM patients and controls, though premenopausal FM patients tended to have lower BMD-femoral neck (p = 0.09). Self reported pain and FIQ-ADL among FM patients correlated with BMD-femoral neck (r(s) = -0.52, p = 0.003); (r(s) = -0.31, p = 0.09). CONCLUSION: Premenopausal FM patients tended to have lower BMD of hip than controls. Self reported pain correlated negatively to BMD. Thus, the severity of FM might have a negative impact on bone mass

     (61)    Martinez-Lavin M, Lopez S, Medina M, Nava A. Use of the leeds assessment of neuropathic symptoms and signs questionnaire in patients with fibromyalgia. Semin Arthritis Rheum 2003; 32(6):407-411.
Abstract: OBJECTIVE: Neuropathic pain syndrome is characterized by chronic, stimulus-independent pain sensation accompanied by hyperalgesia/allodynia and paresthesia. Fibromyalgia (FM) syndrome displays such features. The Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) Pain Scale is an instrument developed and validated to recognize neuropathic pain and set it apart from nociceptive pain. METHODS: This study assessed the responses of patients with FM versus patients with rheumatoid arthritis (RA) to the LANSS Pain Scale questionnaire. Twenty patients with FM and 20 patients with RA answered the Fibromyalgia Impact Questionnaire and LANSS Pain Scale questions related to the following neuropathic sensory disturbance domains: dysesthetic, autonomic, evoked, paroxysmal, and thermal. RESULTS: Pain severity was similar in both groups according to visual analog scale values (5.3 +/- 3.0 for FM v 5.4 +/- 3.1 for RA). There were sharp differences between FM and RA groups in the percentage of affirmative responses to 4 of 5 sensory disturbance questions: dysesthetic (95 v 30), evoked (95 v 35), paroxysmal (90 v 15), and thermal (90 v 20); P <.0001 for each comparison. CONCLUSIONS: The high prevalence of associated sensory disturbances supports the notion that FM is a neuropathic pain syndrome. Clinical Relevance: The LANSS Pain Scale items may become a useful, easily applied bedside test to differentiate FM pain from the nociceptive pain present in RA and in similar arthritic illnesses

     (62)    Bennett RM, Kamin M, Karim R, Rosenthal N. Tramadol and acetaminophen combination tablets in the treatment of fibromyalgia pain: a double-blind, randomized, placebo-controlled study. Am J Med 2003; 114(7):537-545.
Abstract: PURPOSE: To evaluate the efficacy and safety of a combination analgesic tablet (37.5 mg tramadol/325 mg acetaminophen) for the treatment of fibromyalgia pain. METHODS: This 91-day, multicenter, double-blind, randomized, placebo-controlled study compared tramadol/acetaminophen combination tablets with placebo. The primary outcome variable was cumulative time to discontinuation (Kaplan-Meier analysis). Secondary measures at the end of the study included pain, pain relief, total tender points, myalgia, health status, and Fibromyalgia Impact Questionnaire scores. RESULTS: Of the 315 subjects who were enrolled in the study, 313 (294 women [94%], mean [+/- SD] age, 50 +/- 10 years) completed at least one postrandomization efficacy assessment (tramadol/acetaminophen: n = 156; placebo: n = 157). Discontinuation of treatment for any reason was less common in those treated with tramadol/acetaminophen compared with placebo (48% vs. 62%, P = 0.004). Tramadol/acetaminophen-treated subjects also had significantly less pain at the end of the study (53 +/- 32 vs. 65 +/- 29 on a visual analog scale of 0 to 100, P <0.001), and better pain relief (1.7 +/- 1.4 vs. 0.8 +/- 1.3 on a scale of -1 to 4, P <0.001) and Fibromyalgia Impact Questionnaire scores (P = 0.008). Indexes of physical functioning, role-physical, body pain, health transition, and physical component summary all improved significantly in the tramadol/acetaminophen-treated subjects. Discontinuation due to adverse events occurred in 19% (n = 29) of tramadol/acetaminophen-treated subjects and 12% (n = 18) of placebo-treated subjects (P = 0.09). The mean dose of tramadol/acetaminophen was 4.0 +/- 1.8 tablets per day. CONCLUSION: A tramadol/acetaminophen combination tablet was effective for the treatment of fibromyalgia pain without any serious adverse effects

     (63)    Valim V, Oliveira L, Suda A, Silva L, de AM, Barros NT et al. Aerobic fitness effects in fibromyalgia. J Rheumatol 2003; 30(5):1060-1069.
Abstract: OBJECTIVE: To compare 2 exercise modalities, aerobic fitness training and stretching exercises, in patients with fibromyalgia (FM) in relation to function, pain, quality of life, depression, and anxiety, and to correlate the cardiorespiratory fitness gain with symptom improvement. METHODS: Seventy-six women with FM between 18 and 60 years old were randomized to either an aerobic program or stretching program, for 20 weeks. They were evaluated at the beginning of the program and after 10 and 20 weeks in relation to the improvement of aerobic fitness, flexibility, function, Fibromyalgia Impact Questionnaire (FIQ), Short-form Health Survey (SF-36), and depression and anxiety levels. Ventilatory anaerobic threshold (VT) and maximum oxygen uptake (VO2max) were determined by expired gas analyses. RESULTS: Aerobic exercise was superior to stretching in relation to VO2 max, VT, function, depression, pain, and the emotional aspects and mental health domains of SF-36. Patients in the stretching group showed no improvement in depression, "role emotional," and "mental health." No association was noted between improvement in aerobic fitness as measured by VT and the improvement of pain, function, or scores in FIQ and SF-36. CONCLUSION: Our results confirm that aerobic exercise is beneficial to patients with FM, but the cardiorespiratory fitness gain is not related to improvement of FM symptoms

     (64)    Eisinger J. [Clinical evaluation of fibromyalgia]. Rev Med Interne 2003; 24(4):237-242.
Abstract: OBJECTIVES: Fibromyalgia is characterized by diffuse, persistent and unexplained muscle pain associated with tenderness (mechanical allodynia) and unspecific symptoms. Diagnosis criteria as well as pathophysiological mechanisms are still unclear, justifying appropriate questionnaires and clinical investigations. ACTUAL TOPICS: Several questionnaires including visual analogic scales with respect to pain, fatigue, sleep or mood disorders have been used in fibromyalgia such as Fibromyalgia Impact Questionnaire (30 items) and the European List for Fibromyalgia Evaluation (53 items). Similarly several methods have been proposed to evaluate tenderness in fibromyalgia patients: The study of tender points involves their number (normal value < 4/18), or their pain mean intensity score and the sum of their sensitivities defining the tender point index (normal value < 11/72); The average pain threshold (normal value > 4 kg/cm(2)) is more precise, requiring sophisticated devices (mechanical algometers) and physician training; Less complex than pain threshold measurement, more reliable than the tender points number or index, the tensiometer induced myalgia (normal value > 210 mmHg) is probably a promising new alternative way to screen for fibromyalgia. PROSPECTS: Even if further studies are needed, diagnosis approach of fibromyalgia could be improved by new tools such as the European List for Fibromyalgia Evaluation and algotensiometry

     (65)    Pfeiffer A, Thompson JM, Nelson A, Tucker S, Luedtke C, Finnie S et al. Effects of a 1.5-day multidisciplinary outpatient treatment program for fibromyalgia: a pilot study. Am J Phys Med Rehabil 2003; 82(3):186-191.
Abstract: OBJECTIVE: The purpose of this pilot study was to determine the effect of a 1.5-day multidisciplinary fibromyalgia treatment program on impact of illness, depression, and life fulfillment. DESIGN: A sample of 100 consecutive enrollees in a 1.5-day multidisciplinary group outpatient fibromyalgia treatment program between February 14, 2000, and May 9, 2000, in a tertiary medical center was used for this study. The Fibromyalgia Impact Questionnaire, the Life Fulfillment and Satisfaction Scales, and the Center for Epidemiologic Studies Depression Scale were administered to subjects immediately preceding the treatment program and by mail 1 mo after completing the program. RESULTS: The 78 subjects who returned their surveys 1 mo after treatment demonstrated significant improvement in the area of the impact of illness as measured by the Fibromyalgia Impact Questionnaire total score (51.3-44.7, P < 0.002). There was no significant improvement in depressive symptoms (P < 0.056) or the level of life fulfillment (P < 0.53). Subjects with depression improved on the Fibromyalgia Impact Questionnaire to the same degree as those without depression. The 22 nonresponders did not differ significantly from the responders in the variables of sex, age, pretreatment Fibromyalgia Impact Questionnaire score, marital status, educational level, family income, duration of symptoms, or history of depression. CONCLUSIONS: These results suggest that a 1.5-day multidisciplinary fibromyalgia treatment program does have a significant positive effect on the impact of illness among patients with fibromyalgia with or without concomitant depression and may be a cost-effective model for the treatment of these patients

     (66)    Gowans SE, Dehueck A, Abbey SE. Measuring exercise-induced mood changes in fibromyalgia: a comparison of several measures. Arthritis Rheum 2002; 47(6):603-609.
Abstract: OBJECTIVE: To compare scales measuring exercise-induced changes in mood. METHODS: Mood changes in a randomized, 23-week controlled trial of exercise were assessed using the Beck Depression Inventory (BDI), Center for Epidemiologic Studies Depression Scale (CES-D), State Trait Anxiety Inventory (STAI), Fibromyalgia Impact Questionnaire, and the Mental Health Inventory (MHI). Effect sizes and t-tests were computed on 23-week change scores. Scales were deemed to be confounded if items addressed sleep disturbances, fatigue, or effort (symptoms of both mood disturbances and fibromyalgia). RESULTS: Efficacy (15 exercise subjects) and intent-to-treat analyses (27 exercise subjects) generated medium effects for BDI (total, cognitive), MHI depression (efficacy only), and CES-D (intent-to-treat only) scales. BDI (total, cognitive), MHI (depression, positive affect, total [MHI-5]), and STAI scales distinguished exercise from control subjects at 23 weeks in all analyses. BDI somatic and CES-D scales were deemed to be confounded. CONCLUSION: We recommend the BDI cognitive, STAI, and MHI-5 scales to measure depression, anxiety, and general mood, respectively, in patients with fibromyalgia

     (67)    Gur A, Karakoc M, Erdogan S, Nas K, Cevik R, Sarac AJ. Regional cerebral blood flow and cytokines in young females with fibromyalgia. Clin Exp Rheumatol 2002; 20(6):753-760.
Abstract: OBJECTIVE: To determine whether there is any difference in regional cerebral blood flow (rCBF) and serum cytokine levels and association between clinical parameters and rCBF and serum cytokine levels in young females with fibromyalgia (FM). The other aim was to search whether the depression state has any effect on these two parameters. METHODS: Nineteen women with FM and 20 healthy women had 99mTc-HMPAO brain single-photon-emission computed tomography (SPECT) to evaluate rCBF. Serum interleukin (IL) levels (IL 1 beta, IL 2r, IL 6 and IL 8) were measured. Clinical and psychological evaluation was also carried out in FM patients and healthy controls. RESULTS: The patients with FM had significantly higher radioactivity uptake ratio in right and left caudate nucleus (p = 0.009, p = 0.001, respectively) than healthy controls. There was statistically significant decrease in the 99mTc-HMPAO uptake in the right superior parietal (p = 0.041), gyrus rectalis (p = 0.036) and pons (p = 0.023). FM patients had significantly higher serum IL 2r and IL 8 levels (p = 0.023, p = 0.011, respectively) than controls. Additionally, FM patients had significantly higher Fibromyalgia Impact Questionnaire (FIQ), Health Assessment Questionnaire (HAQ), and Hamilton Depression Rate scale (HDRS) scores (p = 0.000) than controls. Interestingly, the patients with mild depressive symptoms or without (i.e. HDRS-score < or = 16) had significantly higher serum IL 8 levels (p = 0.027) and increased radioactivity uptake ratio in the pons (P = 0.036) than the patients with more severe depressive symptoms (i.e. HDRS-score > 16). With regard to regional cerebral blood flow, significant correlations were detected between RSP and morning stiffness (r = 0.70, p < 0.01) and sleep disturbance (r = -0.53, p < 0.05), and between gyrus rectalis and FIQ score. There were significant correlations between LCN and IL-2 (P = 0.025), between RSP and morning stiffness (P = 0.006), sleep disturbance (P = 0.021) according to multiple regression analysis test. CONCLUSION: This study shows a significant increase in rCBF of caudate nuclei, a reduction in the pons, some cortical regions activity and a increase in IL 8, IL2r levels of young female patients with FM. These findings are more prominent in patients with low HDRS scores

     (68)    Fitzcharles MA, Costa DD, Poyhia R. A study of standard care in fibromyalgia syndrome: a favorable outcome. J Rheumatol 2003; 30(1):154-159.
Abstract: OBJECTIVE: A longitudinal prospective study was undertaken to examine the outcome of fibromyalgia (FM) with standard medical care, as well as factors that might either predict or influence this outcome. METHODS: Eighty-two women with clinical FM were evaluated at baseline and 70 were followed for a mean of 40 months. Patients continued their usual management for FM as prescribed by their own physicians. The primary outcome variable was patient's overall status compared to baseline on a 7 point Likert scale (range 1 = much worse, 7 = much better). Secondary outcome measures included measurements for pain, fatigue, and patient and physician global assessment on a visual analog scale. Additional functional measures were the disease-specific Fibromyalgia Impact Questionnaire (FIQ), and the generic Health Assessment Questionnaire (HAQ). RESULTS: Of 70 (85%) patients who were followed up at 3 years, 33 (47%) reported overall moderate to marked improvement, and the remaining 53% reported either slight improvement, no change, or deterioration. The improved group (n = 33) compared to those that remained the same or worsened (n = 37) showed significant differences for change of score from baseline for tender point count, patient global assessment, sleep disturbance, fatigue, pain, FIQ and HAQ, and were younger, 46 versus 51 years. No other baseline demographic or disease variables discriminated between the 2 groups. The only baseline predictors for a favorable outcome were younger age and less sleep disturbance. CONCLUSION: The overall outcome in this group was favorable, with almost half the sample reporting clinically meaningful improvement in overall FM status. These findings are discussed in terms of their implications regarding current theory on the pathogenesis of FM

     (69)    Mannerkorpi K, Ahlmen M, Ekdahl C. Six- and 24-month follow-up of pool exercise therapy and education for patients with fibromyalgia. Scand J Rheumatol 2002; 31(5):306-310.
Abstract: OBJECTIVE: To follow patients with fibromyalgia six and 24 months after they finished a six-month treatment programme. The programme comprised pool exercise therapy, adjusted to the patients' limitations, and education based on their health problems. METHODS: Twenty-six patients were examined six and 24 months after the completion of the treatment programme with the Fibromyalgia Impact Questionnaire (FIQ), SF-36, the 6-minute walk test, and the Grippit measure. The values obtained at the follow-up examinations were compared with the baseline and post-treatment values. RESULTS: As compared with baseline, symptom severity (FIQ, SF-36), physical function (FIQ, SF-36, 6-minute walk test) and quality of life (SF-36) still showed improvements six months after the completion of treatment (p <0.05). Pain (FIQ, SF-36), fatigue (FIQ, SF-36), walking ability, and social function (SF-36) still showed improvements 2 years after the completion of the programme as compared with the baseline values (p < 0.05). No significant changes were found for these variables, when the values obtained at the two follow-up examinations were compared with those of the post-treatment examination. CONCLUSIONS: Improvements in symptom severity, physical function and social function were still found six and 24 months after the completed treatment programme

     (70)    Lindberg L, Iwarsson S. Subjective quality of life, health, I-ADL ability and adaptation strategies in fibromyalgia. Clin Rehabil 2002; 16(6):675-683.
Abstract: OBJECTIVES: To describe subjective quality of life and health, self-perceived instrumental activities of daily living (I-ADL) ability and adaptation strategies, and to explore possible relationships between these variables in fibromyalgia patients. DESIGN: Two instruments were used with fibromyalgia patients: the Fibrositis Impact Questionnaire and 'Living with fibromyalgia - adaptation to chronic disease and handicap', and correlative analyses were performed. SUBJECTS: A sample of 34 patients undergoing rehabilitation (in a specific programme). RESULTS: The majority of the patients used many adaptation strategies, demonstrating some significant relationships with perceived I-ADL ability and subjective quality of life and health. Different symptoms correlated highly significantly with self-perceived ability in I-ADL. CONCLUSION: The significant relationships between adaptation strategies and I-ADL ability and health demonstrated deserve clinical awareness and further research efforts

     (71)    Gur A, Karakoc M, Nas K, Cevik R, Sarac J, Ataoglu S. Effects of low power laser and low dose amitriptyline therapy on clinical symptoms and quality of life in fibromyalgia: a single-blind, placebo-controlled trial. Rheumatol Int 2002; 22(5):188-193.
Abstract: The purpose of this study was to examine the effectiveness of low power laser (LPL) and low-dose amitriptyline therapy and to investigate effects of these therapy modalities on clinical symptoms and quality of life (QOL) in patients with fibromyalgia (FM). Seventy-five patients with FM were randomly allocated to active gallium-arsenide (Ga-As) laser (25 patients), placebo laser (25 patients), and amitriptyline therapy (25 patients). All groups were evaluated for the improvement in pain, number of tender points, skin fold tenderness, morning stiffness, sleep disturbance, muscular spasm, and fatigue. Depression was evaluated by a psychiatrist according to the Hamilton Depression Rate Scale and DSM IV criteria. Quality of life of the FM patients was assessed according to the Fibromyalgia Impact Questionnaire (FIQ). In the laser group, patients were treated for 3 min at each tender point daily for 2 weeks, except weekends, at each point with approximately 2 J/cm(2) using a Ga-As laser. The same unit was used for the placebo treatment, for which no laser beam was emitted. Patients in the amitriptyline group took 10 mg daily at bedtime throughout the 8 weeks. Significant improvements were indicated in all clinical parameters in the laser group (P = 0.001) and significant improvements were indicated in all clinical parameters except fatigue in the amitriptyline group (P = 0.000), whereas significant improvements were indicated in pain (P = 0.000), tender point number (P = 0.001), muscle spasm (P = 0.000), morning stiffness (P = 0.002), and FIQ score (P = 0.042) in the placebo group. A significant difference was observed in clinical parameters such as pain intensity (P = 0.000) and fatigue (P = 0.000) in favor of the laser group over the other groups, and a significant difference was observed in morning stiffness (P = 0.001), FIQ (P = 0.003), and depression score (P = 0.000) after therapy. A significant difference was observed in morning stiffness (P = 0.001), FIQ (P = 0.003), and depression (P = 0.000) in the amitriptyline group compared to the placebo group after therapy. Additionally, a significant difference was observed in depression score (P = 0.000) in the amitriptyline group in comparison to the laser group after therapy. Our study suggests that both amitriptyline and laser therapies are effective on clinical symptoms and QOL in fibromyalgia and that Ga-As laser therapy is a safe and effective treatment in cases with FM. Additionally, the present study suggests that the Ga-As laser therapy can be used as a monotherapy or as a supplementary treatment to other therapeutic procedures in FM

     (72)    Richards SC, Scott DL. Prescribed exercise in people with fibromyalgia: parallel group randomised controlled trial. BMJ 2002; 325(7357):185.
Abstract: OBJECTIVES: To evaluate cardiovascular fitness exercise in people with fibromyalgia. DESIGN: Randomised controlled trial. Setting: Hospital rheumatology outpatients. Group based classes took place at a "healthy living centre." PARTICIPANTS: 132 patients with fibromyalgia. INTERVENTIONS: Prescribed graded aerobic exercise (active treatment) and relaxation and flexibility (control treatment). MAIN OUTCOME MEASURES: Participants' self assessment of improvement, tender point count, impact of condition measured by fibromyalgia impact questionnaire, and short form McGill pain questionnaire. RESULTS: Compared with relaxation exercise led to significantly more participants rating themselves as much or very much better at three months: 24/69 (35%) v 12/67 (18%), P=0.03. Benefits were maintained or improved at one year follow up when fewer participants in the exercise group fulfilled the criteria for fibromyalgia (31/69 v 44/67, P=0.01). People in the exercise group also had greater reductions in tender point counts (4.2 v 2.0, P=0.02) and in scores on the fibromyalgia impact questionnaire (4.0 v 0.6, P=0.07). CONCLUSIONS: Prescribed graded aerobic exercise is a simple, cheap, effective, and potentially widely available treatment for fibromyalgia

     (73)    White KP, Nielson WR, Harth M, Ostbye T, Speechley M. Does the label "fibromyalgia" alter health status, function, and health service utilization? A prospective, within-group comparison in a community cohort of adults with chronic widespread pain. Arthritis Rheum 2002; 47(3):260-265.
Abstract: OBJECTIVE: To determine if assigning the label of fibromyalgia (FM) to individuals with chronic widespread pain has a significant effect on long-term health status, function, and health service utilization.METHODS: In the London Fibromyalgia Epidemiology Study, 100 individuals with FM were identified by screening 3,395 non-institutionalized adults. Only 28 of the 100 had been previously diagnosed with FM; for 72, the diagnostic label was new. All 28 with prediagnosed FM were female compared with 58 of the 72 newly diagnosed cases. In a prospective, within-group comparison, we compared previously non-labeled FM cases at study entry (prelabeling) and at 18 and 36 months followup (postlabeling) with respect to general health status, fibromyalgia-related symptoms, and all items from the Fibromyalgia Impact Questionnaire (FIQ) (including total FIQ score, and several measures of health service utilization) to see if health status, function, and health services utilization had changed, using paired t-tests. We also compared percentage reporting work disability at baseline and 18 months using Pearson's chi(2).RESULTS: Fifty-six (78%) of the original 72 newly diagnosed FM cases were available for reassessment at 18 months, and 43 (60%) at 36 months. Although physical functioning decreased slightly over time, there also was a statistically significant improvement in satisfaction with health, and newly diagnosed FM cases reported fewer symptoms and major symptoms over the long term. No other differences in clinical status or health service use occurred over time.CONCLUSION: The FM label does not have a meaningful adverse affect on clinical outcome over the long term. Further research is necessary to document the short- and long-term effect of labeling in the chronic pain patient

     (74)    Van HB, Neerinckx E, Onghena P, Vingerhoets A, Lysens R, Vertommen H. Daily hassles reported by chronic fatigue syndrome and fibromyalgia patients in tertiary care: a controlled quantitative and qualitative study. Psychother Psychosom 2002; 71(4):207-213.
Abstract: BACKGROUND: This study aimed at providing insight in the frequency, emotional impact and nature of daily hassles, experienced by patients suffering from chronic fatigue syndrome (CFS) and/or fibromyalgia (FM), compared with patients with a chronic organic disease. METHODS: One hundred and seventy-seven CFS/FM patients, 26 multiple sclerosis (MS) and 26 rheumatoid arthritis (RA) patients were investigated within 2-6 months after diagnosis. All patients completed a self-report questionnaire assessing daily hassles and associated distress, a visual analogue scale assessing fatigue and pain and a depression and anxiety questionnaire. RESULTS: CFS/FM patients show a higher frequency of hassles, higher emotional impact and higher fatigue, pain, depression and anxiety levels compared with MS/RA patients. Three hassle themes dominate in the CFS/FM group: dissatisfaction with oneself, insecurity and a lack of social recognition. In contrast, hassles reported by MS/RA patients show a much larger diversity and are not focused on person-dependent problems. CONCLUSIONS: Patients recently diagnosed as suffering from CFS and/or FM are highly preoccupied and distressed by daily hassles that have a severe impact on their self-image, as well as their personal, social and professional functioning. An optimal therapeutic approach of CFS and FM should take account of this heavy psychosocial burden, which might refer to core themes of these patients' illness experience

     (75)    Ostuni P, Botsios C, Sfriso P, Bertagnin A, Cozzi F, Doria A et al. [Prevalence and clinical features of fibromyalgia in systemic lupus erythematosus, systemic sclerosis and Sjogren's syndrome]. Minerva Med 2002; 93(3):203-209.
Abstract: BACKGROUND: We studied the prevalence of fibromyalgia in 3 different groups of patients affected respectively with systemic lupus erythematosus, systemic sclerosis (scleroderma) and primary Sjogren's syndrome. The typical fibromyalgia findings encountered in these diseases were examined. METHODS: We enrolled 250 consecutive outpatients: 100 with systemic lupus erythematosus, 50 with systemic sclerosis, 100 with primary Sjogren's syndrome and 2 control groups (30 healthy subjects and 75 patients with primary fibromyalgia). Fibromyalgia features were evaluated by algometry, VAS for pain, Mc Gill Pain Questionnaire and Fibromyalgia Impact Questionnaire. RESULTS: Fibromyalgia has been found in 1 case (1%) with systemic lupus erythematosus, 1 case with systemic sclerosis (2%), 22 cases (22%) with primary Sjogren's syndrome and in 1 (3.3%) of the healthy controls. The number of tender points was significantly higher (p<0.01) in the patients with Sjogren's syndrome in comparison with the other groups. Fibromyalgic findings were similar in the patients with primary fibromyalgia and Sjogren's syndrome with fibromyalgia, unless for both poor sleep and low algometric thresholds which were more frequently found in primary fibromyalgia (respectively p<0.001 and p=0.05). CONCLUSIONS: Our study suggests that fibromyalgia is relatively frequent in primary Sjogren's syndrome, while in systemic lupus and systemic sclerosis its prevalence is not different from that found in the healthy controls. Typical fibromyalgia findings, except algometric values, were similar between the cases with Sjogren's syndrome plus fibromyalgia and fibromyalgia alone

     (76)    Evcik D, Kizilay B, Gokcen E. The effects of balneotherapy on fibromyalgia patients. Rheumatol Int 2002; 22(2):56-59.
Abstract: Fibromyalgia syndrome (FMS) is a very common rheumatological diagnosis. There are various treatment modalities. This study was planned to investigate the effects of balneotherapy in the treatment of FMS. A total of 42 primary fibromyalgia patients diagnosed according to American College of Rheumatology criteria were included in the study. Their ages ranged between 30 and 55 years. Patients were randomly assigned to two groups. None of them had had a cardiovascular disease before. Group 1 n=22) received 20-min bathing, once a day and five times per week. Patients participated in the study for 3 weeks (total of 15 sessions). Group 2 (n=20) was accepted as the control group. Patients were evaluated by the number of tender points, Visual Analogue Scale for pain, Beck's Depression Index for depression, and Fibromyalgia Impact Questionnaire for functional capacity. Measurements were assessed initially, after the therapy, and at the end of the 6th month. In group 1, there were statistically significant differences in numbers of tender points, Visual Analogue scores, Beck's Depression Index, and Fibromyalgia Impact Questionnaire scores after the therapy program (P<0.001). Also, 6 months later in group 1, there was still an improvement in the number of tender points (P<0.001), Visual Analogue scores, and Fibromyalgia Impact Questionnaire (P<0.005). But there was not a statistical difference in Beck's Depression Index scores compared to the control group (P>0.05). Patients with FMS mostly complain about pain, anxiety, and the difficulty in daily living activities. This study shows that balneotherapy is effective and may be an alternative method in treating fibromyalgia patients

     (77)    Zachrisson O, Regland B, Jahreskog M, Kron M, Gottfries CG. A rating scale for fibromyalgia and chronic fatigue syndrome (the FibroFatigue scale). J Psychosom Res 2002; 52(6):501-509.
Abstract: OBJECTIVE: To construct an observer's rating scale sensitive to change for measuring severity and treatment outcome in fibromyalgia (FM) and chronic fatigue syndrome (CFS) patients. METHODS: A selection of items from the Comprehensive Psychopathological Rating Scale (CPRS) were repeatedly rated and used as outcome measure of a 24-week treatment study. In the study 100 women, fulfilling the criteria for both FM and CFS, received intermittent injections of a staphylococcus toxoid or placebo. Nine CPRS-items with high baseline incidence (cutoff 70%) were extracted and validated against global ratings and the Fibromyalgia Impact Questionnaire (FIQ). The fibromyalgia and chronic fatigue syndrome rating scale (the FibroFatigue scale) was thereafter formed based upon the extracted items and three supplemented ones. The interrater reliability was tested in 27 consecutive patients of both sexes. RESULTS: The FibroFatigue scale is an observer's rating scale with 12 items measuring pain, muscular tension, fatigue, concentration difficulties, failing memory, irritability, sadness, sleep disturbances, and autonomic disturbances (items derived from the CPRS) and irritable bowel, headache, and subjective experience of infection (new items). There was a statistically significant correlation between the CPRS-extracted items and global ratings as well as with the FIQ. The interrater reliability of the new scale was excellent (correlation coefficient.98), irrespective of the patients' gender. CONCLUSION: The FibroFatigue scale seems to be a reliable and valid measuring instrument with capacity to monitor symptom severity and change during treatment of FM/CFS patients

     (78)    King SJ, Wessel J, Bhambhani Y, Sholter D, Maksymowych W. Predictors of success of intervention programs for persons with fibromyalgia. J Rheumatol 2002; 29(5):1034-1040.
Abstract: OBJECTIVE: To determine which sociodemographic, psychological, and behavioral characteristics of persons with fibromyalgia (FM) will predict a positive response to treatment; and to determine if subjects classified according to the Multidimensional Pain Inventory (MPI) responded differently to the interventions. METHODS: One hundred twenty-eight women with FM underwent baseline testing and were randomized into one of 3 intervention groups or a control group. After the 12 week program, the subjects were reexamined on the same pretest measures. Stepwise regression analyses were conducted to determine the variables that could significantly predict the change in the dependent variables. A reliability of change index was calculated to determine the proportion of responders and nonresponders. RESULTS: The stepwise regression revealed significant predictor variables for change for all dependent variables except the Fibromyalgia Impact Questionnaire; however, the percentage of the variance in the change scores explained by the independent variables ranged from 4 to 15%. Results from the reliability of change index indicated that no MPI subgroup responded more than another group on any measure. CONCLUSION: Select sociodemographic and psychosocial variables and type of intervention were not strong predictors of improvement in a variety of measures after a treatment program. The low percentage of explained variance may be due to the heterogeneity of FM. Additionally, the low percentage of responders suggests that current forms of treatment are not effective for a large portion of the FM population

     (79)    Kim YA, Lee SS, Park K. Validation of a Korean version of the Fibromyalgia Impact Questionnaire. J Korean Med Sci 2002; 17(2):220-224.
Abstract: The aim of this study was to translate the Fibromyalgia Impact Questionnaire (FIQ) into Korean and to evaluate its reliability and validity for use with Korean-speaking patients with fibromyalgia (FM). After translating the FIQ into Korean, we administered it to 55 patients with FM (28 patients filled out the questionnaire again 7 days later) together with a Korean version of the Health Assessment Questionnaire (HAQ) and the Symptom Checklist-90-Revision (SCL-90-R). The tender-point count (TPC) was calculated from tender points identified by thumb palpation. In addition to sociodemographic characteristics, the severity of relevant current clinical symptoms, e.g., pain intensity, fatigue, and morning stiffness, were assessed by 10-cm visual analog scales (VAS). The test-retest reliability was between 0.466 and 0.780 (total 0.778). Cronbach's alpha was 0.800 for FIQ1 (the first assessment) and 0.857 for FIQ2 (the second assessment), indicating acceptable levels of internal consistency for both assessments. Significant correlations were obtained between the FIQ items, the HAQ, the severity of clinical symptoms, and the subscales of the SCL-90-R. In conclusion, the Korean version of the FIQ is a reliable and valid instrument for measuring health status and physical functioning in Korean patients with FM

     (80)    Rooks DS, Silverman CB, Kantrowitz FG. The effects of progressive strength training and aerobic exercise on muscle strength and cardiovascular fitness in women with fibromyalgia: a pilot study. Arthritis Rheum 2002; 47(1):22-28.
Abstract: OBJECTIVE: To determine the safety, feasibility and consequences of a program of progressive strength training and cardiovascular exercise in women with fibromyalgia syndrome (FMS). METHODS: Fifteen women with confirmed FMS were monitored for injury and exercise compliance, and assessed for muscle strength (1-repetition maximum technique), cardiovascular endurance (6-minute walk test), and functional status (Fibromyalgia Impact Questionnaire [FIQ]) before and after a 20-week exercise intervention. RESULTS: Zero injuries and an 81% compliance rate occurred during training. Improvement was seen in muscle strength of the lower (191 +/- 75 to 265 +/- 67 pounds; P < 0.001) and upper (61 +/- 18 to 76 +/- 18 pounds; P < 0.001) body, 6-minute walk distance (530 +/- 80 to 629 +/- 74 meters; P < 0.001), and in FIQ score (44 +/- 9 to 32 +/- 14; P < 0.01). CONCLUSION: A program of progressive strength training and cardiovascular exercise can be safe, well tolerated, and effective at improving muscle strength, cardiovascular endurance and functional status in women with FMS without exacerbating symptoms. This program may also contribute to a reduction in the severity of several symptoms

     (81)    Arnold LM, Hess EV, Hudson JI, Welge JA, Berno SE, Keck PE, Jr. A randomized, placebo-controlled, double-blind, flexible-dose study of fluoxetine in the treatment of women with fibromyalgia. Am J Med 2002; 112(3):191-197.
Abstract: PURPOSE: To assess the efficacy of fluoxetine in the treatment of patients with fibromyalgia. SUBJECTS AND METHODS: Sixty outpatients (all women, aged 21-71 years) with fibromyalgia were randomly assigned to receive fluoxetine (10-80 mg/d) or placebo for 12 weeks in a double-blind, parallel-group, flexible-dose study. The primary outcome measures were the Fibromyalgia Impact Questionnaire total score (score range, 0 [no impact] to 80) and pain score (score range, 0-10). Secondary measures included the McGill Pain Questionnaire, change in the number of tender points, and total myalgic score. RESULTS: In the intent-to-treat analysis, women who received fluoxetine (mean [+/- SD] dose, 45 +/- 25 mg/d) had significant (P = 0.005) improvement in the Fibromyalgia Impact Questionnaire total score compared with those who received placebo, with a difference of -12 (95% confidence interval [CI]: -19 to -4). They also had significant (P = 0.002) improvement in the Fibromyalgia Impact Questionnaire pain score (difference, -2.2 [95% CI: -3.6 to -0.9]), as well as in the Fibromyalgia Impact Questionnaire fatigue (P = 0.05) and depression (P = 0.01) scores and the McGill Pain Questionnaire (P = 0.01), when compared with subjects who received placebo. Although counts for the number of tender points and total myalgic scores improved more in the fluoxetine group than in the placebo group, these differences were not statistically significant. CONCLUSIONS: In a 12-week, flexible-dose, placebo-controlled trial, fluoxetine was found to be effective on most outcome measures and generally well tolerated in women with fibromyalgia

     (82)    Valim V, Oliveira LM, Suda AL, Silva LE, Faro M, Neto TL et al. Peak oxygen uptake and ventilatory anaerobic threshold in fibromyalgia. J Rheumatol 2002; 29(2):353-357.
Abstract: OBJECTIVE: To compare maximum oxygen uptake and anaerobic threshold in patients with fibromyalgia (FM) and healthy sedentary controls matched by sex, age, weight, and body mass index. METHODS: Fifty women with FM aged 18-60 years and 50 healthy sedentary controls were studied. All were submitted to a maximum treadmill incremental test. Expired gas, ventilatory anaerobic threshold, and maximum oxygen uptake (VO2max) were evaluated. The influence of FM on quality of life was evaluated by questionnaires: the Fibromyalgia Impact Questionnaire and the Medical Outcomes Study Short-Form (SF-36). RESULTS: In patients with FM, the anaerobic threshold and peak oxygen uptake were significantly reduced. Maximum heartbeat rate was significantly lower in FM, indicating submaximum effort. Linear regression data showed a correlation between peak VO2 and the "Role-physical" domain of the SF-36. No such correlations were noted with anaerobic threshold. CONCLUSION: These results confirm the hypothesis of lower physical fitness in patients with FM. Considering that patients with FM do not achieve a maximum effort, ventilatory anaerobic threshold should be considered as a better fitness index than VO2max

     (83)    Cardol M, de Jong BA, van den Bos GA, Beelem A, de G, I, de Haan RJ. Beyond disability: perceived participation in people with a chronic disabling condition. Clin Rehabil 2002; 16(1):27-35.
Abstract: OBJECTIVE: To describe the impact of a chronic disabling condition on participation and to identify variables that may explain perceived restrictions in participation. STUDY DESIGN: Cross-sectional. SETTING: People were recruited from the outpatient clinics of two rehabilitation centres and the rehabilitation department of an academic hospital. SUBJECTS: One hundred and twenty-six people from five diagnostic groups (neuromuscular disease, rheumatoid arthritis, spinal cord injury, stroke, fibromyalgia) participated in the study. METHOD: The IPA (Impact on Participation and Autonomy) questionnaire was used to describe perceived participation. Explanatory variables were studied in terms of sociodemographic factors and health status variables. RESULTS: Some restrictions in participation seem comparable among diagnostic groups, others are specific to one or two groups. People with stroke, rheumatoid arthritis or fibromyalgia perceived more restrictions in participation than people with spinal cord injury or neuromuscular disorders. Emotional distress was the most important factor contributing to restrictions in participation. CONCLUSIONS: Perceived participation remains a complex concept in which many factors are involved. To make a contribution to meaningful participation of people with a chronic disabling condition, rehabilitation treatment should address physical, social, emotional and environmental aspects

     (84)    Gowans SE, Dehueck A, Voss S, Silaj A, Abbey SE, Reynolds WJ. Effect of a randomized, controlled trial of exercise on mood and physical function in individuals with fibromyalgia. Arthritis Rheum 2001; 45(6):519-529.
Abstract: OBJECTIVE: To evaluate the effect of exercise on mood and physical function in individuals with fibromyalgia. METHODS: Subjects were randomly assigned to an exercise (EX) or control (CTL) group. EX subjects participated in 3 30-minute exercise classes per week for 23 weeks. Subjects were tested at entry and at 6, 12, and 23 weeks. Tests included the Beck Depression Inventory (BDI), 6-minute walk, State-Trait Anxiety Inventory (STAI), Mental Health Inventory (MHI), Fibromyalgia Impact Questionnaire (FIQ), Arthritis Self-Efficacy Scale (ASES), and a measure of tender points and knee strength. RESULTS: Fifty subjects (27 EX, 23 CTL) completed the study, and 31 (15 EX, 16 CTL) met criteria for efficacy analyses. In efficacy analyses, significant improvements were seen for EX subjects in 6-minute walk distances, BDI (total, cognitive/ affective), STAI, FIQ, ASES, and MHI (3 of 5 subscales) scores. These effects were reduced but remained during intent-to-treat analyses. CONCLUSION: Exercise can improve the mood and physical function of individuals with fibromyalgia

     (85)    Donaldson MS, Speight N, Loomis S. Fibromyalgia syndrome improved using a mostly raw vegetarian diet: an observational study. BMC Complement Altern Med 2001; 1:7. Epub;%2001 Sep 26.:7.
Abstract: BACKGROUND: Fibromyalgia engulfs patients in a downward, reinforcing cycle of unrestorative sleep, chronic pain, fatigue, inactivity, and depression. In this study we tested whether a mostly raw vegetarian diet would significantly improve fibromyalgia symptoms. METHODS: Thirty people participated in a dietary intervention using a mostly raw, pure vegetarian diet. The diet consisted of raw fruits, salads, carrot juice, tubers, grain products, nuts, seeds, and a dehydrated barley grass juice product. Outcomes measured were dietary intake, the fibromyalgia impact questionnaire (FIQ), SF-36 health survey, a quality of life survey (QOLS), and physical performance measurements. RESULTS: Twenty-six subjects returned dietary surveys at 2 months; 20 subjects returned surveys at the beginning, end, and at either 2 or 4 months of intervention; 3 subjects were lost to follow-up. The mean FIQ score (n = 20) was reduced 46% from 51 to 28. Seven of the 8 SF-36 subscales, bodily pain being the exception, showed significant improvement (n = 20, all P for trend < 0.01). The QOLS, scaled from 0 to 7, rose from 3.9 initially to 4.9 at 7 months (n = 20, P for trend 0.000001). Significant improvements (n = 18, P < 0.03, paired t-test) were seen in shoulder pain at rest and after motion, abduction range of motion of shoulder, flexibility, chair test, and 6-minute walk. 19 of 30 subjects were classified as responders, with significant improvement on all measured outcomes, compared to no improvement among non-responders. At 7 months responders' SF-36 scores for all scales except bodily pain were no longer statistically different from norms for women ages 45-54. CONCLUSION: This dietary intervention shows that many fibromyalgia subjects can be helped by a mostly raw vegetarian diet

     (86)    Mengshoel AM, Haugen M. Health status in fibromyalgia--a followup study. J Rheumatol 2001; 28(9):2085-2089.
Abstract: OBJECTIVE: To examine symptoms, physical function, and nutritional status in patients with fibromyalgia (FM) after 6 to 8 years. METHODS: Of 51 women with FM initially included in exercise and patient education programs 6 and 8 years ago, 33 agreed to participate. Median (range) age was 45.5 years (33-64) and symptom duration 18 years (8-46). Symptoms (visual analog scales), cardiovascular capacity (Aastrand's test), and restriction on daily activities (Fibromyalgia Impact Questionnaire) were measured. Employment status and experience of coping with everyday life were addressed in an interview. Nutritional status was evaluated by anthropometric measurements and dietary intake. RESULTS: All the 33 participants had widespread chronic pain, and 79% had enough tender points to satisfy the FM classification criteria. Compared with initital data there were significant reductions in the number of tender points (p = 0.004) in the exercise group, and in fatigue (p = 0.008) and pain (p = 0.5) in the patient education group. Cardiovascular capacity was within normal limits in 33% of the participants. Currently, 26 performed regular physical activity and of these, 10 were engaged in organized exercise. Seventy-two percent reported regular use of dietary supplements and attached importance to a healthy diet. Still, there was a significant increase in weight and body fat, and 24% were obese (BMI > 30). The coping strategies adopted were adjustments to the new situation and distraction from symptoms. CONCLUSION: No worsening of symptoms and no change in employment status, as well as frequent participation in physical activities, suggests a benign longterm outcome in these patients with FM

     (87)    Goulding C, O'Connell P, Murray FE. Prevalence of fibromyalgia, anxiety and depression in chronic hepatitis C virus infection: relationship to RT-PCR status and mode of acquisition. Eur J Gastroenterol Hepatol 2001; 13(5):507-511.
Abstract: BACKGROUND: Musculoskeletal complaints, dry eyes, fatigue and anxiety are common symptoms in patients with hepatitis C virus (HCV) infection, but there are few controlled data evaluating this. AIM: To assess the prevalence of rheumatological disease, fatigue and anxiety in different groups of patients with chronic HCV infection. PATIENTS AND METHODS: Seventy-seven patients with HCV were evaluated. Of these, 49 (64%) had been infected via contaminated anti-D immunoglobulin, 25 (33%) were intravenous drug users (IVDUs), and three were transfusion related; 78% were female. Twenty-five age- and sex-matched controls were also evaluated. Assessment was performed by history, physical examination, the Fibromyalgia Impact Questionnaire (FIQ) and the Hospital Anxiety and Depression Score (HADS). RESULTS: Four (5%) patients fulfilled the criteria for fibromyalgia. All were infected via anti-D immunoglobulin, and three were PCR positive. The mean number of tender points in anti-D patients was 5.0 (+/- 4.07) compared with 2.8 (+/- 2.7) in controls (P= 0.028) and 2.5 (+/- 2.2) in IVDUs (P< 0.004). There was no significant difference in the number of tender points between PCR-positive and PCR-negative patients (P= 0.23). Anxiety and depression scores were significantly higher in anti-D patients (P= 0.0001) and IVDUs (P= 0.005) compared with controls. Forty per cent of the HCV patients had a positive Schirmer test. Forty-two per cent of PCR-positive patients had a positive rheumatoid factor (RF, > 1/80). CONCLUSION: This study reveals a moderate increase in prevalence of fibromyalgia in HCV patients. The number of tender points was related to mode of acquisition but not to PCR status. Anxiety and depression levels are also increased in HCV patients compared with controls. Prevalence of RF was higher in PCR-positive patients compared with controls and those who had cleared the virus

     (88)    Worrel LM, Krahn LE, Sletten CD, Pond GR. Treating fibromyalgia with a brief interdisciplinary program: initial outcomes and predictors of response. Mayo Clin Proc 2001; 76(4):384-390.
Abstract: OBJECTIVES: To evaluate the efficacy of a brief, intense treatment program for fibromyalgia and to determine which patient characteristics are associated with a better treatment response. PATIENTS AND METHODS: Two self-report measures, the Fibromyalgia Impact Questionnaire (FIQ) and the Multidimensional Pain Inventory (MPI), were administered before patients completed treatment and 1 month after participating in the program. The main outcome measure was the difference in FIQ score and MPI scale before and after program participation. RESULTS: Of 139 patients who met the American College of Rheumatology criteria for fibromyalgia, 100 chose to participate in the 1 1/2-day Fibromyalgia Treatment Program at the Mayo Clinic, Rochester, Minn. Of these 100 patients, 74 completed the follow-up surveys. Patients were less affected by fibromyalgia after participation in the treatment program. This was demonstrated by a posttreatment improvement in the total FIQ score (P<.001), the MPI pain severity score (P<.001), and the MPI interference score (P=.01). The 1 patient characteristic found to be significantly associated (P<.001) with a better response to treatment was a high pretreatment level of impairment from fibromyalgia, as measured by the pretreatment FIQ score. CONCLUSIONS: A brief interdisciplinary program for treating fibromyalgia reduced some associated symptoms. Patients more severely affected by fibromyalgia may benefit most from this approach. Clinicians may apply these findings to develop beneficial and convenient treatment programs for patients with fibromyalgia

     (89)    Jentoft ES, Kvalvik AG, Mengshoel AM. Effects of pool-based and land-based aerobic exercise on women with fibromyalgia/chronic widespread muscle pain. Arthritis Rheum 2001; 45(1):42-47.
Abstract: OBJECTIVE: To examine the effects of pool-based (PE) and land-based (LE) exercise programs on patients with fibromyalgia. METHODS: The outcomes were assessed by the Fibromyalgia Impact Questionnaire, the Arthritis Self-Efficacy Scale, and tests of physical capacity. RESULTS: Eighteen subjects in the PE group and 16 in the LE group performed a structured exercise program. After 20 weeks, greater improvement in grip strength was seen in the LE group compared with the PE group (P < 0.05). Statistically significant improvements were seen in both groups in cardiovascular capacity, walking time, and daytime fatigue. In the PE group improvements were also found in number of days of feeling good, self-reported physical impairment, pain, anxiety, and depression. The results were mainly unchanged at 6 months followup. CONCLUSION: Physical capacity can be increased by exercise, even when the exercise is performed in a warm-water pool. PE programs may have some additional effects on symptoms

     (90)    Alfano AP, Taylor AG, Foresman PA, Dunkl PR, McConnell GG, Conaway MR et al. Static magnetic fields for treatment of fibromyalgia: a randomized controlled trial. J Altern Complement Med 2001; 7(1):53-64.
Abstract: OBJECTIVE: To test effectiveness of static magnetic fields of two different configurations, produced by magnetic sleep pads, as adjunctive therapies in decreasing patient pain perception and improving functional status in individuals with fibromyalgia. DESIGN: Randomized, placebo-controlled, 6-month trial conducted from November 1997 through December 1998. SETTING AND SUBJECTS: Adults who met the 1990 American College of Rheumatology criteria for fibromyalgia were recruited through clinical referral and media announcements and evaluated at a university-based clinic. INTERVENTIONS: Subjects in Functional Pad A group used a pad for 6 months that provided whole-body exposure to a low, uniform static magnetic field of negative polarity. Subjects in the Functional Pad B group used a pad for 6 months that exposed them to a low static magnetic field that varied spatially and in polarity. Subjects in two Sham groups used pads that were identical in appearance and texture to the functional pads but contained inactive magnets; these groups were combined for analysis. Subjects in the Usual Care group continued with their established treatment regimens. OUTCOME MEASURES: Primary outcomes were the change scores at 6 months in the following measures: functional status (Fibromyalgia Impact Questionnaire), pain intensity ratings, tender point count, and a tender point pain intensity score. RESULTS: There was a significant difference among groups in pain intensity ratings (p = 0.03), with Functional Pad A group showing the greatest reduction from baseline at 6 months. All four groups showed a decline in number of tender points, but differences among the groups were not significant (p = 0.72). The functional pad groups showed the largest decline in total tender point pain intensity, but overall differences were not significant (p = 0.25). Improvement in functional status was greatest in the functional pad groups, but differences among groups were not significant (p = 0.23). CONCLUSIONS: Although the functional pad groups showed improvements in functional status, pain intensity level, tender point count, and tender point intensity after 6 months of treatment, with the exception of pain intensity level these improvements did not differ significantly from changes in the Sham group or in the Usual Care group

     (91)    Martinez JE, Barauna F, I, Kubokawa K, Pedreira IS, Machado LA, Cevasco G. Evaluation of the quality of life in Brazilian women with fibromyalgia, through the medical outcome survey 36 item short-form study. Disabil Rehabil 2001; %20;23(2):64-68.
Abstract: PURPOSE: The purpose of this study is to assess the impact of Fibromyalgia (FM) on the female patient's quality of life who attended the Rheumatology Outpatient Unit of Sorocaba Hospital Complex and compare it to the quality of life of healthy control group, through the Medical Outcome Study Short-form 36 item Survey (SF36). SUBJECTS: 32 women who fitted the American College of Rheumatology Classification Criteria for Fibromyalgia and 28 healthy women. MATERIALS AND METHODS: The groups were submitted to 'Medical Outcome Study 36 Item Short-form Survey' (SF36). This questionnaire is composed of 8 scales about several aspects of the quality of life. RESULTS: The SF36 scales in the Fibromyalgia group presented the following results: general health--43.3; functional ability--39.4; bodily pain--26.5; physical functioning--14.8 (0-75); vitality--38.5 (5-85); emotional functioning--32.2; mental health--44.2; social functioning--45.1. The SF36 scales in the control group presented the following results: general health--73.2; functional ability--86.6; bodily pain--68.9; physical functioning--82.4; vitality--59.6; emotional functioning--78.5; mental health--67.4; social functioning--77.9. Significant statistics variations in all evaluated scales were presented by the survey group. CONCLUSION: Fibromyalgia has had a negative impact on the quality of life

     (92)    Van HB, Neerinckx E, Lysens R, Vertommen H, Van HL, Onghena P et al. Victimization in chronic fatigue syndrome and fibromyalgia in tertiary care: a controlled study on prevalence and characteristics. Psychosomatics 2001; 42(1):21-28.
Abstract: The authors studied the prevalence and characteristics of different forms of victimization in 95 patients suffering from chronic fatigue syndrome (CFS) or fibromyalgia (FM) compared with a chronic disease group, including rheumatoid arthritis (RA) and multiple sclerosis (MS) patients, and a matched healthy control group. The authors assessed prevalence rates, nature of victimization (emotional, physical, sexual), life period of occurrence, emotional impact, and relationship with the perpetrator by a self-report questionnaire on burdening experiences. CFS and FM patients showed significantly higher prevalences of emotional neglect and abuse and of physical abuse, with a considerable subgroup experiencing lifelong victimization. The family of origin and the partner were the most frequent perpetrators. With the exception of sexual abuse, victimization was more severely experienced by the CFS/FM group. No differences were found between healthy control subjects or RA/MS patients, and between CFS and FM patients. These findings support etiological hypotheses suggesting a pivotal role for chronic stress in CFS and FM and may have important therapeutic implications

     (93)    Sarmer S, Ergin S, Yavuzer G. The validity and reliability of the Turkish version of the Fibromyalgia Impact Questionnaire. Rheumatol Int 2000; 20(1):9-12.
Abstract: This study was undertaken to translate and adapt the Fibromyalgia Impact Questionnaire (FIQ) into the Turkish language and investigate its validity and reliability for Turkish female fibromyalgia (FM) patients. After translation into Turkish, we administered the FIQ and Health Assessment Questionnaire (HAQ) to 51 women with fibromyalgia. As well as sociodemographic characteristics, the severity of relevant clinical symptoms, e.g., pain intensity, fatigue, and sleep disturbance, were assessed by visual analog scales. A tender point score (TPS) was calculated from tender points conducted by thumb palpation. Test-retest reliability, internal consistency, and concurrent and construct validities of FIQ were evaluated. Test-retest reliability and internal consistency were good at 0.81 and 0.72, respectively. Correlation between FIQ and HAQ scores was 0.43, which was low but statistically significant. Significant moderate correlations were obtained between the FIQ items and severity of clinical symptoms (0.63-0.77), except TPS, 0.31. The FIQ is a reliable and valid instrument for measuring functional disability in Turkish female FM patients

     (94)    Hakkinen A, Hakkinen K, Hannonen P, Alen M. Strength training induced adaptations in neuromuscular function of premenopausal women with fibromyalgia: comparison with healthy women. Ann Rheum Dis 2001; 60(1):21-26.
Abstract: OBJECTIVE: To investigate the effects of 21 weeks' progressive strength training on neuromuscular function and subjectively perceived symptoms in premenopausal women with fibromyalgia (FM). METHODS: Twenty one women with FM were randomly assigned to experimental (FM(T)) or control (FM(C)) groups. Twelve healthy women served as training controls (H(T)). The FM(T) and H(T) groups carried out progressive strength training twice a week for 21 weeks. The major outcome measures were muscle strength and electromyographic (EMG) recordings. Secondary outcome measures were pain, sleep, fatigue, physical function capacity (Stanford Health Assessment Questionnaire), and mood (short version of Beck's depression index). RESULTS: Female FM(T) subjects increased their maximal and explosive strength and EMG activity to the same extent as the H(T) group. Moreover, the progressive strength training showed immediate benefits on subjectively perceived fatigue, depression, and neck pain of training patients with FM. CONCLUSIONS: The strength training data indicate comparable trainability of the neuromuscular system of women with FM and healthy women. Progressive strength training can safely be used in the treatment of FM to decrease the impact of the syndrome on the neuromuscular system, perceived symptoms, and functional capacity. These results confirm the opinion that FM syndrome has a central rather than a peripheral or muscular basis

     (95)    Bernard AL, Prince A, Edsall P. Quality of life issues for fibromyalgia patients. Arthritis Care Res 2000; 13(1):42-50.
Abstract: OBJECTIVE: To collect information from patients with fibromyalgia syndrome (FMS) in regard to quality of life, impact of FMS, coping strategies, and what they want from their health care providers. METHODS: Two hundred seventy support group members in Washington, Illinois, and Pennsylvania completed an 85-item questionnaire. RESULTS: On a scale from 1 to 10 (10 being highest positive rating), patients ranked past quality of life as 8.6, present quality of life as 4.8, and future quality of life without FMS as 9.2. Respondents indicated that FMS has had a negative impact on personal relationships, career, and mental health. Many also reported a lack of social support. Most respondents reported a variety of coping responses including talking to friends, praying, exercise, hobbies, relaxation techniques, talking to a professional, and meditation. Patients reported needing more support, better educated health professionals, for people to believe that this disease exists, more funding for research, and better diagnostic tools. CONCLUSIONS: Health care workers need to be cognizant of the effect FMS has on quality of life. Treatment options should not be limited to prescription medication therapy. Patients are using a variety of methods to cope with their FMS symptoms, some positive, but others that are negative, and health care providers need to be alert to negative coping strategies such as alcohol and nonprescription medication abuse

     (96)    Dunkl PR, Taylor AG, McConnell GG, Alfano AP, Conaway MR. Responsiveness of fibromyalgia clinical trial outcome measures. J Rheumatol 2000; 27(11):2683-2691.
Abstract: OBJECTIVE: To assess the responsiveness of the Fibromyalgia Impact Questionnaire (FIQ), patient ratings of pain intensity, number of tender points, and total tender point pain intensity score to perceived changes in clinical status in patients with fibromyalgia (FM). METHODS: Using data from a randomized placebo controlled study evaluating efficacy of magnetic therapy in patients with FM, the ability of primary outcomes to detect clinically meaningful changes over a 6 month period was assessed by: (1) degree of association between outcome change scores and patient global ratings of symptom change (Spearman rank-order correlations); (2) ability of these scores to discriminate among groups of patients whose perceived health status had changed to varying degrees (ANOVA); (3) ability of these scores, individually and jointly, to discriminate between patients who had reported improvement and those who did not (logistic regression); (4) effect size, standardized response mean, and Guyatt's statistic were calculated to quantify responsiveness. RESULTS: Correlations showed the outcome measures were moderately responsive to perceived symptomatic change. For FIQ, pain intensity ratings and number of tender points, differences in change scores between globally improved and unchanged groups and between globally improved and worsened groups were significant; for total tender point pain intensity, the globally improved differed from worsened group. FIQ outperformed the other measures in discriminating between patients who reported improvement from those who did not. Summary statistics were consistent with discriminatory analyses, indicating the measures were sensitive to improvement, but relatively unresponsive to decline. CONCLUSION: The FIQ was the most responsive measure to perceived clinical improvement and we recommend its inclusion as a primary endpoint in FM clinical trials

     (97)    Pankoff B, Overend T, Lucy D, White K. Validity and responsiveness of the 6 minute walk test for people with fibromyalgia. J Rheumatol 2000; 27(11):2666-2670.
Abstract: OBJECTIVE: To determine the concurrent validity and responsiveness of the 6 minute walk test (6-MWT) as a measure of cardiorespiratory fitness in people with fibromyalgia. METHODS: Subjects completed the 6-MWT, a Fibromyalgia Impact Questionnaire (FIQ), and a peak oxygen consumption (pVO2) exercise test before (n = 28) and after (n = 20) a 12 week exercise program. RESULTS: The correlations between 6-MWT distance and pVO2 before (r = 0.328) and after (r = 0.420) the exercise program were not significant. Significant correlations were obtained between 6-MWT distance and FIQ total (r = -0.494, p < 0.01) and physical impairment (r = -0.403, p < 0.05) scores. Fifteen of 28 subjects completed the exercise program, with significant (p < 0.05) changes in 6-MWT distance (+78 m), pVO2 (+1.8 ml/kg/min), and FIQ total score (-9.9). The change in 6-MWT distance was correlated significantly (p < 0.05) with change in FIQ total score but no change in pVO2. CONCLUSION: The 6-MWT was not a valid predictor of cardiorespiratory fitness. However, it was sensitive to change and was also significantly related to FIQ total score

     (98)    Bramwell B, Ferguson S, Scarlett N, Macintosh A. The use of ascorbigen in the treatment of fibromyalgia patients: a preliminary trial. Altern Med Rev 2000; 5(5):455-462.
Abstract: Twelve female fibromyalgia syndrome (FMS) patients were given 500 mg per day of a blend containing 100 mg ascorbigen and 400 mg broccoli powder in a preliminary, one-month, open-label trial. This group of patients showed a mean 20.1 percent (p=0.044) decrease in their physical impairment score and a mean 17.8 percent (p=0.016) decrease in their total fibromyalgia impact scores as measured by the Fibromyalgia Impact Questionnaire. The mean physical impairment score two weeks post-treatment showed a significant return to near pre-treatment level (p=0.028). Analysis of ten of the patients' mean threshold pain levels at the 18 possible tender points obtained before and at the end of treatment showed a strong trend toward an increase in the mean threshold pain level (p=0.059). The reduced sensitivity to pain and improvement in quality of life measured in this study appear to be clinically relevant and a larger, double-blind study is warranted

     (99)    Mannerkorpi K, Nyberg B, Ahlmen M, Ekdahl C. Pool exercise combined with an education program for patients with fibromyalgia syndrome. A prospective, randomized study. J Rheumatol 2000; 27(10):2473-2481.
Abstract: OBJECTIVE: To evaluate the effects of 6 months of pool exercise combined with a 6 session education program for patients with fibromyalgia syndrome (FM). METHODS: The study population comprised 58 patients, randomized to a treatment or a control group. Patients were instructed to match the pool exercises to their threshold of pain and fatigue. The education focused on strategies for coping with symptoms and encouragement of physical activity. The primary outcome measurements were the total score of the Fibromyalgia Impact Questionnaire (FIQ) and the 6 min walk test, recorded at study start and after 6 mo. Several other tests and instruments assessing functional limitations, severity of symptoms, disabilities, and quality of life were also applied. RESULTS: Significant differences between the treatment group and the control group were found for the FIQ total score (p = 0.017) and the 6 min walk test (p < 0.0001). Significant differences were also found for physical function, grip strength, pain severity, social functioning, psychological distress, and quality of life. CONCLUSION: The results suggest that a 6 month program of exercises in a temperate pool combined with education will improve the consequences of FM

   (100)    Wolfe F, Hawley DJ, Goldenberg DL, Russell IJ, Buskila D, Neumann L. The assessment of functional impairment in fibromyalgia (FM): Rasch analyses of 5 functional scales and the development of the FM Health Assessment Questionnaire. J Rheumatol 2000; 27(8):1989-1999.
Abstract: OBJECTIVE: Functional assessment by self-report questionnaire plays an important role in most rheumatic conditions, but psychometric properties of questionnaires have not been studied in fibromyalgia (FM), particularly by Rasch analysis, which allows for examining adequacy of the questionnaire scale. To assess currently used instruments, we examined the Fibromyalgia Impact Scale (FIQ), 4 versions of the Health Assessment Questionnaire (HAQ), and the Medical Outcome Survey Short Form (SF-36). METHODS: More than 2,500 patients from 4 sites (3 US, 1 Israel) completed the FIQ. The HAQ questionnaires were completed by 1438 patients participating in the US National Data Bank for Rheumatic Diseases. Seven hundred sixty patients from Wichita, Kansas, completed the SF-36. Rasch analysis was applied separately to each of these data sets. RESULTS: The FIQ systematically underestimated functional impairment by its handling of activities not usually performed. All questionnaires had problems with non-unidimensionality and ambiguous items when applied to patients with FM. In addition, scales were found to be non-linear. Because of these findings we used the 20 item HAQ questionnaire as an item bank to develop a new questionnaire more suitable for use in FM, the fibromyalgia HAQ (FHAQ). This questionnaire fits the Rasch model well, is relevant, is linear, and has a long, well spaced scale. CONCLUSION: No available functional assessment questionnaire works well in FM. A new questionnaire, the FHAQ, was developed. It has appropriate metric properties and should function well in this condition. Since the FHAQ is a subset of the larger HAQ questionnaire, a new questionnaire is not required; only a different method of scoring is needed. Additional studies regarding sensitivity to change are required to fully validate the FHAQ

   (101)    Offenbaecher M, Waltz M, Schoeps P. Validation of a German version of the Fibromyalgia Impact Questionnaire (FIQ-G). J Rheumatol 2000; 27(8):1984-1988.
Abstract: OBJECTIVE: To translate the Fibromyalgia Impact Questionnaire (FIQ) into German and to evaluate its reliability and validity for the use of German speaking patients with fibromyalgia (FM). METHODS: We administered the FIQ to 55 patients with FM (15 patients filled out the questionnaire 10 days later) together with German versions of the Stanford Health Assessment Questionnaire (HAQ), the Medical Outcomes Survey Short Form-36 (SF-36), and a tender point count (TPC). All patients were asked about the severity of pain today (10 cm visual analog scale) and the duration of symptoms. Tenderness thresholds were assessed by dolorimetry at all tender points with a Fisher dolorimeter and laboratory tests were obtained. Test-retest reliability was assessed using Spearman correlations. Internal consistency was evaluated with Cronbach's alpha of reliability. Construct validity of the FIQ was evaluated by correlating the HAQ and subscales of the SF-36 as well as the TPC and the tenderness thresholds. RESULTS: Mean age of participants was 54.3 years and mean duration of symptoms 9.5 years. Test-retest reliability was between 0.62 and 1 for the physical functioning as well as for the total FIQ and other components. Internal consistency was 0.92 for the overall FIQ. Significant correlations were obtained between the FIQ items, the HAQ, and the SF-36. CONCLUSION: The German FIQ is a reliable and valid instrument for measuring functional disability and health status in German patients with FM

   (102)    Neumann L, Press J, Glibitzki M, Bolotin A, Rubinow A, Buskila D. CLINHAQ scale--validation of a Hebrew version in patients with fibromyalgia. Clinical Health Assessment Questionnaire. Clin Rheumatol 2000; 19(4):265-269.
Abstract: Assessment of health status in patients with rheumatic disease, including fibromyalgia (FM), using structured questionnaires has become an important approach to evaluate treatment and outcome. The objectives of this study were to validate a translated version of the Clinical Health Assessment Questionnaire (CLINHAQ) to be used by Hebrew-speaking populations, and specifically to evaluate its usefulness in fibromyalgia syndrome (FM). The CLINHAQ was translated into Hebrew and administered to 90 women with FM along with the Hebrew versions of the Fibromyalgia Impact Questionnaire (FIQ) and the Quality of Life (QOL) Scale. The CLINHAQ includes scales of functional disability, helplessness, anxiety and depression, as well as assessment of current health status and satisfaction with this. All subjects were asked about the presence and severity (assessed by visual analogue scale) of current FM symptoms (pain, fatigue, anxiety etc.); a count of 18 tender points was conducted by thumb palpation, and tenderness thresholds were measured by dolorimetry. Test-retest reliability was assessed by Pearson correlation coefficients, and internal consistency was evaluated with Cronbach's alpha coefficient of reliability. Construct validity was tested by correlating the CLINHAQ items with measures of symptom severity, count of tender point, tenderness thresholds, physical functioning measured by FIQ, and with a score of QOL. Test-retest reliability coefficients ranged from 0.82 to 0.99, and Cronbach's alpha coefficients from 0.725 to 0.929. Significant moderate to high correlations were obtained between most subscales of CLINHAQ and measures of physical functioning, quality of life and severity of FM symptoms. In conclusion, the CLINHAQ is a reliable and valid instrument for measuring health status and physical functioning in Israeli women with FM

   (103)    Anderberg UM, Marteinsdottir I, von KL. Citalopram in patients with fibromyalgia--a randomized, double-blind, placebo-controlled study. Eur J Pain 2000; 4(1):27-35.
Abstract: The effect of the selective serotonin reuptake inhibitor citalopram was studied in a randomized, double-blind, placebo-controlled, 4-month trial in patients with the fibromyalgia syndrome (FMS) who all fulfilled the American College of Rheumatology criteria. The citalopram doses varied between 20-40 mg daily. Forty female patients, 21 patients in the citalopram and 19 in the placebo group, participated. Assessment of pain, depressive symptoms and physical functioning were made using Visual Analogue Scales (VAS), the Montgomery Asberg Depression Rating Scale (MADRS) and the Fibrositis Impact Questionnaire (FIQ).In the global judgement of improvement, no significant changes were found between the citalopram and placebo groups as concerns pain or well-being, either in the Intention to Treat (ITT) analysis or in the completer analysis. However, among the completers, it was a tendency that more patients in the citalopram group (52.9%) were improved as compared to the placebo group (22.2%) concerning well-being. Furthermore, the results indicated that treatment with citalopram had a significant effect on pain on the VAS after 2 months of treatment compared to baseline. After 4 months, however, the effect had diminished. Measured with the FIQ, significant differences in the pain ratings were seen at the end of the trial. Significant effects on the depressive symptomatology measured by means of the MADRS were seen already after 1 month of treatment and were increasing further at the end of the trial, when a significant difference between the groups was also found

   (104)    Dessein PH, Shipton EA, Joffe BI, Hadebe DP, Stanwix AE, Van der Merwe BA. Hyposecretion of adrenal androgens and the relation of serum adrenal steroids, serotonin and insulin-like growth factor-1 to clinical features in women with fibromyalgia. Pain 1999; 83(2):313-319.
Abstract: Neuroendocrine deficiencies have been implicated in fibromyalgia (FM). In the present study, adrenal androgen metabolites and their relationship with health status in FM were investigated. For comparison, serum levels of other implicated neuroendocrine mediators were correlated with health status. Fifty-seven consecutive women with FM completed the Fibromyalgia Impact Questionnaire (FIQ). Fasting blood samples were taken for measurement of dehydroepiandrosterone sulphate (DHEAS), free testosterone (T), cortisol, serotonin and insulin-like growth factor-1. Normal value for DHEAS and T were obtained from 114 controls. DHEAS levels were decreased significantly in pre- and postmenopausal patients (P<0.0001 and P<0.0005, respectively). T levels were decreased significantly in premenopausal and insignificantly in postmenopausal patients (P<0.0001 and P=0.06, respectively). The following correlations between neurohormonal levels and FIQ scores were found: DHEAS (after adjustment for age) vs. pain (P<0.001) and T (after adjustment for age) versus physical functioning (P=0.002). None of the other neurohormonal levels correlated significantly with any of the FIQ scores. IGF-1 levels were lower in the obese patients as compared to those who were non-obese (P=0.03). The BMI correlated positively with pain (P<0. 001) and inversely with DHEAS levels (P=0.006). After further adjustment for BMI, the correlation between age adjusted DHEAS and pain was no longer significant. Hyposecretion of adrenal androgens was documented in FM. This was more pronounced in obese patients. Low serum androgen levels correlated with poor health status in FM. Longitudinal studies are needed to elucidate whether these are cause and/or effect relationships

   (105)    King S, Wessel J, Bhambhani Y, Maikala R, Sholter D, Maksymowych W. Validity and reliability of the 6 minute walk in persons with fibromyalgia. J Rheumatol 1999; 26(10):2233-2237.
Abstract: OBJECTIVE: To assess the reliability and construct validity of the 6 minute walk (6MW) in persons with fibromyalgia (FM) and to determine an equation for predicting peak oxygen consumption (pVO2) from the distance covered in 6 minutes. METHODS: Ninety-six women who met the American College of Rheumatology (ACR) criteria for FM were tested on the 6MW and the Fibromyalgia Impact Questionnaire (FIQ). A subset (n = 23) were tested on a separate day for pVO2 during a symptom-limited, incremental treadmill test. Twelve subjects repeated the 6MW five times over 10 days. Heart rate and rating of perceived exertion (RPE) were recorded for each walk. Intraclass correlations were used to determine the reliability of the 6MW. Validity was examined by correlating the 6MW with pVO2 and the FIQ. Body mass index (BMI) and 6MW were independent variables in a stepwise regression to predict pVO2. RESULTS: A significant increase in distance occurred from Walk 1 to Walk 2 (p = 0.000) with the distance maintained on the remaining walks (p = 0.148) The correlations of the 6MW with the FIQ and pVO2 were -0.325 and 0.657, respectively. The regression equation to predict pVO2 from 6MW distance and BMI was: pVO2 (ml/kg/min) = 21.48 + (-0.4316 x BMI) + [0.0304 x distance(m)] (R = 0.76, R2 = 0.66). CONCLUSION: When using the 6MW it is necessary to conduct a practice walk, with the second walk taken as the baseline measure. It was determined from the correlations that the 6MW cannot replace the FIQ as a measure of function. The 6MW may be used as an indicator of aerobic fitness, although obtaining VO2 by means of a graded exercise test is preferable

   (106)    Gowans SE, Dehueck A, Voss S, Richardson M. A randomized, controlled trial of exercise and education for individuals with fibromyalgia. Arthritis Care Res 1999; 12(2):120-128.
Abstract: OBJECTIVE: To evaluate the efficacy of a 6-week exercise and educational program for patients with fibromyalgia. METHODS: Forty-one subjects were randomly assigned to the program or served as waiting list controls. Program outcome was assessed with a 6-minute walk test, the Fibromyalgia Impact Questionnaire, a Self-Efficacy Scale, and a "knowledge" questionnaire (based on information provided during the educational sessions). Waiting list control subjects subsequently completed the program. Program outcome was reassessed 3 or 6 months post-program. RESULTS: The program produced significant improvements in 6-minute walk distance, well-being, fatigue, self-efficacy (for controlling pain and other symptoms), and knowledge. At followup, immediate gains in walk distance, well-being, and self-efficacy were maintained, but gains in fatigue and knowledge were lost. CONCLUSION: Short-term exercise and educational programs can produce immediate and sustained benefits for patients with fibromyalgia. The benefits of our program may be due to exercise or education since both interventions were given

   (107)    Fallon J, Bujak DI, Guardino S, Weinstein A. The Fibromyalgia Impact Questionnaire: a useful tool in evaluating patients with post-Lyme disease syndrome. Arthritis Care Res 1999; 12(1):42-47.
Abstract: OBJECTIVE: To determine the reliability and validity of a modified version of the Fibromyalgia Impact Questionnaire (FIQ) in evaluating patients with post-Lyme disease syndrome (PLDS). METHODS: In this cross-sectional analysis 13 PLDS, 18 fibromyalgia (FM), and 16 healthy controls (n = 47) completed a modified FIQ containing items to evaluate physical impairment, symptom severity, and global well-being. Comparisons between groups were done using analysis of variance with a significance level set at 0.05. RESULTS: PLDS patients demonstrated statistically significantly greater levels of impairment than controls in physical functioning, FIQ total score, global well-being, joint pain, fatigue, depression, ability to perform activities of daily living, and memory/concentration. FM patients demonstrated a statistically significantly greater level of impairment than the control group in all categories, and the scores were significantly higher than the PLDS group in the measurement of physical impairment, FIQ total score, muscle pain, and joint pain. Overall, the instrument possesses good reliability and validity, although adequacy of this instrument to measure impairment in the male PLDS population needs further elucidation. CONCLUSION: The results of this study suggest that the modified FIQ may be a useful tool in evaluating PLDS patients. The findings suggest that there may be some differences in the etiopathology of the symptoms experienced by PLDS and FM patients

   (108)    Jamison J. Stress: the chiropractic patients' self-perceptions. J Manipulative Physiol Ther 1999; 22(6):395-398.
Abstract: BACKGROUND: Psychosocial stress pervades modern life and is known to have an impact on health. Pain, especially chronic back pain, is influenced by stress. Various strategies have been shown to successfully reduce stress and its consequences. OBJECTIVES: This study explores stress as a potential disease trigger among chiropractic patients. METHOD: A descriptive study was undertaken to ascertain the stress perceptions of chiropractic patients. Purposive sampling of chiropractic practices and convenience sampling of patients was undertaken. Patients were allocated to 1 of 4 groups according to their presentation: acute, chronic biomechanical, fibromyalgia, or maintenance care. Participating patients were requested to complete a questionnaire. RESULTS: Of the 138 patients attending 1 of 10 participating chiropractic clinics, more than 30% regarded themselves as moderately to severely stressed, and over 50% felt that stress had a moderate or greater effect on their current problem. Some 71% of patients felt it would be helpful if their chiropractic care included strategies to help them cope with stress, and 44% were interested in taking a self-development program to enhance their stress management skills. CONCLUSION: Patient perceptions are known to be important in health care. A number of chiropractic patients perceive they are moderately or severely stressed. Interventions that reduce stress, or even the patient's perception of being stressed, may be construed as valid, non-specific clinical interventions. It may be timely for chiropractors to actively contemplate including stress management routinely in their clinical care protocols

   (109)    Adler GK, Kinsley BT, Hurwitz S, Mossey CJ, Goldenberg DL. Reduced hypothalamic-pituitary and sympathoadrenal responses to hypoglycemia in women with fibromyalgia syndrome. Am J Med 1999; 106(5):534-543.
Abstract: PURPOSE: To perform a detailed comparison of the hypothalamic-pituitary-adrenal axis and the sympathoadrenal system in women with and without fibromyalgia. SUBJECTS AND METHODS: Fifteen premenopausal women who met the 1990 American College of Rheumatology criteria for the diagnosis of fibromyalgia and 13 healthy, premenopausal women were enrolled. We measured baseline 24-hour urinary free cortisol levels and evening and morning adrenocorticotropic hormone (ACTH) and cortisol levels, performed stepped hypoglycemic hyperinsulinemic clamp studies in which serum glucose levels were decreased from 5.0 to 2.2 mmol/L, and compared the effects of infusions of placebo and ACTH. RESULTS: Women with fibromyalgia had normal 24-hour urinary free cortisol levels and normal diurnal patterns of ACTH and cortisol. There was a significant, approximately 30%, reduction in the ACTH and epinephrine responses to hypoglycemia in women with fibromyalgia compared with controls. Prolactin, norepinephrine, cortisol, and dehydroepiandrosterone responses to hypoglycemia were similar in the two study groups. In subjects with fibromyalgia, the epinephrine response to hypoglycemia correlated (P = 0.01) inversely with overall health status as measured by the fibromyalgia impact questionnaire. Graded ACTH infusion revealed similar increases in cortisol in women with fibromyalgia and healthy controls. CONCLUSIONS: Patients with fibromyalgia have an impaired ability to activate the hypothalamic-pituitary portion of the hypothalamic-pituitary-adrenal axis as well as the sympathoadrenal system, leading to reduced ACTH and epinephrine responses to hypoglycemia

   (110)    White KP, Speechley M, Harth M, Ostbye T. Comparing self-reported function and work disability in 100 community cases of fibromyalgia syndrome versus controls in London, Ontario: the London Fibromyalgia Epidemiology Study. Arthritis Rheum 1999; 42(1):76-83.
Abstract: OBJECTIVE: To compare function and disability in fibromyalgia syndrome (FMS) cases in the community versus controls, and to identify variables predicting poor function and disability. METHODS: We identified 100 FMS cases, 76 pain controls, and 135 general controls in a random survey of 3,395 noninstitutionalized adults. RESULTS: FMS cases reported worse function (P < 0.00001), more days in bed (P < 0.001), and more healthy years of life lost (P < 0.0001). More FMS cases were disabled (P < 0.00001) and receiving pensions (P < 0.00001). Risk factors for disability included middle age and previous heavy manual labor. Pain, fatigue, and weakness were most often claimed to affect the ability to work Variables predicting work disability were the Fibromyalgia Impact Questionnaire (FIQ) score, a prior diagnosis of FMS, nonrestorative sleep, and past heavy physical labor. Variables influencing the FIQ score were the number of major symptoms, self-reported health satisfaction, tender point count, and education level. CONCLUSION: FMS commonly results in loss of function and work disability

   (111)    Ambrogio N, Cuttiford J, Lineker S, Li L. A comparison of three types of neck support in fibromyalgia patients. Arthritis Care Res 1998; 11(5):405-410.
Abstract: OBJECTIVE: To determine the effectiveness of 3 types of neck support for patients with fibromyalgia (FMS) and their preference for the type of support. METHODS: Thirty-five patients with FMS chose the order of application and used each type of neck support for a 2-week period, followed by a 2-week washout. The same schedule was repeated a second time. The neck supports included a Shape of Sleep pillow, two neck ruffs with one standard pillow, and a single standard pillow. All subjects received a physiotherapy treatment and educational program in the home. Outcome measures included visual analog scales (VAS) for neck pain and quality of sleep, the Fibromyalgia Impact Questionnaire (FIQ), and a neck and shoulder pain distribution diagram. RESULTS: Analysis using Friedman's 2-way analysis of variance revealed no significant differences in any outcome measure, although there was a trend towards improvement in the FIQ and VAS neck pain and quality of sleep scores for some patients. Most participants (62.9%) preferred the Shape of Sleep pillow, 20.0% preferred cervical ruffs with one standard pillow, and 17.1% preferred a single standard pillow. CONCLUSIONS: The results of this study are inconclusive due to the small sample size. However, from a patient's perspective, neck support is an important part of a comprehensive physiotherapy program. Most participants preferred the more rigid support of a Shape of Sleep pillow. Further research into the efficacy of the use of neck support in people with FMS is warranted

   (112)    Singh BB, Berman BM, Hadhazy VA, Creamer P. A pilot study of cognitive behavioral therapy in fibromyalgia. Altern Ther Health Med 1998; 4(2):67-70.
Abstract: BACKGROUND: Fibromyalgia is a syndrome characterized by widespread musculoskeletal pain and multiple tender points as well as high levels of self-reported disability and poor quality of life. OBJECTIVES: In this pilot study, a mind-body approach (cognitive-behavioral therapy) was tested that has been successful in treating chronic back pain patients to determine whether it would improve function, decrease perceived pain, and improve mood state for fibromyalgia patients. PARTICIPANTS: 28 patients recruited from the greater Baltimore area. INTERVENTION: Eight weekly sessions, 2 1/2 hours each, with three components: an educational component focusing on the mind-body connection, a portion focusing on relaxation response mechanisms (primarily mindfulness meditation techniques), and a qigong movement therapy session. MAIN OUTCOME MEASURES: Data collection instruments were the Fibromyalgia Impact Questionnaire, the Health Assessment Questionnaire, the Beck Depression Inventory, the Coping Strategies Questionnaire, the helplessness subscale of the Arthritis Attitudes Index, the Medical Outcomes Study Short Form General Health Survey, and a double-anchored 100-mm visual analog scale to assess sleep. RESULTS: Twenty patients completed the study. Standard outcome measures showed significant reduction in pain, fatigue, and sleeplessness; and improved function, mood state, and general health following an 8-week intervention. CONCLUSION: A mind-body intervention including patient education, meditation techniques, and movement therapy appears to be an effective adjunctive therapy for patients with fibromyalgia

   (113)    Finckh A, Morabia A, Deluze C, Vischer T. Validation of questionnaire-based response criteria of treatment efficacy in the fibromyalgia syndrome. Arthritis Care Res 1998; 11(2):116-123.
Abstract: OBJECTIVE: To compare the validity of self-reported questionnaires as response criteria of treatment efficacy in patients with fibromyalgia syndrome. METHOD: At the beginning of the treatment period, 70 fibromyalgia patients, randomly allocated to electro-acupuncture or placebo, underwent a clinical evaluation by rheumatologists and answered 1) a generic quality of life questionnaire--the Psychological General Well-Being Index (PGWB), 2) a specific function and symptom questionnaire, and 3) a pain questionnaire--the Regional Pain Score (RPS). The same evaluation was repeated at the end of the treatment period. Severity of the condition was assessed by a composite outcome score, a combination of different clinical outcome measures forming a clinical severity index. The variations between these questionnaire scores before and after treatment and the variations between the clinical severity indices estimated by clinicians were used as measures of the treatment impact. The first rationale for the validation was a positive correlation between clinical and questionnaire score changes. Another rationale for validation of the new instruments was the ability to identify the different treatment interventions. RESULTS: The correlation between the clinical severity index and the RPS was good (r = 0.62). Moreover, the RPS demonstrated a good discriminant power in detecting patients with effective treatment: it showed a specificity of 74% and a sensitivity of 75%. The PGWB correlated less well with the clinical score and was less discriminant. The specific function and symptom questionnaire showed little additional validity. CONCLUSIONS: Outcomes of syndrome severity such as pain and subjective well-being, as measured by self-reported questionnaires, can be valid instruments to evaluate treatment efficacy in short-term clinical trials. In the current study, the RPS proved to be particularly useful to assess the widespread tenderness of fibromyalgia and demonstrated high discriminative power

   (114)    Bennett RM, Clark SC, Walczyk J. A randomized, double-blind, placebo-controlled study of growth hormone in the treatment of fibromyalgia. Am J Med 1998; 104(3):227-231.
Abstract: PURPOSE: The cause of fibromyalgia (FM) is not known. Low levels of insulin-like growth factor 1 (IGF-1), a surrogate marker for low growth hormone (GH) secretion, occur in about one third of patients who have many clinical features of growth hormone deficiency, such as diminished energy, dysphoria, impaired cognition, poor general health, reduced exercise capacity, muscle weakness, and cold intolerance. To determine whether suboptimal growth hormone production could be relevant to the symptomatology of fibromyalgia, we assessed the clinical effects of treatment with growth hormone. METHODS: Fifty women with fibromyalgia and low IGF-1 levels were enrolled in a randomized, placebo-controlled, double-blind study of 9 months' duration. They gave themselves daily subcutaneous injections of growth hormone or placebo. Two outcome measures--the Fibromyalgia Impact Questionnaire and the number of fibromyalgia tender points-were evaluated at 3-monthly intervals by a blinded investigator. An unblinded investigator reviewed the IGF-1 results monthly and adjusted the growth hormone dose to achieve an IGF-1 level of about 250 ng/mL. RESULTS: Daily growth hormone injections resulted in a prompt and sustained increase in IGF-1 levels. The treatment (n=22) group showed a significant improvement over the placebo group (n=23) at 9 months in both the Fibromyalgia Impact Questionnaire score (P <0.04) and the tender point score (P <0.03). Fifteen subjects in the growth hormone group and 6 subjects in the control group experienced a global improvement (P <0.02). There was a delayed response to therapy, with most patients experiencing improvement at the 6-month mark. After discontinuing growth hormone, patients experienced a worsening of symptoms. Carpal tunnel symptoms were more prevalent in the growth hormone group (7 versus 1); no other adverse events were more common in this group. CONCLUSIONS: Women with fibromyalgia and low IGF-1 levels experienced an improvement in their overall symptomatology and number of tender points after 9 months of daily growth hormone therapy. This suggests that a secondary growth hormone deficiency may be responsible for some of the symptoms of fibromyalgia

   (115)    Walker EA, Katon WJ, Keegan D, Gardner G, Sullivan M. Predictors of physician frustration in the care of patients with rheumatological complaints. Gen Hosp Psychiatry 1997; 19(5):315-323.
Abstract: Recent studies of the doctor-patient relationship have shown that certain patients are perceived as frustrating or difficult by their doctors; however, little is known about the characteristics of these patients that elicit this dissatisfaction. As part of a larger study of rheumatology clinic patients with fibromyalgia or rheumatoid arthritis (N = 68) we used stepwise multiple regression to select the factors most associated with physician frustration while controlling for the effects of other variables. Variable domains included demographics, psychiatric diagnoses, personality factors, functional disability, disease state, and trauma history. These domains as well as individual variables within these domains were systematically evaluated for their unique contribution to the prediction of physician frustration as measured by the Difficult Doctor-Patient Relationship Questionnaire (DDPRQ). Initial bivariate correlates of physician frustration included marital status, current dysthymia and agoraphobia, lifetime panic disorder and obsessive-compulsive disorder, adult rape and physical abuse, somatization disorder, physical and social disability, the presence of fibromyalgia, as well as neuroticism, illness impact, and perceived loss of control. The best multivariable model for estimating frustration magnitude included somatization disorder, perception of lack of control over illness, and a lifetime history of obsessive-compulsive disorder. These factors explained 48% of the variance in DDPRQ score. Physicians in this study were most frustrated with patients who had ongoing preoccupation with multiple medically unexplained physical symptoms as well as the perception of greater impact and lack of control over their illness. These findings suggest that treatment of somatization in patients with chronic symptoms may decrease physician frustration

   (116)    Neumann L, Buskila D. Quality of life and physical functioning of relatives of fibromyalgia patients. Semin Arthritis Rheum 1997; 26(6):834-839.
Abstract: OBJECTIVES: The quality of life (QOL) and health status of fibromyalgia syndrome (FS) patients is impaired, and may adversely affect their close relatives. The aim of this study was to assess the QOL and physical functioning of relatives of FS patients. METHODS: A total of 118 relatives (parents, husbands, siblings, and offspring) of 30 FS female patients were evaluated using a QOL scale and the Fibromyalgia Impact Questionnaire (FIQ) and were compared with 124 healthy controls. These measures of functioning and QOL were further studied in relatives with and without FS. RESULTS: Although the QOL of the relatives was better than that of the FS index women, they were significantly less satisfied than the controls with functioning-related aspects, namely work (job or home), independence, and health (P < .05). Relatives with FS (n = 29) and female relatives (n = 40) reported lower QOL than relatives without FS (n = 89) and male relatives (n = 78), respectively. Similarly, physical functioning of relatives, though better than in FS index cases, was significantly worse than in healthy controls. Furthermore, the health status of female relatives and relatives with FS was significantly worse than that of male relatives and relatives without FS, respectively. CONCLUSIONS: The quality of life and physical functioning of relatives of FS patients were found to be impaired, especially in female relatives and those with undiagnosed FS. This finding may be attributed to the psychological distress in families of FS patients and to the high prevalence (25%) of undiagnosed FS among the relatives

   (117)    Fitzcharles MA, Esdaile JM. Nonphysician practitioner treatments and fibromyalgia syndrome. J Rheumatol 1997; 24(5):937-940.
Abstract: OBJECTIVE: Patients with fibromyalgia syndrome (FM) are high consumers of alternative medical interventions and frequently consult nonphysician practitioners. Although individuals may express satisfaction with alternative treatment methods, their effect upon symptoms and outcome of FM is not known. We compare symptom reporting and functional status in patients with FM being treated or not being treated by nonphysician practitioners. METHODS: 82 patients with FM enrolled in a cross sectional study were divided into current users (n = 33) and nonusers (n = 49) of nonphysician practitioner treatment over the preceding 6 months. Included were treatments by physiotherapists and psychologists, as well as all categories of alternative practitioners. The measurements studied were a patient global assessment of disease severity on a 100 mm visual analog scale (VAS), a physician global assessment on a 100 mm VAS, the Health Assessment Questionnaire (HAQ), and the Fibromyalgia Impact Questionnaire (FIQ). RESULTS: There were no differences for the FIQ, HAQ, or patient or physician global severity scores for users and nonusers of nonphysician practitioner treatments. The total number of health care professional visits in the preceding 6 months was higher for users than nonusers (27.0 vs 9.3; p < 0.001), although physician visits did not differ (9.0 vs 9.3). CONCLUSION: Patients with FM who had been treated by nonphysician practitioners during the preceding 6 months reported similar pain and functional impairment to those not receiving treatments

   (118)    Friedman PJ. Predictors of work disability in work-related upper-extremity disorders. J Occup Environ Med 1997; 39(4):339-343.
Abstract: The aim of this study was to compare symptoms, signs, grip strength, passive wrist flexion angle, and self-rated disability in work-related upper extremity disorders (WRUEDs) to determine predictors of work disability in 106 consecutive patients. Age, gender, and duration of symptoms were unrelated to current work status. The best predictors of current work hours were, in descending order, the Fibromyalgia Impact Questionnaire (FIQ), Modified Stanford Health Assessment Questionnaire (SHAQ), weeks of work absence, passive wrist flexion angle of the affected arm, neck pain or stiffness on movement, and grip in affected arm. FIQ and SHAQ scores were significantly correlated with objective measures of upper-extremity function. FIQ and SHAQ scores are valid measures of work disability in WRUEDs, which are more closely related to current work hours than to time off work, symptoms, or physical signs

   (119)    Volkmann H, Norregaard J, Jacobsen S, nneskiold-Samsoe B, Knoke G, Nehrdich D. Double-blind, placebo-controlled cross-over study of intravenous S-adenosyl-L-methionine in patients with fibromyalgia. Scand J Rheumatol 1997; 26(3):206-211.
Abstract: The objective of this study was to test the efficacy of intravenously administered S-adenosyl-L-methionine (SAMe) in patients with fibromyalgia (FM). Thirty-four out-patients with fibromyalgia symptoms received SAMe 600 mg i.v. or placebo daily for 10 days in a cross-over trial. There was no significant difference in improvement in the primary outcome: tender point change between the two treatment groups. There was a tendency towards statistical significance in favour of SAMe on subjective perception of pain at rest (p = 0.08), pain on movement (p = 0.11), and overall well-being (p = 0.17) and slight improvement only on fatigue, quality of sleep, morning stiffness, and on the Fibromyalgia Impact Questionnaire for pain. No effect could be observed on isokinetic muscle strength, Zerrsen self-assessment questionnaire, and the face scale. No effect of SAMe in patients with FM was found in this short term study

   (120)    Martin MY, Bradley LA, Alexander RW, Alarcon GS, Triana-Alexander M, Aaron LA et al. Coping strategies predict disability in patients with primary fibromyalgia. Pain 1996; 68(1):45-53.
Abstract: We administered the Coping Strategies Questionnaire (CSQ) to 80 patients with fibromyalgia (FM) to determine the relationship between coping strategies and functional disability. A principal components factor analysis revealed two dimensions of patients' CSQ responses: Coping Attempts and Catastrophizing. Coping Attempts consists of five scales: Reinterpreting Pain, Ignoring Pain Sensations, Diverting Attention, Coping Self-Statements and Increasing Activity Level. Catastrophizing is comprised solely of the CSQ Catastrophizing scale. Both coping strategy dimensions were significantly related to patients' disability scores on the Sickness Impact Profile even after controlling for demographic and clinical variables as well as neuroticism. Coping Attempts was associated with higher levels of Physical (P < 0.05) and Total Disability (P < 0.01), and lower levels of Psychosocial Disability (P < 0.05). Catastrophizing was associated with higher levels of Total Disability (P < 0.01). These relationships suggest that investigators should attempt to identify Coping Attempts strategies that best reduce patients' psychological distress in the laboratory. It then may be possible to teach patients to use these strategies to reduce distress in their home and work environments

   (121)    Goldenberg D, Mayskiy M, Mossey C, Ruthazer R, Schmid C. A randomized, double-blind crossover trial of fluoxetine and amitriptyline in the treatment of fibromyalgia. Arthritis Rheum 1996; 39(11):1852-1859.
Abstract: OBJECTIVE: To study the effect of fluoxetine (FL) and amitriptyline (AM), alone and in combination, in patients with fibromyalgia (FM). METHODS: Nineteen patients with FM completed a randomized, double-blind crossover study, which consisted of 4 6-week trials of FL (20 mg), AM (25 mg), a combination of FL and AM, or placebo. Patients were evaluated on the first and last day of each trial period. Outcome measures included a tender point score, the Fibromyalgia Impact Questionnaire (FIQ), the Beck Depression Inventory (BDI) scale, and visual analog scales (VAS) for global well-being (1 completed by the physician and 1 by the patient), pain, sleep trouble, fatigue, and feeling refreshed upon awakening. RESULTS: Both FL and AM were associated with significantly improved scores on the FIQ and on the VAS for pain, global well-being, and sleep disturbances. When combined, the 2 treatments worked better than either medication alone. Similar, but nonsignificant, improvement occurred in the BDI scale, the physician global VAS, and the VAS for fatigue and feeling refreshed upon awakening. Trends were less clear for the tender point score. CONCLUSION: Both FL and AM are effective treatments for FM, and they work better in combination than either medication alone

   (122)    Buskila D, Neumann L. Assessing functional disability and health status of women with fibromyalgia: validation of a Hebrew version of the Fibromyalgia Impact Questionnaire. J Rheumatol 1996; 23(5):903-906.
Abstract: OBJECTIVE. To validate a translated version of the Fibromyalgia Impact Questionnaire (FIQ) to be used by Hebrew speaking populations. METHODS. We administered the FIQ to 100 women with fibromyalgia (FM). The FIQ measures physical functioning, work status, depression, anxiety, sleep, pain, stiffness, fatigue, and well being. All patients were asked about the presence and severity (assessed by visual analog scale) of relevant FM symptoms (pain, fatigue, anxiety, etc.); a count of 18 tender points was conducted by thumb palpation, and tenderness thresholds were assessed by dolorimetry. Test-retest reliability was assessed using Spearman correlations. Internal consistency was evaluated with Cronbach's alpha coefficient of reliability. To assess content validity a cutoff criterion of > or = 25% impairment responses was set to indicate a valid item. Construct validity of the FIQ was evaluated by correlating the physical functioning score as well as the separate items with measures of symptom severity, count of tender points, and tenderness thresholds. RESULTS. Test-retest reliability was r = 0.96 for physical functioning, and 0.80-0.96 for other items of FIQ. Internal consistency was alpha = 0.93 at Time 1 and 0.86 at Time 2. Seventeen of 19 items of the FIQ met the > or = 25% criterion. Significant moderate to high correlations were obtained between the FIQ items and severity symptoms, point count, and tenderness threshold. CONCLUSION. The FIQ is a reliable and valid instrument for measuring functional disability and health status in Israeli women with FM

   (123)    Jacobs JW, Rasker JJ, van der HA, Boersma JW, de Blecourt AC, Griep EN et al. Lack of correlation between the mean tender point score and self-reported pain in fibromyalgia. Arthritis Care Res 1996; 9(2):105-111.
Abstract: OBJECTIVES: To study the validity and nature of self-assessed symptoms among patients with fibromyalgia syndrome (FMS) and to compare our data with findings reported in the US. To determine whether tender point scores correlate with self-reported pain and other symptoms and to study the influence of disease duration. METHODS: Tender point scores were assessed in 113 consecutive patients with FMS. All patients completed 2 self-assessment questionnaires (an extended Campbell list, the Enschede Fibromyalgia Questionnaire, and the Dutch Arthritis Impact Measurement Scales). RESULTS: The self-assessed symptoms of the Dutch FMS patients seem to be valid and are comparable with those of American patients. No association between disease duration and number of self-reported symptoms was found. An association between self-reported pain and mean tender point score was lacking for patients with disease of shorter duration and was weak for patients with disease of longer duration. CONCLUSIONS: The use of a self-report questionnaire for patients with FMS is feasible and appears to be valid. Tender point scores and self-reported pain represent very different aspects of pain in FMS

   (124)    Bennett RM, Burckhardt CS, Clark SR, O'Reilly CA, Wiens AN, Campbell SM. Group treatment of fibromyalgia: a 6 month outpatient program. J Rheumatol 1996; 23(3):521-528.
Abstract: OBJECTIVE: To evaluate the impact of a 6 month group therapy program on the treatment of patients with fibromyalgia (FM). Since FM is a common problem in rheumatology practice, a program was designed to treat patients in a group setting using allied health professionals. METHODS: The FM group (15 to 25 patients) met once a week for 6 months. The average session lasted 90 min and consisted of formal lectures, group sessions emphasizing behavior modification, stress reduction techniques, strategies to improve fitness and flexibility and support sessions for spouses/significant others. The 2 major outcome measures were the fibromyalgia impact questionnaire (FIQ) and the total tender point score. Secondary outcome measures were the quality of life scale, questionnaires to assess coping strategies and attitudes to illness, an index of aerobic conditioning, flexibility, distance walked in 6 min., Beck depression and Beck anxiety questionnaires. Patients were followed 2 years and compared to a group of patients outside the program. RESULTS: Between 1989 and 1993 170 patients were evaluated and 104 patients completed the program. At the end of the 6 months 73 (70%) of patients had <11 tender points and FIQ improved 25%. Having a pain profile on MMPI or having major depression, did not predict poorer outcome. Thirty-three patients followed for 2 years after the program continue to show improvement. A control group of 29 patients who never entered the program showed no significant improvement. CONCLUSION: The group treatment of patients with FM in an outpatient setting shows promise; a more formal controlled study is needed to confirm this impression

   (125)    Goldenberg DL, Mossey CJ, Schmid CH. A model to assess severity and impact of fibromyalgia. J Rheumatol 1995; 22(12):2313-2318.
Abstract: OBJECTIVE: To establish a model for the detection of specific factors associated with the severity of symptoms and the impact of fibromyalgia (FM). METHODS: We evaluated 332 consecutive new patients with FM for factors that may be associated with disease severity, assessed by patient global assessment, and function, evaluated by the Fibromyalgia Impact Questionnaire (FIQ). Fifteen potential explanatory factors were evaluated in a multiple linear regression model on data taken from an extensive group of standardized instruments. RESULTS: Of the 15 factors, pain levels, self-assessed inability to work, psychological distress, pending litigation, helplessness, level of education, and coping ability had a significant association with patients' global assessment and with scores on the total FIQ as well as on the activities of daily living subcomponent of the FIQ. CONCLUSION: Disease related factors such as pain and psychological factors such as work status, helplessness, education, and coping ability had an independent and significant relationship to FM symptom severity and function

   (126)    Martinez JE, Ferraz MB, Sato EI, Atra E. Fibromyalgia versus rheumatoid arthritis: a longitudinal comparison of the quality of life. J Rheumatol 1995; 22(2):270-274.
Abstract: OBJECTIVE. To evaluate and compare the quality of life of patients with fibromyalgia (FM) and rheumatoid arthritis (RA). METHODS. Forty-four women with FM and 41 with RA were studied. There were 3 evaluations, with a 3-month interval. Besides special and general clinical examinations, the following tests were applied: pain numerical scale (PNS), Health Assessment Questionnaire (HAQ), Fibromyalgia Impact Questionnaire (FIQ), Arthritis Helplessness Index (AHI), Modified Post-Sleep Inventory (PSI), and questions about sleep disorders and socioeconomic impact. RESULTS. Results include the following: tender points (TP): FM = 13.9, RA = 2.9; PNS: FM = 7.2, RA = 6.8; HAQ: FM = 0.90, RA = 1.22; FIQ: FM = 47.2, RA = 42.5; AHI: FM = 32.7, RA = 31.8; sleep quality--mean duration of daily sleep: FM = 6.7 h, RA = 6.1; PSI scores: FM = 64.6, RA = 57.2. On questioning regarding economic impact, there was a decrease in family income for 65% of patients with FM and 75.1% for those with RA. Fifty-five percent of patients with FM and 66.6% of those with RA received social security aid. At followup evaluation, there was a statistically significant improvement in the following items for the patients with FM: TP count, HAQ, and AHI. The patients with RA improved in number of TP and AHI. CONCLUSION. FM has a negative impact on quality of life, similar to RA. Clinical, functional, and economic problems related to the disease were observed. The alteration observed remained relatively stable during the study period, except for physical disability

   (127)    Hedin PJ, Hamne M, Burckhardt CS, Engstrom-Laurent A. The Fibromyalgia Impact Questionnaire, a Swedish translation of a new tool for evaluation of the fibromyalgia patient. Scand J Rheumatol 1995; 24(2):69-75.
Abstract: The American Fibromyalgia Impact Questionnaire (FIQ) was translated into Swedish. The FIQ is a brief 10-item self-administered instrument designed to evaluate the special problems bothering fibromyalgia patients. After the translation procedure, 73 Swedish women fibromyalgia patients answered the translated FIQ. The questionnaire was fast and simple to handle both for the patients and the investigators. There was a good level of correspondence between FIQ items and related items in the Health Assessment Questionnaire, the Nottingham Health Profile and the Psychological General Well-Being Index. There were no significant differences in a test-retest analysis. The study has provided evidence that the translated and slightly modified Swedish version of the American Fibromyalgia Impact Questionnaire has the validity and sensitivity to be able to function as a relevant and comprehensible tool to monitor FMS-patients

   (128)    Simms RW. Controlled trials of therapy in fibromyalgia syndrome. Baillieres Clin Rheumatol 1994; 8(4):917-934.
Abstract: Many different interventions have been studied in the therapy of fibromyalgia syndrome (Tables 1 and 2). While most have been effective, in general these trials have been short term. Furthermore, important or substantial improvement, when it has been assessed, occurs in only small proportions of patients. Long-term, comparative trials of both efficacy and toxicity are necessary. Trials such as these require large numbers of patients (compared with placebo-controlled trials, which are generally impractical in long-duration trials due to the large numbers of dropouts in the placebo arm) and therefore are expensive and difficult to accomplish. Two other approaches offer potential solutions to the problem of adequate long-term comparative trials: (a) N-of-1 trials and (b) meta-analysis. N-of-1 trials have the advantage of random assignment, double-blinding and multiple potential comparisons in the same patient. Meta-analysis involves combining the results of studies, which individually may have conflicting results and lack adequate statistical power, to reach an overall result with sufficient statistical power to make meaningful conclusions, especially with respect to comparative efficacy. Peluso and colleagues (1993) have performed a recent meta-analysis of available therapies in fibromyalgia syndrome and found that the effect-size (a standardized measure of the efficacy of a given therapy) of several non-medication therapies such as electroacupuncture exceeded that of traditional medication therapies. Unfortunately, lack of uniformity in the use of outcome measures across included trials and the small numbers of comparable non-medication trials makes definitive conclusions regarding relative efficacy of therapies difficult. Nevertheless, application of meta-analytic methods such as these should facilitate future comparisons of different interventions. Ideally, future clinical trials in fibromyalgia syndrome should employ the same outcome measures to permit application of these methods. Few trials have assessed improvement in functional status. Functional status measures such as the HAQ (Fries et al., 1980), the Fibromyalgia Impact Questionnaire (Burckhardt et al, 1991) or similar instruments should be employed in future studies of therapy in fibromyalgia. Given that individual modalities appear to confer relatively modest benefit on average. Combination approaches are reasonable, although randomized, blinded trials to assess these approaches are methodologically complex. Several preliminary studies which have addressed this approach appear promising (see Chapter 12; Goldenberg et al, 1993). Finally, no studies have yet assessed the comparative cost-efficacy of available treatments. Controlled trials which address the cost-efficacy of commonly employed, but unproven treatments such as physiotherapy chiropractic manipulation and injection techniques are urgently needed

   (129)    Nichols DS, Glenn TM. Effects of aerobic exercise on pain perception, affect, and level of disability in individuals with fibromyalgia. Phys Ther 1994; 74(4):327-332.
Abstract: BACKGROUND AND PURPOSE. The purpose of this study was to evaluate the effect of aerobic walking on the pain, disability, and psychological symptoms of individuals with fibromyalgia. SUBJECTS. Nineteen subjects with fibromyalgia (2 men, 17 women), aged 30 to 69 years (mean = 49.35, SD = 11.83), participated. METHODS. Ten subjects walked 20 minutes, three times per week, for 8 weeks at 60% to 70% of the predicted maximum heart rate for their age. Nine subjects served as sedentary controls. Each subject completed pretests and posttests of the McGill Pain Questionnaire (MPQ), the Sickness Impact Profile (SIP), and the Brief Symptom Inventory (BSI). Due to initial differences on all measures, final scores were adjusted and analyzed by an analysis of covariance. RESULTS. The experimental group had lower scores on the MPQ on two of the three BSI indexes, and on the Psychosocial Dimension scale of the SIP, but higher ratings on the Physical Dimension scale of the SIP than did the control group on final testing. Only the differences on one index of the BSI and the Physical Dimension scale of the SIP were significant. CONCLUSION AND DISCUSSION. The results of the study are inconclusive. There were trends suggestive of a beneficial response to aerobic walking (lower psychological and pain ratings) but limited significant findings and higher physical disability ratings, for these individuals with fibromyalgia

   (130)    Burckhardt CS, Mannerkorpi K, Hedenberg L, Bjelle A. A randomized, controlled clinical trial of education and physical training for women with fibromyalgia. J Rheumatol 1994; 21(4):714-720.
Abstract: OBJECTIVE: To determine the effectiveness of self-management education and physical training in decreasing fibromyalgia (FMS) symptoms and increasing physical and psychological well being. METHODS: A pretest-posttest control group design was used. Ninety-nine women with FMS were randomly assigned to 1 of 3 groups; 86 completed the study. The education only group received a 6-week self-management course. The education plus physical training group received the course and 6 h of training designed to assist them to exercise independently. The control group got treatment after 3 months. RESULTS: The experimental programs had a significant positive impact on quality of life and self-efficacy. Helplessness, number of days feeling bad, physical dysfunction, and pain in the tender points decreased significantly in one or both of the treated groups when retested 6 weeks after the end of the program. Longterm followup of 67 treated subjects showed significant positive changes on the Fibromyalgia Impact Questionnaire primarily in the physical training group. Among all subjects, 87% were exercising at least 3 times/week for 20 min or more; 46% said they had increased their exercise level since participating in the program; 70% were practicing relaxation strategies as needed; 46% were working at least half time as opposed to 37% at pretest. CONCLUSION: Self-efficacy of the treated groups was enhanced significantly by the program. Other changes were smaller and more delayed than had been expected. Recommendations for future trials include a longer education program, more vigorous physical training, and longterm followup

   (131)    Bakker C, Rutten M, van DE, Bennett K, van der LS. Feasibility of utility assessment by rating scale and standard gamble in patients with ankylosing spondylitis or fibromyalgia. J Rheumatol 1994; 21(2):269-274.
Abstract: OBJECTIVE. To assess the feasibility of utility measurement in patients with ankylosing spondylitis (AS) or fibromyalgia (FMS). Patient derived utilities provide overall estimates of the impact of a disease on patient well being. METHODS. The Maastricht Utility Measurement Questionnaire was applied cross sectionally to 57 patients with AS and 86 outpatients with FMS. By means of rating scale and standard gamble techniques, patients were asked to value their own health state. RESULTS. All 143 patients completed the interview. Patients with AS valued their personal health state on the rating scale (0-100) considerably higher than patients with FMS (AS: 69 and FMS: 54). Standard gamble utility values (0-1), however, were about the same at a higher level (AS: 0.86 and FMS: 0.83). Four weeks test-retest reliability was examined in 15 patients with FMS. The intraclass correlation coefficient of the utility score for the patient's own health state was 0.56 for the rating scale and 0.66 for the standard gamble technique. CONCLUSION. Feasibility of the Maastricht Utility Measurement Questionnaire was generally satisfactory in both patient groups. Utility values obtained by rating scale and standard gamble technique differed considerably. Our data support the view that utility measurement is sensitive to the method chosen to elicit patient well being

   (132)    Henriksson CM. Longterm effects of fibromyalgia on everyday life. A study of 56 patients. Scand J Rheumatol 1994; 23(1):36-41.
Abstract: Fifty-six patients with fibromyalgia, previously studied in 1984, were followed up after five years, using a mail questionnaire and a global health assessment instrument, the Sickness Impact Profile. The aim was to investigate the patients' perception of their symptoms and to describe the consequences for everyday life. Half of the patients reported that pain, fatigue and sleep problems had increased, less than 20% reported improvements, and 30-40%, no change. In spite of this, 25% reported that their overall condition had improved. Motor tasks were somewhat less difficult to manage. The symptoms had severe consequences for the patients' ability to manage everyday life activities. The study confirms that fibromyalgia, once established, is a non-remitting syndrome. Also, the social consequences were constant over time

   (133)    Kaplan KH, Goldenberg DL, Galvin-Nadeau M. The impact of a meditation-based stress reduction program on fibromyalgia. Gen Hosp Psychiatry 1993; 15(5):284-289.
Abstract: Fibromyalgia is a chronic illness characterized by widespread pain, fatigue, sleep disturbance, and resistance to treatment. The purpose of this study was to evaluate the effectiveness of a meditation-based stress reduction program on fibromyalgia. Seventy-seven patients meeting the 1990 criteria of the American College of Rheumatology for fibromyalgia took part in a 10-week group outpatient program. Therapists followed a carefully defined treatment approach and met weekly to further promote uniformity. Patients were evaluated before and after the program. Initial evaluation included a psychiatric structured clinical interview (SCID). Outcome measures included visual analog scales to measure global well-being, pain, sleep, fatigue, and feeling refreshed in the morning. Patients also completed a medical symptom checklist, SCL-90-R, Coping Strategies Questionnaire, Fibromyalgia Impact Questionnaire, and the Fibromyalgia Attitude Index. Although the mean scores of all the patients completing the program showed improvement, 51% showed moderate to marked improvement and only they were counted as "responders." These preliminary findings suggest that a meditation-based stress reduction program is effective for patients with fibromyalgia

   (134)    Burckhardt CS, Clark SR, Bennett RM. The fibromyalgia impact questionnaire: development and validation. J Rheumatol 1991; 18(5):728-733.
Abstract: An instrument has been developed to assess the current health status of women with the fibromyalgia syndrome. The Fibromyalgia Impact Questionnaire (FIQ) is a brief 10-item, self-administered instrument that measures physical functioning, work status, depression, anxiety, sleep, pain, stiffness, fatigue, and well being. We describe its development and validation. This initial assessment indicates that the FIQ has sufficient evidence of reliability and validity to warrant further testing in both research and clinical situations