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Global Pain, Fibromyalgia and the Insula – Ground Zero for Pain and Stimuli Issues in FM?

 
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Altered Functional Performance in Patients with Fibromyalgia.

  [ 3 votes ]   [ 1 Comment ]
By Costa ID, et al. • www.ProHealth.com • February 20, 2017


ABSTRACT
 
Fibromyalgia is a common chronic pain condition that exerts a considerable impact on patients' daily activities and quality of life.
 
Objectives: The main objective of the present study was to evaluate kinematic parameters of gait, functional performance, and balance in women with fibromyalgia syndrome.
 
Methods: The study included 26 female patients with fibromyalgia (49.2 ± 8.0 years) according to the criteria of the American College of Rheumatology, as well as 16 pain-free women (43.5 ± 8.5 years). Gait and balance parameters were extracted from video recordings of participants performing several motor tasks. Non-linear dynamic of body sway time series was also analyzed by computing the Hurst exponent. In addition, functional performance and clinical pain were obtained by using standardized motor tests (Berg's balance scale, 6-min walking test, timed up and go task, Romberg's balance test) and self-report questionnaires (Fibromyalgia Impact Questionnaire).
 
Results: Walking speed was significantly diminished (p < 0.001) in FM patients as compared to pain-free controls, probably due to significant reductions in stride length (p < 0.001) and cycle frequency (p < 0.001). Analyses of balance also revealed significant differences between fibromyalgia and pain-free controls on body sway in the medial-lateral and anterior-posterior axes (all ps < 0.01). Several parameters of gait and balance were significantly associated with high levels of pain, depression, stiffness, anxiety, and fatigue in fibromyalgia.
 
Conclusion: Our data revealed that both gait and balance were severely impaired in FM, and that subjective complaints associated with FM could contribute to functional disability in these patients. These findings suggest that optimal rehabilitation and fall prevention in fibromyalgia require a comprehensive assessment of both psychological responses to pain and physical impairments during postural control and gait.
 
Full text available here.
 
Costa ID, Gamundí A, Miranda JG, França LG, De Santana CN, Montoya P.  Altered Functional Performance in Patients with Fibromyalgia. Front Hum Neurosci. 2017 Jan 26;11:14. doi: 10.3389/fnhum.2017.00014. eCollection 2017.




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Article Comments Post a Comment

Good study - strayed off-track
Posted by: IanH
Feb 23, 2017
Why does this study jump to conclusions about a relationship between function and psychological factors?

There is no structural component measuring depression in the study at all except to ask people about "depression". This is no way to measure the presence of depression in FM. In the summary/discussion, this whole section (abbreviated here) is questionable and flimsy.

"Although the influence of psychological factors on motor disturbances observable in chronic pain is still unclear, a common assumption is that pain catastrophizing, hypervigilance, fear of pain, and subsequent avoidance of activities that are known to exacerbate pain .. . might contribute to reduce physical activity and to alter gait and balance parameters (such as muscle weakness, slower walking, shorter step length, shorter stride time, or higher trunk muscle activity) in chronic back pain . . . for instance, reduced stride length and increased time taken to perform the TUG task were linked to high pain intensity, depression and stiffness, whereas increased body sway in the medial-lateral axis was positively associated with pain intensity and anxiety. In addition, other gait parameters such as gait velocity, gait duration or cadence were only associated with pain intensity, and body sways in the anterior-posterior axis or Hurst exponents of body sways in both axes were even not correlated with pain-related complaints in FM patients.

These differences may reflect a differential effect of depression and anxiety on gait and balance and warrant further investigation in FM patients. . . .instilling greater self-confidence in patients to engage in physical exercise to improve functional outcomes.

Come on!

This was a good study on functional disability in FM, why spoil it by bringing such weak associations to psychological factors, especially depression, which was not properly assessed.
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