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Pain & Fatigue Variability in Fibromyalgia Patients
J Pain; ePub 2017 Dec 15; Bartley, et al
Patients with fibromyalgia experience daily variability in pain, fatigue, and mood, and targeting this symptom variability may be an important clinical initiative, a recent study found. 256 fibromyalgia (FM) patients completed daily diaries up to a period of 154 days and reported on symptoms of pain intensity, pain unpleasantness, fatigue, anxiety, and depressed mood. Researchers found:
- Significant intra- and inter-individual variability in daily FM symptoms was observed.
- Higher levels of pain were associated with greater fluctuations in pain unpleasantness, fatigue, and depressed mood.
- Differences in pain and social functioning emerged across variability clusters.
- The mixed variability group characterized by low fluctuation in pain unpleasantness; moderate pain, fatigue, and depressed mood variability; and high anxiety variability, exhibited lower social functioning and higher levels of pain, compared to the low variability in symptoms group.
Bartley EJ, Robinson ME, Staud R. Pain and fatigue variability patterns distinguished subgroups of fibromyalgia patients. [Published online ahead of print December 15, 2017]. J Pain. doi:10.1016/j.jpain.2017.11.014.
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Sleep Disturbance and Chronic Pain Intensity, Clin J Pain; ePub 2019 Mar 25; Burgess, et al
Fibromyalgia, characterized by widespread pain, and often accompanied by fatigue and cognitive issues, affects up to 2% of the population. Patients with fibromyalgia have lower pain thresholds and when painful stimuli is encountered the pain lasts for a longer length of time than it does in those without fibromyalgia.1 Physiologic alterations in pain processing have been shown on functional MRI and increases in cerebrospinal fluid concentration of substance P support the concept that it is due to abnormalities in central processing of pain signals. The approaches to treatment are both lifestyle and medication based. Exercise has strong evidence of efficacy for helping improve symptoms of fibromyalgia.2 In addition, cognitive behavioral therapy (CBT) has strong evidence of efficacy. Evidence of efficacy exists for the use of amitriptyline and cyclobenzaprine (typically thought of as a muscle relaxant, but structurally related to the tricyclic antidepressants), neither of which are FDA approved for this indication. FDA approved medications for fibromyalgia include duloxetine (Cymbalta), milnacipran (Savella), and pregabalin (Lyrica). The current study shows that symptom variability is an important area to target in therapy. —Neil Skolnik, MD