Wednesday, June 28, 2017

Disparities between Objective Measures and Self-report in Fibromyalgia at the 2017 EULAR Annual Meeting in Madrid

There has been a session with four speakers named “Closing the gap between objective measures and self-report in fibromyalgia” at the 2017 EULAR Annual Meeting in Madrid.

M. Henriksen talked on [1]: “DIVERGENCES BETWEEN OBJECTIVE AND SELF-REPORTED PHYSICAL FUNCTION IN FIBROMYALGIA”. “In fibromyalgia (FM), intolerance to physical activity, with increased pain and experience of early muscle fatigue, is a predominant feature.” “Much like central sensitization of pain, it has been suggested that impaired sensory-motor interaction is present in FM, which may be a cause for observed discrepancies between perceived and objective signs of muscle fatigue.” Dr. Henriksen outlined a controlled experiment, in which objective measures were compared to perceived fatigue in fibromyalgia (FM) patients and healthy volunteers after a muscle exhaustion test. FM patients showed central nervous system processes of muscular fatigue “without any evidence of peripheral muscle fatigue”. “The study supports a hypothesis about abnormal sensory-motor interaction among FM patients that can explain the discrepancies between perceived and observed physical disability in FM.”

UNDERSTANDINGS OF THE SYMPTOM OF DYSCOGNITION”. Conclusions: “… the experience of cognitive fog is not well captured by current testing paradigms. Subjective complaint is a poor predictor of objective cognitive performance. The neuronal mechanisms responsible for the experience of cognitive fog may be separate from those required to perform cognitive tasks.” Fibro fog is another name for this condition. Sometimes in therapy one can see it that patients unable to read two pages of a book are happy again to read, once the fibro fog is gone.

F. Estevez-Lopez talked on [3]: “ASSOCIATIONS OF PAIN-RELATED COGNITIONS WITH THE DISCORDANCE BETWEEN SUBJECTIVE AND OBJECTIVE PHYSICAL FUNCTION IN FIBROMYALGIA: THE AL-ANDALUS PROJECT”. In the Al-Andalus Project 405 female FM patients and 193 age matched controls were studied with “the Pain Catastrophizing Scale, Chronic Pain Self-efficacy Scale, and physical functioning subscales of the Revised Fibromyalgia Impact Questionnaire (FIQR) and Short Form-36 (SF-36) health survey”. Conclusions: “Although both are markedly impaired, subjective physical function is more impaired than objective physical function in fibromyalgia. Catastrophizing is associated with this discordance.” Allow me to match this with own observations. FM patients were always surprised looking at the Borg scale (rating of perceived exertion) before and after physical training.

L. Piggott looked from the patient’s perspective [4]: “THE DRUGS DON’T WORK”. She talked about “her own search for answers and cure to Fibromyalgia in an attempt to salvage her life and independence, prior to accepting that this is a long-term condition which will require self-management and perseverance.” Mrs. Piggott made the observation that “drugs don’t work”. I can understand the frustration of any FM patient, when drugs don’t work. I’ve written quite often on fibromyalgia and that I don’t think drugs would be the solution [5]. Often drugs create new problems. Analgesics have a place in acute pain (nociceptive pain), but aren’t of much use in chronic pain (non-nociceptive / central pain). F. Wolfe has shown how little effective modern antidepressants are [6]: “Physicians and patients should be realistic about the potential benefits of antidepressants in FMS. A small number of patients experience a substantial symptom relief with no or minor adverse effects. However, a remarkable number of patients dropout of therapy because of intolerable adverse effects or experience only a small relief of symptoms, which does not outweigh the adverse effects.”

There are disparities between objective measures and self-report in fibromyalgia, but in recognizing these, we can gain a new perspective, which enables us as health care professionals to help our patients instead of adding harm.

Links and References:
[1] DOI: 10.1136/annrheumdis-2017-eular.7148
[2] DOI: 10.1136/annrheumdis-2017-eular.7215
[3] DOI: 10.1136/annrheumdis-2017-eular.7185
[4] DOI: 10.1136/annrheumdis-2017-eular.7191


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