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.”
B. Walitt presented [2]: “COGNITIVE FOG: SUBJECTIVE AND OBJECTIVE
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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