OBJECTIVE: Acupuncture has demonstrated efficacy as a treatment for fibromyalgia; however, predictors of short- and long-term analgesic response in this population are not well understood. METHODS: This manuscript describes a secondary analysis of a single-center, blinded, sham-controlled, randomized longitudinal acupuncture clinical trial in fibromyalgia. Baseline characterization included pressure pain threshold and pain interference, while residualized change in pain intensity from baseline to follow-up served as the primary outcome measure. Participants were randomized into groups that received verum (n = 36) or sham (n = 29) acupuncture treatment over a 12-week period (18 treatments) and were followed for 37 weeks from the initiation of treatment. RESULTS: Lower pressure pain thresholds at baseline were associated with greater analgesia only in the sham treatment group immediately following treatment, while those with higher pressure pain thresholds had greater analgesia with verum treatment (B = -13.43, P = 0.001). Additionally, greater perceived impact of pain at baseline was predictive of greater short-term analgesia irrespective of treatment. Pressure pain threshold was not found to be predictive of long-term differential treatment response (B = -1.71, P = 0.66). There was a significant difference in the relationship between perceived impact of pain at baseline and subsequent long-term analgesia between groups where those with greater perceived impact of pain displayed improved long-term analgesia for verum acupuncture compared to the sham group (B = -11.37, P = 0.004). CONCLUSION Our results support the use of a self-reported pain outcome in predicting long-term analgesia following acupuncture in fibromyalgia. Please cite this article as: Murphy AE, Arewasikporn A, Taylor-Swanson L, Williams DA, Harris RE. Pressure pain threshold and perceived impact of pain differentially predict short-term and long-term pain reduction following acupuncture in fibromyalgia. J Integr Med. 2025; 23(2): 152-158.
Adult ; Female ; Humans ; Male ; Middle Aged ; Acupuncture Therapy ; Fibromyalgia/therapy* ; Pain Management/methods* ; Pain Measurement/statistics & numerical data* ; Pain Threshold/physiology* ; Pressure ; Treatment Outcome ; Longitudinal Studies

OBJECTIVE: To explore the effects of overweight and obesity (overweight/obesity) on symptom severity and quality of life in Chinese patients with fibromyalgia syndrome (FMS). METHODS: A cross-sectional survey was used to collect general data on height, weight, gender and age of 435 FMS patients who visited the rheumatology clinic of Guang 'anmen Hospital from October 2018 to December 2021. The numbers of tender points, widespread pain index and symptom severity scale were used as diagnostic indicators of the disease. The pain visual analogue scale, Beck depression inventory, perceived stress scale (PSS), Pittsburgh sleep quality index (PSQI) and multidimensional fatigue scale were used to assess the severity of pain and negative emotions, stress perception, sleep quality, and fatigue symptoms of this disease. The revised fibromyalgia impact questionnaire, fibromyalgia symptom scale (FS) and quality of life assessment scale (36 item short-form health survey, SF-36) were used to evaluate the overall condition and quality of life of the FMS patients. At the same time, 50 healthy volunteers matched in gender and age were recruited as the control group. Covariance analysis was used to explore the effects of overweight/obesity on the FMS patients after adjusting for age and gender. RESULTS: According to the Chinese body mass index (BMI) standard, there were 242 (59%) and 170 (41%) FMS patients in the normal weight group and overweight/obesity group, respectively, with average BMI of (21.66±1.42) kg/m² and (26.25±1.83) kg/m², respectively. Compared with the normal weight FMS patients, the overweight/obesity patients had higher PSS scores (P=0.010), PSQI sub-dimension sleep efficiency scores (P < 0.001) and FS scores (P=0.025), and lower SF-36 sub-dimension physical functioning scores (P=0.041). However, there were no statistical differences in the above indicators between normal weight and overweight/obesity patients in the healthy control group (P > 0.05). CONCLUSION Compared with normal-weight FMS patients, overweight/obesity patients have higher levels of perceived stress, lower sleep efficiency, and more severe fibromyalgia symptoms, as well as a low quality of life characterized by decreased physiological function. It is important for overweight/obesity FMS patients to control BMI actively in order to improve sleep efficiency, psychological state, physical functioning, and the overall condition.
Humans ; Fibromyalgia/psychology* ; Quality of Life ; Cross-Sectional Studies ; Overweight/psychology* ; Obesity/psychology* ; Female ; Male ; Surveys and Questionnaires ; Pain Measurement ; Severity of Illness Index ; Fatigue/etiology* ; Sleep Quality ; Middle Aged ; Adult ; Depression/psychology*

OBJECTIVE: To evaluate the sensitivity and specificity of Pollard' s classification criteria(2010) for the diagnosis of rheumatoid arthritis (RA) patients withfibromyalgia (FM) in Chinese patients, and to assess the clinical features and psychological status of RA-FM patients in a real-world observational setting. METHODS: Two hundred and two patients with rheumatoid arthritis were enrolled from the outpatients in Rheumatology and Immunology Department in Peking University People' s Hospital. All the patients were evaluated whether incorporating fibromyalgia translation occured using the 1990 American College of Rheumatolgy (ACR)-FM classification criteria. Forty two RA patients were concomitant with FM, while the other one hundred and sixty RA patients without FM were set as the control group. RESULTS: There was no significant difference in general demography between the two groups (P>0.05). In this study, the Pollard' s classification criteria (2010) for RA-FM in Chinese patients had a high sensitivity of 95.2% and relatively low specificity of 52.6%. Compared with those patients without FM, RA patients with FM (RA-FM patients) had higher Disease Activity Scale in 28 joints (DAS-28) score (5.95 vs. 4.38, P=0.011) and much more 28-tender joint counts (TJC) (16.5 vs.4.5, P < 0.001).RA-FM patients had worse Health Assessment Questionnaire (HAQ) score (1.24 vs. 0.66, P < 0.001) and lower SF-36 (28.63 vs. 58.22, P < 0.001). Fatigue was more common in RA-FM patients (88. 1% vs. 50.6%, P < 0.001) and the degree of fatigue was significantly increased in RA-FM patients (fatigue VAS 5.55 vs. 3.55, P < 0.001). RA-FM patients also had higher anxiety (10 vs.4, P < 0.001) and depression scores (12 vs.6, P < 0.001). erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), morning stiffness time and 28-swollen joint counts (SJC) showed no difference between these two groups. CONCLUSION The Pollard' s classification criteria (2010) for RA-FM are feasible in Chinese rheumatoid arthritis patients. The Pollard' s classification criteria is highly sensitive in clinical application, while the relativelylow specificity indicates that various factors need to be considered in combination. RA patients with FM result in higher disease activity, worse function aland psychological status. RA patients with FM also have poorer quality of life. DAS-28 scores may be overestimated in RA patients with FM. In a RA patient thatdoes not reach remission, the possibility of fibromyalgia should be con-sidered.
Arthritis, Rheumatoid/diagnosis* ; Fatigue/etiology* ; Fibromyalgia/diagnosis* ; Humans ; Quality of Life ; Severity of Illness Index

Background: Fibromyalgia is a difficult-to-treat chronic musculoskeletal pain and tenderness syndrome. It is considered due to augmented pain processing in central nervous system. Interest in antiepileptic drugs, included pregabalin, for treatment of fibromyalgia is currently growing. This study aimed to investigate the effectiveness of pregabalin for fibromyalgia. Methods: We conducted the study according to the meta-analysis PRISMA guideline. Relevant randomized controlled trials (RCTs) were identified from a search of PubMed and Cochrane databases. Quality of selected studies was assessed using Jadad score for randomized placebo-controlled trials (RCT). Primary outcome was pain score reduction (30% and 50% reduction) and secondary outcome was patient global impression of change. Statistical analysis was performed using Review Manager 5.3. Results: Six international, multicenter, high-quality RCTs with 8-15 weeks duration of treatment met inclusion criteria. Four studies used different fixed dose (300 mg/d, 450 mg/d, 600mg/d) and 2 studies used titrated dose in evaluating the efficacy of pregabalin. There was statistically significant benefit of pregabalin over placebo in mean pain score reduction [odds ratio (OR) 1.81, 95% confidence interval (CI) 1.56-2.10 p < 0.00001 in fixed dose pregabalin 30% pain reduction; OR 2.06 95% CI 1.66-2.56 p < 0.00001 in fixed dose pregabalin 50% pain reduction; OR 1.53 95% CI 1.10-2.13 p 0.01 in titrated dose pregabalin 30% pain reduction; OR 1.80 95% CI 1.12-2.88 p 0.01 in titrated dose pregabalin 50% pain reduction]. Pregabalin also demonstrated significantly better patient global impression of change than placebo. No heterogeneity was seen in most groups. No publication bias was observed. Conclusion Our study showed pregabalin monotherapy was effective for pain treatment associated with fibromyalgia. Further studies with longer treatment duration are needed to confirm the long-term effectiveness of pregabalin for fibromyalgia treatment.
Fibromyalgia ; Pregabalin ; Meta-Analysis

Almost 50% of patients with inflammatory bowel disease (IBD) exhibit at least one extra-intestinal manifestation in their lifetime. Extra-intestinal manifestations of IBD are often associated with the intestinal disease activity, reducing the quality of life of the patient but rarely leading to fatal complications. Musculoskeletal involvement is the most frequent extra-intestinal manifestation of patients with IBD but this rarely occurs before IBD is diagnosed. They are manifested in various forms, such as arthropathy, fibromyalgia, and osteoporosis. Therefore, a multidisciplinary team approach including gastroenterologists and rheumatologists are necessary for optimal treatment. This review focuses on the diagnosis and treatment of musculoskeletal manifestations of IBD from the perspectives of rheumatologists who can assist gastroenterologists.
Diagnosis ; Fibromyalgia ; Humans ; Inflammatory Bowel Diseases ; Intestinal Diseases ; Joint Diseases ; Musculoskeletal Diseases ; Osteoporosis ; Quality of Life

BACKGROUND: We aimed to explore the American College of Rheumatology (ACR) 1990 and 2011 fibromyalgia (FM) classification criteria’s items and the components of Fibromyalgia Impact Questionnaire (FIQ) to identify features best discriminating FM features. Finally, we developed a combined FM diagnostic (C-FM) model using the FM’s key features. METHODS: The means and frequency on tender points (TPs), ACR 2011 components and FIQ items were calculated in the FM and non-FM (osteoarthritis [OA] and non-OA) patients. Then, two-step multiple logistic regression analysis was performed to order these variables according to their maximal statistical contribution in predicting group membership. Partial correlations assessed their unique contribution, and two-group discriminant analysis provided a classification table. Using receiver operator characteristic analyses, we determined the sensitivity and specificity of the final model. RESULTS: A total of 172 patients with FM, 75 with OA and 21 with periarthritis or regional pain syndromes were enrolled. Two steps multiple logistic regression analysis identified 8 key features of FM which accounted for 64.8% of variance associated with FM group membership: lateral epicondyle TP with variance percentages (36.9%), neck pain (14.5%), fatigue (4.7%), insomnia (3%), upper back pain (2.2%), shoulder pain (1.5%), gluteal TP (1.2%), and FIQ fatigue (0.9%). The C-FM model demonstrated a 91.4% correct classification rate, 91.9% for sensitivity and 91.7% for specificity. CONCLUSIONS: The C-FM model can accurately detect FM patients among other pain disorders. Re-inclusion of TPs along with saving of FM main symptoms in the C-FM model is a unique feature of this model.
Back Pain ; Chronic Pain ; Classification ; Discriminant Analysis ; Fatigue ; Fibromyalgia ; Humans ; Logistic Models ; Neck Pain ; Osteoarthritis ; Periarthritis ; Rheumatology ; Sensitivity and Specificity ; Shoulder Pain ; Sleep Initiation and Maintenance Disorders

OBJECTIVE: The purpose of this study is to evaluate the usefulness of infrared thermography in patients with carpal tunnel syndrome by comparing with electrodiagnostic and ultrasonographic findings.METHOD: From January 2014 to October 2017, electrodiagnosis, ultrasound, and digital infrared thermal image (DITI) of unilateral carpal tunnel syndrome diagnosed in a single hospital were retrospectively analyzed. The subjects with bilateral symptoms of carpal tunnel syndrome, peripheral vascular disease, diabetes, thyroid disease, fibromyalgia, rheumatic disease, systemic infection, inflammation, malignant tumor, and other musculoskeletal disorders such as finger osteoarthritis, peripheral neuropathy, cervical radiculopathy, and the previous history of surgery were excluded.RESULTS: Of 53 patients diagnosed with carpal tunnel syndrome, 11 were male and 42 were female. The visual analogue scale was 4.9 ± 1.9, and the duration of symptom was 11.8 ± 12.5 months. There was no statistically significant difference in the body surface temperature between the unaffected and affected sides. The severity of symptoms, electrodiagnostic findings, and cross-sectional area of the median nerve significantly correlates to each other. The temperature difference between the second fingers of the affected and unaffected sides showed a weak correlation with the amplitude of sensory nerve action potential and onset latency of compound muscle action potential, when there was no significant correlation with the other parameters.CONCLUSION: The difference in temperature on the surface of the body, which can be confirmed by DITI, is little diagnostic value when DITI is performed in unilateral carpal tunnel syndrome patients, especially when compared with ultrasonography.
Action Potentials ; Carpal Tunnel Syndrome ; Electrodiagnosis ; Female ; Fibromyalgia ; Fingers ; Humans ; Inflammation ; Male ; Median Nerve ; Methods ; Osteoarthritis ; Peripheral Nervous System Diseases ; Peripheral Vascular Diseases ; Radiculopathy ; Retrospective Studies ; Rheumatic Diseases ; Thermography ; Thyroid Diseases ; Ultrasonography

Almost 50% of patients with inflammatory bowel disease (IBD) exhibit at least one extra-intestinal manifestation in their lifetime. Extra-intestinal manifestations of IBD are often associated with the intestinal disease activity, reducing the quality of life of the patient but rarely leading to fatal complications. Musculoskeletal involvement is the most frequent extra-intestinal manifestation of patients with IBD but this rarely occurs before IBD is diagnosed. They are manifested in various forms, such as arthropathy, fibromyalgia, and osteoporosis. Therefore, a multidisciplinary team approach including gastroenterologists and rheumatologists are necessary for optimal treatment. This review focuses on the diagnosis and treatment of musculoskeletal manifestations of IBD from the perspectives of rheumatologists who can assist gastroenterologists.
Diagnosis ; Fibromyalgia ; Humans ; Inflammatory Bowel Diseases ; Intestinal Diseases ; Joint Diseases ; Musculoskeletal Diseases ; Osteoporosis ; Quality of Life

Fibromyalgia (FM) is a contested illness with ill-defined boundaries. There is no clearly defined cut-point that separates FM from non-FM. Diagnosis of FM has been faced with several challenges that occur, including patients' health care-seeking behavior, symptoms recognition, and FM labeling by physicians. This review focuses on important but less visible factors that have a profound influence on under- or over-diagnosis of FM. FM shows different phenotypes and disease expression in patients and even in one patient over time. Psychosocial and cultural factors seem to be a contemporary ferment in FM which play a major role in physician diagnosis even more than having severe symptom levels in FM patients. Although the FM criteria are the only current methods which can be used for classification of FM patients in surveys, research, and clinical settings, there are several key pieces missing in the fibromyalgia diagnostic puzzle, such as invalidation, psychosocial factors, and heterogeneous disease expression. Regarding the complex nature of FM, as well as the arbitrary and illusory constructs of the existing FM criteria, FM diagnosis frequently fails to provide a clinical diagnosis fit to reality. A physicians' judgment, obtained in real communicative environments with patients, beyond the existing constructional scores, seems the only reliable way for more valid diagnoses. It plays a pivotal role in the meaning and conceptualization of symptoms and psychosocial factors, making diagnoses and labeling of FM. It is better to see FM as a whole, not as a medical specialty or constructional scores.
Chronic Pain ; Classification ; Diagnosis ; Dyssomnias ; Fatigue Syndrome, Chronic ; Fibromyalgia ; Headache ; Humans ; Judgment ; Musculoskeletal Diseases ; Patient Selection ; Phenotype ; Psychology ; Reproducibility of Results ; Surveys and Questionnaires

Vitamin D is a cofactor responsible for autoimmune disorders. There is no agreement in the studies investigating the association between vitamin D and fibromyalgia. This study aims to combine the conflicting results of the primary studies which compared these patients with control groups regarding the serum concentration of vitamin D. This meta-analysis has been designed based on PRISMA guidelines. Relevant keywords were searched in PubMed, Science direct, Scopus, Cochrane, and Google scholar and primary studies were selected. After screening the eligible studies according to inclusion/exclusion criteria, we investigated the risk of bias in the selected studies and also the heterogeneity between the primary results using Cochrane (Q) and I-squared (I2) indices. The primary results were combined using inverse variance method and Cohen statistics as well as a random effects model. Publication bias was assessed using Egger test. Sensitivity analysis was applied to investigate the influence of each primary study on the final result of the meta-analysis. Suspected factors in the heterogeneity were assessed using meta-regression models. We entered 12 eligible studies in the meta-analysis including 851 cases compared with 862 controls. The standardized mean difference of Vitamin D between the two groups was −0.56 (95% confidence interval: −1.05, −0.08). Our meta-analysis showed that vitamin D serum levels of patients with fibromyalgia was significantly lower than that of control group.
Bias (Epidemiology) ; Eligibility Determination ; Fibromyalgia* ; Humans ; Mass Screening ; Methods ; Myofascial Pain Syndromes ; Population Characteristics ; Publication Bias ; Vitamin D* ; Vitamins*