Clin Exp Rheumatol
-
Medically 'unexplained' chronic disorders remain a challenge for clinicians because the patients with these syndromes have a wide range of symptoms, including pain, impaired concentration, sleep disturbances, fatigue and mood disorders, as well as functional problems and difficulties in carrying out the activities of daily living. Such disorders are the result of a complex physiological interaction of central and peripheral nervous signaling that leads to a highly individual symptom complex, although some of them seem to be related to one another, especially in terms of the mechanism of chronicity and pain amplification, and the co-occurrence of fatigue, sleep alterations, mood disturbances and cognitive impairment. This review will discuss the recent literature concerning the most common dysfunctional disorders: fibromyalgia syndrome, myalgic encephalomyelitis/chronic fatigue syndrome, and irritable bowel syndrome.
-
Review Meta Analysis
Placebo and nocebo responses in randomised controlled trials of drugs applying for approval for fibromyalgia syndrome treatment: systematic review and meta-analysis.
The superiority of true drug treatment over placebo in reducing symptoms of fibromyalgia syndrome (FMS) is small and bought by relevant rates of drop-outs due to adverse events. Recent systematic reviews demonstrated that a substantial proportion of the beneficial and adverse effects of true drug is attributable to placebo in chronic pain trials. We determined the magnitude of the placebo and nocebo response and its impact on the benefits and harms of true drug in trials of drugs which were submitted for approval for treatment of FMS. ⋯ The magnitude of placebo and nocebo response in trials of drugs applying for approval for FMS treatment was substantial. Study investigators aim to reduce placebo response. By contrast, clinicians often utilise placebo effects. Strategies to reduce nocebo responses in clinical trials and practice should be developed.
-
Depression is a common comorbid condition in fibromyalgia (FM) and a major contributor to poor quality of life and disability. However, depression can be difficult to assess in patients with FM due to overlapping symptoms between the two conditions. This review aims to present the most used rating scales for depression in FM patients by discussing their potential drawbacks. Moreover, we aimed to discuss the possible approach to mood symptoms in FM patients according to the mood spectrum model. ⋯ The need of a careful screening of depressive symptoms and of their proper management is primary in FM. In our opinion instruments like MOODS-SR are particularly suitable for screening FM patients because they allow to recognise also sub-threshold mood symptoms with minimal contamination by somatic conditions.