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Fibromyalgia: HELP
Articles from University of Toronto
Based on 23 articles published since 2009
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These are the 23 published articles about Fibromyalgia that originated from University of Toronto during 2009-2019.
 
+ Citations + Abstracts
1 Editorial Editorial: Mood Disorders and General Medical Comorbidities: Shared Biology and Novel Therapeutic Targets. 2016

McIntyre, Roger S / Carvalho, André F. ·Departments of Psychiatry and Pharmacology, Mood Disorders Psychopharmacology Unit, University of Toronto, 399 Bathurst Street, MP 9-325, Toronto, ON M5T 2S8, Canada. roger.mcintyre@uhn.ca. · Translational Psychiatry Research Group and Department of Clinical Medicine, Faculty of Medicine, Federal University of Ceará, Rua Prof. Costa Mendes, 1608, 4o andar, 60.430-140 Fortaleza, CE, Brazil. andrefc7@terra.com.br. ·Curr Mol Med · Pubmed #26812953.

ABSTRACT: -- No abstract --

2 Review Ultrasound imaging for sarcopenia, spasticity and painful muscle syndromes. 2018

Özçakar, Levent / Ata, Ayşe Merve / Kaymak, Bayram / Kara, Murat / Kumbhare, Dinesh. ·Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, Ankara. · Department of Physical Medicine and Rehabilitation, Viranşehir State Hospital, Şanlıurfa, Turkey. · Division of Physical Medicine and Rehabilitation, Department of Medicine, University of Toronto, Toronto, Canada. ·Curr Opin Support Palliat Care · Pubmed #29912727.

ABSTRACT: PURPOSE OF REVIEW: On the basis of its various advantages and the relevant awareness of physicians, ultrasound imaging has overwhelmingly taken its place in the scientific arena. This is true both from the side of daily clinical applications and also from the side of research. Yet, ultrasound provides real-time (diagnostic) imaging and (interventional) guidance for a wide spectrum of muscle disorders. In this regard, this review aims to discuss the potential/actual utility of ultrasound imaging in particular muscle disorders, that is, sarcopenia, spasticity and fibromyalgia/myofascial pain syndrome. RECENT FINDINGS: Due to the aging population worldwide and the importance of functionality in the older population, mounting interest has been given to the diagnosis and management of sarcopenia in the recent literature. Likewise, several articles started to report that ultrasound imaging can be used conveniently and effectively in the early diagnosis and quantification of sarcopenia.For spasticity, aside from ultrasound-guided botulinum toxin injections, intriguing attention has been paid to sonographic evaluation of muscle architecture, echogenicity and elasticity in the follow-up of these chronic conditions.As regards painful muscle syndromes, quantitative ultrasound techniques have been shown to detect statistically significant differences between healthy controls and patients with myofascial pain syndrome. SUMMARY: Ultrasound imaging seems to be a promising tool that indisputably deserves further research in the management of a wide range of muscle disorders. VIDEO ABSTRACT: http://links.lww.com/COSPC/A17.

3 Review Prevalence of fibromyalgia and co-morbid bipolar disorder: A systematic review and meta-analysis. 2015

Kudlow, P A / Rosenblat, J D / Weissman, C R / Cha, D S / Kakar, R / McIntyre, R S / Sharma, V. ·Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, Canada; Institute of Medical Science, University of Toronto, Toronto, Canada. · Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, Canada. · Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, Canada; University of British Columbia, Vancouver, BC, Canada. · Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, Canada; Institute of Medical Science, University of Toronto, Toronto, Canada. · Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, Canada; Department of Psychiatry, Western University, London and Windsor, ON, Canada. · Department of Psychiatry, Western University, London and Windsor, ON, Canada. Electronic address: vsharma@uwo.ca. ·J Affect Disord · Pubmed #26363263.

ABSTRACT: BACKGROUND: Fibromyalgia (FM) is a chronic disorder with high morbidity and significant health service utilization costs. Few studies have reported on the phenotypic overlap of FM and bipolar disorder (BD). The aim of this review is to qualitatively and quantitatively summarize the results and clinical implications of the extant literature on the co-occurrence of FM and BD. METHODS: A systematic search of PubMed/Medline, Cochrane, PsycINFO, CINAHL and Embase was conducted to search for relevant articles. Articles were included if incidence and/or prevalence of BD was determined in the FM sample. Results of prevalence were pooled from all studies. Pooled odds ratio (OR) was calculated based on case-control studies using standard meta-analytic methods. RESULTS: A total of nine studies were included. The pooled rate of BD comorbidity in samples of FM patients was 21% (n=678); however, results varied greatly as a function of study methodology. Case-controlled studies revealed a pooled OR of 7.55 of BD co-morbidity in samples of FM patients [95% Confidence Interval (CI)=3.9-14.62, FM n=268, controls n=413] with low heterogeneity (I(2)=0%). LIMITATIONS: The current study was limited by the low number of available studies and heterogeneity of study methods and results. CONCLUSIONS: These data strongly suggest an association between BD and FM. Future studies employing a validated diagnostic screen are needed in order to more accurately determine the prevalence of BD in FM. An adequate psychiatric assessment is recommended in FM patients with suspected symptoms consistent with BD prior to administration of antidepressants in the treatment of FM.

4 Review Nondermatomal somatosensory deficits: overview of unexplainable negative sensory phenomena in chronic pain patients. 2010

Mailis-Gagnon, Angela / Nicholson, Keith. ·Comprehensive Pain Program, Toronto Western Hospital, Canada. angela.mailis@uhn.on.ca ·Curr Opin Anaesthesiol · Pubmed #20657277.

ABSTRACT: PURPOSE OF REVIEW: To review the literature and our current understanding of nondermatomal somatosensory deficits (NDSDs) associated with chronic pain in regards to their prevalence, assessment and clinical presentation, cause and pathophysiology, relationship with conversion disorder and psychological factors, as well as their treatment and prognosis. RECENT FINDINGS: NDSDs are negative sensory deficits consisting of partial or total loss of sensation to pinprick, light touch or other cutaneous modalities. Although they had been noted more than a century ago and appear prevalent in chronic pain populations, they are poorly studied. They may be very mild or very dense, may occupy large body areas, are often highly dynamic and changeable or, to the contrary, very stable and long lasting. NDSDs may occur in the absence of biomedical pathology or coexist with structural musculoskeletal or nervous system abnormalities. They appear to be associated with psychological factors and a poor prognosis for response to treatment and return to work. Recent brain imaging studies provide a basis for understanding NDSD pathophysiology. SUMMARY: NDSDs represent prevalent phenomena associated with chronic pain. Further, research is needed to elucidate their origin, response to treatment, and prevalence in the general population, primary care settings, and nonpain patients.

5 Review The significance of dysfunctions of the sleeping/waking brain to the pathogenesis and treatment of fibromyalgia syndrome. 2009

Moldofsky, Harvey. ·Sleep Disorders Clinics of the Centre for Sleep & Chronobiology, University of Toronto, Toronto, Ontario, Canada. h.moldofsky@utoronto.ca ·Rheum Dis Clin North Am · Pubmed #19647142.

ABSTRACT: This article reviews how functional disturbances of the sleeping-waking brain are involved in pathogenesis of the widespread pain, unrefreshing sleep, fatigue, and impaired quality of life of patients who have fibromyalgia syndrome. Recent studies of the effects on EEG sleep by some specific pharmacologic and physical therapeutic agents demonstrate not only benefit for the widespread pain and fatigue, but also improved sleep physiology and restorative sleep of patients who suffer from fibromyalgia.

6 Article Clustering a large Spanish sample of patients with fibromyalgia using the Fibromyalgia Impact Questionnaire-Revised: differences in clinical outcomes, economic costs, inflammatory markers, and gray matter volumes. 2019

Pérez-Aranda, Adrián / Andrés-Rodríguez, Laura / Feliu-Soler, Albert / Núñez, Christian / Stephan-Otto, Christian / Pastor-Mira, María A / López-Roig, Sofía / Peñacoba, Cecilia / Calandre, Elena P / Slim, Mahmoud / Salgueiro, Monika / Feixas, Guillem / Luciano, Juan V. ·Group of Psychological Research in Fibromyalgia and Chronic Pain (AGORA), Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain. · Teaching, Research and Innovation Unit, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain. · Primary Care Prevention and Health Promotion Research Network, RedIAPP, Madrid, Spain. · Department of Clinical Psychology and Psychobiology (Section Personality, Assessment and Psychological Treatments), University of Barcelona, Barcelona, Spain. · Cerebral Imprints of Gender, Development and Pathology, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain. · Center for Biomedical Research in Mental Health, CIBERSAM, Madrid, Spain. · Department of Health Psychology, Miguel Hernández University, Elche, Spain. · Department of Medicine and Surgery, Public Health, Psychology and Immunology and Medical Microbiology, Rey Juan Carlos University, Madrid, Spain. · Instituto de Neurociencias Federico Olóriz, Universidad de Granada, Armilla, Spain. · Division of Neurology, The Hospital for Sick Children, Toronto, Canada. · Department of Psychiatry, Cruces University Hospital, Osakidetza-Basque Health System, BioCruces Health Research Institute, Barakaldo, Spain. · The Institute of Neurosciences, University of Barcelona, Barcelona, Spain. ·Pain · Pubmed #30586023.

ABSTRACT: The main objective of this study is to identify fibromyalgia syndrome (FMS) clusters using the Revised Fibromyalgia Impact Questionnaire (FIQR), and to examine whether the clusters differ in sociodemographic characteristics, clinical measures, direct and indirect costs, levels of inflammatory markers, and brain morphometry. A hierarchical cluster analysis was performed to classify a large, pooled Spanish sample of patients with FMS (N = 947) using the FIQR as clustering variable. A latent profile analysis was subsequently conducted to confirm the optimal number of FMS clusters. To examine external validity, a battery of clinical measures, economic costs, inflammatory markers, and gray matter volumes of relevant cortical and subcortical areas were analyzed. We also compared the discriminant validity of the clusters with the original FIQR severity categories. To promote the implementation in real-world clinical practice, we built a free online cluster calculator. Our findings indicated that a four-cluster solution more clearly captured the heterogeneity of FIQR data and provided the best fit. This cluster solution allowed for detection of differences for most clinical outcomes and economic costs. Regarding the inflammatory and brain-based biomarkers, differences were found in C-reactive protein, and tendencies were found in the right medial prefrontal cortex, the right parahippocampal gyrus, and the right middle cingulate cortex; brain regions associated with executive functions and pain processing. The original FIQR categories presented similar results, although their precision in discriminating among the nonextreme categories (ie, moderate and severe) was not sound. These findings are discussed in relation to previous research on FMS clustering.

7 Article Quantitative Ultrasound Using Texture Analysis of Myofascial Pain Syndrome in the Trapezius. 2018

Kumbhare, Dinesh A / Ahmed, Sara / Behr, Michael G / Noseworthy, Michael D. ·Department of Medicine, Division of Physical Medicine and Rehabilitation, University of Toronto, Toronto, Ontario, Canada; McMaster School of Biomedical Engineering, McMaster University, Hamilton, Ontario, Canada. · Faculty of Science, McMaster University, Hamilton, Ontario, Canada. · McMaster School of Biomedical Engineering, McMaster University, Hamilton, Ontario, Canada; Imaging Research Centre, St. Joseph's Healthcare, Hamilton, Ontario, Canada. · McMaster School of Biomedical Engineering, McMaster University, Hamilton, Ontario, Canada; Imaging Research Centre, St. Joseph's Healthcare, Hamilton, Ontario, Canada; Department of Radiology, McMaster University, Hamilton, Ontario, Canada; Department of Electrical and Computer Engineering, McMaster University, Hamilton, Ontario, Canada. ·Crit Rev Biomed Eng · Pubmed #29717675.

ABSTRACT: Objective-The objective of this study is to assess the discriminative ability of textural analyses to assist in the differentiation of the myofascial trigger point (MTrP) region from normal regions of skeletal muscle. Also, to measure the ability to reliably differentiate between three clinically relevant groups: healthy asymptomatic, latent MTrPs, and active MTrP. Methods-18 and 19 patients were identified with having active and latent MTrPs in the trapezius muscle, respectively. We included 24 healthy volunteers. Images were obtained by research personnel, who were blinded with respect to the clinical status of the study participant. Histograms provided first-order parameters associated with image grayscale. Haralick, Galloway, and histogram-related features were used in texture analysis. Blob analysis was conducted on the regions of interest (ROIs). Principal component analysis (PCA) was performed followed by multivariate analysis of variance (MANOVA) to determine the statistical significance of the features. Results-92 texture features were analyzed for factorability using Bartlett's test of sphericity, which was significant. The Kaiser-Meyer-Olkin measure of sampling adequacy was 0.94. PCA demonstrated rotated eigenvalues of the first eight components (each comprised of multiple texture features) explained 94.92% of the cumulative variance in the ultrasound image characteristics. The 24 features identified by PCA were included in the MANOVA as dependent variables, and the presence of a latent or active MTrP or healthy muscle were independent variables. Conclusion-Texture analysis techniques can discriminate between the three clinically relevant groups.

8 Article A Survey of Physicians' Knowledge and Adherence to the Diagnostic Criteria for Fibromyalgia. 2018

Kumbhare, Dinesh / Ahmed, Sara / Sander, Tori / Grosman-Rimon, Liza / Srbely, John. ·Division of Physical Medicine and Rehabilitation, Deptartment of Medicine, University of Toronto, Toronto, Ontario, Canada. · McMaster University, Hamilton, Ontario, Canada. · University of Guelph, Guelph, Ontario, Canada. ·Pain Med · Pubmed #29177458.

ABSTRACT: Objective: In 2010, Wolfe et al. demonstrated poor physician use of the 1990 fibromyalgia diagnostic criteria and proposed the 2010 criteria to address physician shortcomings. No follow-up studies have investigated whether physicians are using these criteria. The purpose of this study was to provide seminal data on physician knowledge and use of the fibromyalgia diagnostic criteria. Methods: This was an observational study. A questionnaire was distributed to a convenience sample of physicians who diagnose chronic pain conditions. Physician agreement was evaluated with statements testing their knowledge on the fibromyalgia criteria, and then intraclass correlations were calculated to determine the homogeneity of physicians' responses. We also determined whether physician knowledge was impacted by their specialist training and clinical experience. Results: Physician responses varied between correct and incorrect agreement on most questions. Physician specialist training was positively correlated with knowledge of the criteria. Physician knowledge overall was not comprehensive and was very poor for the 1990 and 2010 criteria. Fifty-one percent of physicians used a set of criteria in their practice, and 49% used their clinical acumen. Conclusions: Physicians do not have adequate and homogenous knowledge of the fibromyalgia diagnostic criteria. Approximately half of physicians did not adhere to the criteria. Poor knowledge and adherence to the criteria may increase diagnosis delays and misdiagnoses. Knowledge translation strategies should be implemented to address this problem.

9 Article 'You want to show you're a valuable employee': A critical discourse analysis of multi-perspective portrayals of employed women with fibromyalgia. 2018

Oldfield, Margaret / MacEachen, Ellen / MacNeill, Margaret / Kirsh, Bonnie. ·1 Rehabilitation Sciences Institute, University of Toronto, ON, Canada. · 2 School of Public Health and Health Systems, University of Waterloo, ON, Canada. · 3 Faculty of Kinesiology & Physical Education, University of Toronto, ON, Canada. ·Chronic Illn · Pubmed #28661193.

ABSTRACT: Background Advice on fibromyalgia, a chronic illness primarily affecting women, often presents it as incompatible with work and rarely covers how to remain employed. Yet many women do. Objectives We aimed to understand how these women, their family members, and workmates portrayed employees with fibromyalgia, and how these portrayals helped women retain employment. Methods We interviewed 22 participants, comprising five triads and three dyads of people who knew each other. Using the methodology of critical discourse analysis, we analysed the interview data within and across the triads/dyads through coding, narrative summaries, and relational mapping. Results Participants reported stereotypes that employees with fibromyalgia are lazy, malingering, and less productive than healthy workers. Countering these assumptions, participants portrayed the women as normal, valuable employees who did not 'give in' to their illness. The portrayals drew on two discourses, normalcy and mind-controlling-the-body, and a related narrative, overcoming disability. We propose that participants' portrayals helped women manage their identities in competitive workplaces and thereby remain employed. Discussion Our findings augment the very sparse literature on employment with fibromyalgia. Using a new approach, critical discourse analysis, we expand on known job-retention strategies and add the perspectives of two key stakeholders: family members and workmates.

10 Article Clinicians' perspective of the current diagnostic criteria for myofascial pain syndrome. 2017

Grosman-Rimon, Liza / Clarke, Hance / Chan, Aaron K / Mills, Patricia Branco / Rathbone, Alasdair Timothy Llewelyn / Kumbhare, Dinesh. ·Toronto Rehabilitation Institute, Toronto, ON, Canada. · University Health Network, Toronto, ON, Canada. · University of Toronto, Toronto, ON, Canada. · Toronto General Hospital, Toronto, ON, Canada. · University of British Columbia, Vancouver, BC, Canada. · GF Strong Rehabilitation Centre, Vancouver, BC, Canada. · Western University, London, ON, Canada. ·J Back Musculoskelet Rehabil · Pubmed #27858678.

ABSTRACT: INTRODUCTION: Myofascial pain syndrome (MPS) is one of the most common chronic musculoskeletal pain disorders. However, MPS is often under-diagnosed. The purpose of this study was to characterize practicing clinicians' perspectives of the current diagnostic criteria for MPS. METHODS: A cross-sectional study design was used with a self-administered questionnaire. The questionnaire evaluated clinicians' perspective of the current diagnostic criteria for MPS. The sample population (n= 119) consisted of 40% family physicians, 31% physical medicine (PM) and rehabilitation specialists, 11% rheumatologists, 10% emergency room (ER) physicians, and 8% anesthesiologists specializing in chronic pain. RESULTS: Our findings demonstrated that participating clinicians agree that ``point tenderness'' and ``pain reproduction'' are criteria for MPS. In contrast, the clinicians do not consider ``autonomic symptoms'' as an important criterion for MPS. The anesthesiologists view ``restricted range of motion'' as a criterion for MPS more than the other groups, and they tend to consider ``referred pain'' and ``pain reproduction'' as criteria. Physical medicine and rehabilitation specialists and anesthesiologists tend to view ``local twitch response'' more as a criterion for MPS compared with the other groups. Most groups of clinicians consider ``weakness without atrophy'' as an important MPS criterion except for family physicians. It is important to note that ``poor sleep'', ``daytime fatigue'' and ``cognitive symptoms'', which are not considered as MPS symptoms, are often mistaken for MPS among practicing clinicians. CONCLUSION: Our findings suggest that the diagnostic criteria are not well known, highlighting the need for an expert consensus to determine the importance of each criterion for MPS diagnosis.

11 Article Combination of pregabalin with duloxetine for fibromyalgia: a randomized controlled trial. 2016

Gilron, Ian / Chaparro, Luis E / Tu, Dongsheng / Holden, Ronald R / Milev, Roumen / Towheed, Tanveer / DuMerton-Shore, Deborah / Walker, Sarah. ·Departments of aAnesthesiology and Perioperative Medicine and bBiomedical and Molecular Sciences, Queen's University, Kingston, Canada cUniversity of Toronto, Department of Anesthesia, University of Toronto, Toronto, Canada dPublic Health Sciences eMathematics and Statistics fPsychology and gPsychiatry, Queen's University, Kingston, Canada hDivision of Rheumatology, Department of Medicine Queen's University, Kingston, ON, Canada iDepartment of Anesthesiology and Perioperative Medicine, Queen's University, Kingston, Canada. ·Pain · Pubmed #26982602.

ABSTRACT: Fibromyalgia is a syndrome characterized by chronic widespread pain and associated with sleep disturbance, depression, fatigue, and cognitive dysfunction. Polypharmacy is commonly used, but supportive evidence is limited. Most fibromyalgia trials focus primarily on pain reduction with monotherapy. This trial compares a pregabalin-duloxetine combination to each monotherapy. Using a randomized, double-blind, 4-period crossover design, participants received maximally tolerated doses of placebo, pregabalin, duloxetine, and pregabalin-duloxetine combination-for 6 weeks. Primary outcome was daily pain (0-10); secondary outcomes included global pain relief, Fibromyalgia Impact Questionnaire, SF-36 survey, Medical Outcomes Study Sleep Scale, Beck Depression Inventory (BDI-II), adverse events, and other measures. Of 41 participants randomized, 39 completed ≥2 treatments. Daily pain during placebo, pregabalin, duloxetine, and combination was 5.1, 5.0, 4.1, and 3.7, respectively (P < 0.05 only for combination vs placebo, and pregabalin). Participants (%) reporting ≥moderate global pain relief were 18%, 39%, 42%, and 68%, respectively (P < 0.05 for combination vs placebo, pregabalin, and duloxetine). Fibromyalgia Impact Questionnaire scores were 42.9, 37.4, 36.0, and 29.8, respectively (P < 0.05 for combination vs placebo, pregabalin, and duloxetine). SF-36 scores were 50.2, 55.7, 56.0, and 61.2, respectively (P < 0.05 for combination vs placebo, pregabalin, and duloxetine). Medical Outcomes Study Sleep Scale scores were 48.9, 35.2, 46.1, and 32.1, respectively (P < 0.05 only for combination vs placebo, and duloxetine). BDI-II scores were 11.9, 9.9, 10.7, and 8.9, respectively (P < 0.05 only for combination vs placebo). Moderate-severe drowsiness was more frequent during combination vs placebo. Combining pregabalin and duloxetine for fibromyalgia improves multiple clinical outcomes vs monotherapy. Continued research should compare this and other combinations to monotherapy for fibromyalgia.

12 Article Impromptu everyday disclosure dances: how women with fibromyalgia respond to disclosure risks at work. 2016

Oldfield, M / MacEachen, E / Kirsh, B / MacNeill, M. ·a Rehabilitation Sciences Institute , University of Toronto , Toronto , Ontario , Canada. · b School of Public Health and Health Systems , University of Waterloo , Waterloo , Ontario , Canada. · c Rehabilitation Sciences Institute , University of Toronto , Toronto , Ontario , Canada. · d Faculty of Kinesiology & Physical Education , University of Toronto , Toronto , Ontario , Canada. ·Disabil Rehabil · Pubmed #26613401.

ABSTRACT: PURPOSE: Findings from a study examining how women with fibromyalgia remain employed are used to explicate a conceptualization that adds to literature on workplace disclosure of stigmatized illnesses and impairments: disclosure dances that employees improvise in response to workplace-relationships needs and disclosure risks. METHODS: Critical-discourse-analysis (CDA) methodology framed the study. Data were collected through 26 semi-structured, individual interviews with participant triads or dyads comprising women with fibromyalgia, family members and supervisors or co-workers. Interviews with managers who supervised disabled employees other than the women supplemented these data. Following coding, data were compared within and across triads/dyads through code-dimension summaries, narrative summaries and relational diagrams. RESULTS: Women with fibromyalgia and other stigmatized illnesses improvised everyday disclosures when they needed to explain fluctuating work ability, when others needed reminding about invisible impairments, and when workplace relationships changed. These impromptu disclosures comprised three dimensions: exposing oneself to scrutiny by disclosing both illness and impairments, divulging stigmatized illness, and revealing invisible impairments selectively. CONCLUSION: Through impromptu disclosure dances, women tailored disclosure to changing immediate circumstances. While assumptions from psychological theories of risk underlie current conceptualizations of disclosure as planned in advance, this article examines disclosure through a different lens: social theories of everyday risk. Implications for rehabilitation For women with fibromyalgia, disclosing illness and impairments at work may entail risks to their jobs and workplace relationships. Rehabilitation professionals need to consider these risks when advising women with fibromyalgia about disclosing their illness and impairments at work. Professionals may first want to learn from clients about their workplace cultures and relationships, and their perceptions of disclosure risk. Professionals can then suggest a range of disclosure responses, depending on the relationship and risk.

13 Article Basal Ganglia Perfusion in Fibromyalgia is Related to Pain Disability and Disease Impact: An Arterial Spin Labeling Study. 2016

Shokouhi, Mahsa / Davis, Karen D / Moulin, Dwight E / Morley-Forster, Pat / Nielson, Warren R / Bureau, Yves / St Lawrence, Keith. ·*Lawson Health Research Institute, St. Joseph's Health Care London Departments of †Medical Biophysics ∥Clinical Neurosciences and Oncology ¶Anesthesia and Perioperative Medicine #Psychology, The University of Western Ontario, London ‡Division of Brain, Imaging and Behaviour-Systems Neuroscience, Toronto Western Research Institute §Department of Surgery and Institute of Medical Science, University of Toronto, Toronto, ON, Canada. ·Clin J Pain · Pubmed #26340652.

ABSTRACT: OBJECTIVES: Pain disability is a major impediment to fibromyalgia (FM) patients' quality of life. Neuroimaging studies have demonstrated abnormal pain processing in FM. However, it is not known whether there are brain abnormalities linked to pain disability. Understanding neural correlates of pain disability in FM, independent from pain intensity, could provide a framework to guide future more efficient therapy strategies to improve patients' functional ability. METHODS: We used arterial spin labeling to image cerebral blood flow (CBF) in 23 FM patients and 16 controls. Functional connectivity was also estimated using blood oxygenation level-dependent imaging to further investigate the possible underpinnings of the observed CBF changes. RESULTS: Among patients, CBF in the basal ganglia correlated negatively with pain disability index and positively with the overall impact of FM (Fibromyalgia Impact Questionnaire) but did not correlate with pain intensity. Whole-brain analysis revealed no CBF differences between the 2 groups; however, post hoc analysis in the basal ganglia showed CBF reductions mainly in the right putamen and right lateral globus pallidus in patients, likely reflecting the negative correlation with the pain disability index. However, the connectivity of the corresponding corticobasal ganglia-thalamus loop, that is, motor network (the connection between supplementary motor area, putamen, and thalamus) remained intact. DISCUSSION: Basal ganglia perfusion reflects long-term symptoms, including somatic and psychological components of FM rather than pain intensity. These CBF findings may reflect differences in behavioral and psychological responses between patients.

14 Article Overlap between fibromyalgia tender points and Charcot's hysterical zones: A historical curiosity. 2015

Teive, Hélio A G / Germiniani, Francisco M B / Munhoz, Renato Puppi. ·From the Movement Disorder Unit (H.A.G.T., F.M.B.G.), Neurology Service, Internal Medicine Department, Hospital de Clínicas, Federal University of Paraná, Curitiba, PR, Brazil · and the Centre for Movement Disorders (R.P.M.), Toronto Western Hospital, University of Toronto, Canada. ·Neurology · Pubmed #25987668.

ABSTRACT: -- No abstract --

15 Article Fibromyalgia and the Risk of a Subsequent Motor Vehicle Crash. 2015

Redelmeier, Donald A / Zung, Jeremy D / Thiruchelvam, Deva / Tibshirani, Robert J. ·From the Department of Medicine, University of Toronto; Evaluative Clinical Sciences Platform, Sunnybrook Research Institute; Institute for Clinical Evaluative Sciences in Ontario; Division of General Internal Medicine, Sunnybrook Health Sciences Centre; Center for Leading Injury Prevention Practice Education and Research, Toronto, Ontario, Canada; Department of Statistics, Stanford University, Stanford, California, USA.D.A. Redelmeier, MD, FRCPC, MSHSR, FACP, Department of Medicine, University of Toronto, and the Evaluative Clinical Sciences Platform, Sunnybrook Research Institute, and the Institute for Clinical Evaluative Sciences in Ontario, and Division of General Internal Medicine, Sunnybrook Health Sciences Centre, and the Center for Leading Injury Prevention Practice Education and Research; J.D. Zung, BSc, Department of Medicine, University of Toronto, and the Evaluative Clinical Sciences Platform, Sunnybrook Research Institute, and the Institute for Clinical Evaluative Sciences in Ontario; D. Thiruchelvam, MSc, Evaluative Clinical Sciences Platform, Sunnybrook Research Institute, and the Institute for Clinical Evaluative Sciences in Ontario; R.J. Tibshirani, PhD, Department of Statistics, Stanford University. ·J Rheumatol · Pubmed #25979716.

ABSTRACT: OBJECTIVE: Motor vehicle crashes are a widespread contributor to mortality and morbidity, sometimes related to medically unfit motorists. We tested whether patients diagnosed with fibromyalgia (FM) have an increased risk of a subsequent serious motor vehicle crash. METHODS: We conducted a population-based self-matched longitudinal cohort analysis to estimate the incidence rate ratio of crashes among patients diagnosed with FM relative to the population norm in Ontario, Canada. We included adults diagnosed from April 1, 2006, to March 31, 2012, excluding individuals younger than 18 years, living outside Ontario, lacking valid identifiers, or having only a single visit for the diagnosis. The primary outcome was an emergency department visit as a driver involved in a motor vehicle crash. RESULTS: The patients (n = 137,631) accounted for 738 crashes during the first year of followup after diagnosis, equal to an incidence rate ratio of 2.44 compared with the population norm (95% CI 2.27-2.63, p < 0.001). The crash rate was more than twice the population norm for those with a new or a persistent diagnosis. The increased risk included patients with diverse characteristics, approached the rate observed among other patients diagnosed with alcoholism, and was mitigated among those who received dedicated FM care or a physician warning for driving safety. CONCLUSION: A diagnosis of FM is associated with an increased risk of a subsequent motor vehicle crash that might justify medical interventions for traffic safety.

16 Article An efficient strategy allowed English-speaking reviewers to identify foreign-language articles eligible for a systematic review. 2014

Busse, Jason W / Bruno, Paul / Malik, Keshena / Connell, Gaelan / Torrance, David / Ngo, Trung / Kirmayr, Karin / Avrahami, Daniel / Riva, John J / Ebrahim, Shanil / Struijs, Peter A A / Brunarski, David / Burnie, Stephen J / LeBlanc, Frances / Coomes, Eric A / Steenstra, Ivan A / Slack, Tesha / Rodine, Robert / Jim, Janey / Montori, Victor M / Guyatt, Gordon H. ·Department of Anesthesia, McMaster University, HSC-2U1, 1200 Main Street West, Hamilton, Ontario, Canada L8S 4K1; Department of Clinical Epidemiology and Biostatistics, McMaster University, 1280 Main Street West, Hamilton, Ontario, Canada L8S 4K1; The Michael G. DeGroote Institute for Pain Research and Care, McMaster University, MDCL 2101, 1280 Main Street West, Hamilton, Ontario, Canada L8S 4K1. Electronic address: bussejw@mcmaster.ca. · Faculty of Kinesiology and Health Studies, University of Regina, 3737 Wascana Pkwy, Regina, Saskatchewan, Canada S4S 0A2. · School of Rehabilitation Science, McMaster University, 1400 Main St. W., Hamilton, Ontario, Canada L8S 1C7. · Canadian Memorial Chiropractic College, 6100 Leslie St, Toronto, Ontario, Canada M2H 3J1. · German Hospital, 1640 Pueyrredón, C1118 AAT, Buenos Aires, Argentina. · Department of Clinical Epidemiology and Biostatistics, McMaster University, 1280 Main Street West, Hamilton, Ontario, Canada L8S 4K1; Department of Family Medicine, McMaster University, The Atrium at McMaster Innovation Park, 175 Longwood Road South, Hamilton, Ontario, Canada L8P 0A1. · Department of Anesthesia, McMaster University, HSC-2U1, 1200 Main Street West, Hamilton, Ontario, Canada L8S 4K1; Department of Clinical Epidemiology and Biostatistics, McMaster University, 1280 Main Street West, Hamilton, Ontario, Canada L8S 4K1; Stanford Prevention Research Center, Department of Medicine, Stanford University, 1265 Welch Road, Stanford, California, USA 94305; Department of Anaesthesia & Pain Medicine, The Hospital for Sick Children, 555 University Ave, Toronto, Ontario, Canada M5G 1X8. · Department of orthopaedic surgery, Academic Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands. · Ontario Chiropractic Association, 20 Victoria St., Suite 200 Toronto, Ontario, Canada M5C 2N8. · Canadian Memorial Chiropractic College, 6100 Leslie St, Toronto, Ontario, Canada M2H 3J1; Canadian Chiropractic Association, 186 Spadina Avenue, Suite 6, Toronto, Ontario, Canada M5T 3B2. · University of Toronto, Faculty of Medicine, 1 King's College Circle Toronto, Ontario, Canada M5S 1A8. · The Institute for Work & Health, 8th floor, 481 University Ave., Toronto, Ontario, Canada M5G 2E9; Dalla Lana School of Public Health, University of Toronto, 6th floor, 155 College St, Toronto, Ontario, Canada M5T 3M7. · The Institute for Work & Health, 8th floor, 481 University Ave., Toronto, Ontario, Canada M5G 2E9. · Restorative Health, 12 William St W, Smiths Falls, Ontario, Canada K7A 1M9. · Jointworks Chiropractic Inc., 3860 Main St, Vancouver, British Columbia, Canada V5V 3N9. · Knowledge and Evaluation Research Unit, Mayo Clinic, 200 First Street SW, Plummer 3-35, Rochester, MN, USA 55905. · Department of Anesthesia, McMaster University, HSC-2U1, 1200 Main Street West, Hamilton, Ontario, Canada L8S 4K1. ·J Clin Epidemiol · Pubmed #24613496.

ABSTRACT: OBJECTIVE: To assess English-speaking reviewers' accuracy in determining the eligibility of foreign-language articles for a systematic review. STUDY DESIGN AND SETTINGS: Systematic review of randomized controlled trials of therapy for fibromyalgia. Guided by 10 questions, English-speaking reviewers screened non-English-language articles for eligibility. Teams of two native-language speakers provided reference standard judgments of eligibility. RESULTS: Of 15,466 potentially eligible articles, we retrieved 763 in full text, of which 133 were published in 19 non-English languages; 53 trials published in 11 languages other than English proved eligible. Of the 53 eligible articles, English-language reviewers guided by the 10 questions mistakenly judged 6 as ineligible; of the 80 ineligible articles, 8 were incorrectly judged eligible by English-language reviewers (sensitivity=0.89; specificity=0.90). Use of a simple three-step rule (excluding languages with less than three articles, reviewing titles and abstracts for clear indications of eligibility, and noting the lack of a clearly reported statistical analysis unless the word "random" appears) led to accurate classification of 51 of 53 articles (sensitivity=0.96; specificity=0.70). CONCLUSION: Our findings show promise for limiting the need for non-English-language review teams in systematic reviews with large numbers of potentially eligible non-English-language articles.

17 Article Ghrelin- and serotonin-producing gastric carcinoid. 2012

Latta, Eleanor / Rotondo, Fabio / Leiter, Lawrence A / Horvath, Eva / Kovacs, Kalman. ·Department of Laboratory Medicine, Division of Pathology, St. Michael's Hospital, University of Toronto, Toronto, ON, M5B1W8, Canada. ·J Gastrointest Cancer · Pubmed #21424696.

ABSTRACT: We report the case of a 57-year-old woman with gastric carcinoid. The tumor was surgically removed and immunohistochemical investigation demonstrated a rare combination: ghrelin and serotonin in the cytoplasm of the tumor cells. The functional significance of simultaneous production of ghrelin and serotonin is not clear. It may be that an autocrine/paracrine interaction exists between these two different hormones.

18 Article Individuals with fibromyalgia and depression: findings from a nationally representative Canadian survey. 2012

Fuller-Thomson, Esme / Nimigon-Young, Jodie / Brennenstuhl, Sarah. ·Sandra Rotman Chair, Factor-Inwentash Faculty of Social Work, Department of Family & Community Medicine, University of Toronto, Toronto, Canada. esme.fuller.thomson@utoronto.ca ·Rheumatol Int · Pubmed #21221590.

ABSTRACT: The aim of the study is to determine the prevalence of and factors associated with major depression among those with Fibromyalgia Syndrome (FMS) in a Canadian representative sample. The study was a secondary analysis of a large, nationally representative sample from the Canadian Community Health Survey. The full sample (n = 126,805) was used to determine the prevalence of FMS and odds ratio of depression among those with FMS (n = 1,635) compared to those without (n = 125,170). A subsample of those with FMS (n = 1,635) was used to determine the prevalence of major depression and the demographic, psychosocial and health-related factors associated with it. Those with FMS had approximately three times higher odds of depression in comparison with those without FMS, even when controlling for important socio-demographic characteristics (OR = 2.90; 95% CI = 2.52, 3.33). Based on the subsample of those with FMS, it was found that 22% had current major depression. A multivariate logistic regression model of those with FMS showed depression was associated with younger age, female gender, being unmarried, food insecurity, number of chronic conditions, and limitations in activities. Two-fifths of those with depression and FMS had not discussed mental health concerns with any health professionals in the previous year, highlighting the underuse of mental health services and the need for health professionals to increase screening within this population. The findings may help clinicians target mental health assessments and interventions for their patients with fibromyalgia.

19 Article Effects of bedtime very low dose cyclobenzaprine on symptoms and sleep physiology in patients with fibromyalgia syndrome: a double-blind randomized placebo-controlled study. 2011

Moldofsky, Harvey / Harris, Herbert W / Archambault, W Tad / Kwong, Terence / Lederman, Seth. ·Sleep Disorders Clinics, Centre for Sleep and Chronobiology, University of Toronto, Toronto, Ontario, Canada. h.moldofsky@utoronto.ca ·J Rheumatol · Pubmed #21885490.

ABSTRACT: OBJECTIVE: To determine the effects of bedtime very low dose (VLD) cyclobenzaprine (CBP) on symptoms and sleep physiology of patients with fibromyalgia (FM), unrefreshing sleep, and the α-nonREM sleep electroencephalographic (EEG) anomaly at screening. METHODS: Of 37 patients with FM in the screened population, 36 were randomized and treated in this 8-week, double-blind, placebo-controlled, dose-escalating study of VLD CBP 1-4 mg at bedtime. We evaluated changes in subjective symptoms including pain, tenderness, fatigue, mood [Hospital Anxiety and Depression Scale (HAD)], and objective EEG sleep physiology (at screening, baseline, and Weeks 2, 4, and 8). RESULTS: In the VLD CBP-treated group (n = 18) over 8 weeks, musculoskeletal pain and fatigue decreased, tenderness improved; total HAD score and the HAD depression subscore decreased; patient-rated and clinician-rated fatigue improved. In the placebo-treated group (n = 18), none of these outcome measures changed significantly. Compared to placebo at 8 weeks, VLD CBP significantly improved pain, tenderness, and the HAD Depression subscore. Analysis of cyclic alternating pattern (CAP) sleep EEG revealed that significantly more subjects in the VLD CBP group than the placebo group had increased nights of restorative sleep in which CAP(A2+A3)/CAP(A1+A2+A3) = CAP(A2+A3(Norm)) ≤ 33%. For VLD CBP-treated subjects, the increase in nights with CAP(A2+A3(Norm)) ≤ 33% was correlated to improvements in fatigue, total HAD score, and HAD depression score. CONCLUSION: Bedtime VLD CBP treatment improved core FM symptoms. Nights with CAP(A2+A3(Norm)) ≤ 33% may provide a biomarker for assessing treatment effects on nonrestorative sleep and associated fatigue and mood symptoms in persons with FM.

20 Article Chronic widespread musculoskeletal pain, fatigue, depression and disordered sleep in chronic post-SARS syndrome; a case-controlled study. 2011

Moldofsky, Harvey / Patcai, John. ·Sleep Disorders Clinic of the Centre for Sleep and Chronobiology, 340 College St,, Suite 580, Toronto, ON M5T 3A9, Canada. h.moldofsky@utoronto.ca ·BMC Neurol · Pubmed #21435231.

ABSTRACT: BACKGROUND: The long term adverse effects of Severe Acute Respiratory Syndrome (SARS), a viral disease, are poorly understood. METHODS: Sleep physiology, somatic and mood symptoms of 22 Toronto subjects, 21 of whom were healthcare workers, (19 females, 3 males, mean age 46.29 yrs.+/- 11.02) who remained unable to return to their former occupation (mean 19.8 months, range: 13 to 36 months following SARS) were compared to 7 healthy female subjects. Because of their clinical similarities to patients with fibromyalgia syndrome (FMS) these post-SARS subjects were similarly compared to 21 drug free female patients, (mean age 42.4 +/- 11.8 yrs.) who fulfilled criteria for fibromyalgia. RESULTS: Chronic post-SARS is characterized by persistent fatigue, diffuse myalgia, weakness, depression, and nonrestorative sleep with associated REM-related apneas/hypopneas, an elevated sleep EEG cyclical alternating pattern, and alpha EEG sleep anomaly. Post- SARS patients had symptoms of pre and post-sleep fatigue and post sleep sleepiness that were similar to the symptoms of patients with FMS, and similar to symptoms of patients with chronic fatigue syndrome. Both post-SARS and FMS groups had sleep instability as indicated by the high sleep EEG cyclical alternating pattern rate. The post-SARS group had a lower rating of the alpha EEG sleep anomaly as compared to the FMS patients. The post-SARS group also reported less pre-sleep and post-sleep musculoskeletal pain symptoms. CONCLUSIONS: The clinical and sleep features of chronic post-SARS form a syndrome of chronic fatigue, pain, weakness, depression and sleep disturbance, which overlaps with the clinical and sleep features of FMS and chronic fatigue syndrome.

21 Article Fibromyalgia: Increased regular physical activity as 'exercise' in fibromyalgia. 2010

Gowans, S E. ·Allied Health, eb 4-306, Toronto General Hospital, University Health Network, 200 Elizabeth Street, Toronto, ON M5G 2C4, Canada. sue.gowans@uhn.on.ca ·Nat Rev Rheumatol · Pubmed #20808303.

ABSTRACT: -- No abstract --

22 Article Effects of sodium oxybate on sleep physiology and sleep/wake-related symptoms in patients with fibromyalgia syndrome: a double-blind, randomized, placebo-controlled study. 2010

Moldofsky, Harvey / Inhaber, Neil H / Guinta, Diane R / Alvarez-Horine, Sarah B. ·Centre for Sleep and Chronobiology and Toronto Psychiatric Research Foundation, Toronto, Ontario, Canada. h.moldofsky@utoronto.ca ·J Rheumatol · Pubmed #20682669.

ABSTRACT: OBJECTIVE: To determine the effects of sodium oxybate (SXB) on sleep physiology and sleep/wake-related symptoms in patients with fibromyalgia syndrome (FM). METHODS: Of 304 patients with FM (American College of Rheumatology tender point criteria) in the screened study population, 209 underwent polysomnography, 195 were randomized, and 151 completed this 8-week, double-blind, placebo-controlled study of SXB 4.5 g and 6 g/night. We evaluated changes in objective sleep measures and subjective symptoms, including daytime sleepiness [Epworth Sleepiness Scale (ESS)], fatigue visual analog scale (FVAS), sleep [Jenkins Scale for Sleep (JSS)], and daytime functioning [Functional Outcome of Sleep Questionnaire (FOSQ), SF-36 Vitality domain, and Fibromyalgia Impact Questionnaire (FIQ) general and morning tiredness]. RESULTS: Pretreatment screening revealed an elevated incidence of maximum alpha EEG-intrusion > 24 min/hour of sleep (66%), periodic limb movements of sleep (20.1% ≥ 5/hour), and moderate to severe obstructive sleep apnea disorder (15.3% apnea-hypopnea index ≥ 15/hour). Compared with placebo, both doses of SXB achieved statistically significant improvements in ESS, morning FVAS, JSS, FOSQ, SF-36 Vitality, and FIQ general and morning tiredness; both doses also demonstrated decreased rapid eye movement (REM) sleep (all p ≤ 0.040). SXB 6 g/night improved afternoon, evening and overall FVAS, reduced wakefulness after sleep onset, and increased Stage 2, slow-wave, and total non-REM sleep (all p ≤ 0.032) versus placebo. Moderate correlations (≥ 0.40) were noted between changes in subjective sleep and pain measures. Adverse events occurring significantly more frequently with SXB than placebo were nausea, pain in extremity, nervous system disorders, dizziness, restlessness, and renal/urinary disorders (including urinary incontinence). CONCLUSION: This large cohort of patients with FM demonstrated that SXB treatment improved EEG sleep physiology and sleep-related FM symptoms.

23 Article Functional impairment in chronic fatigue syndrome, fibromyalgia, and multiple chemical sensitivity. 2010

Lavergne, M Ruth / Cole, Donald C / Kerr, Kathleen / Marshall, Lynn M. ·Women's College Hospital, Family and Community Medicine, Toronto, ON M5S 1B2. ·Can Fam Physician · Pubmed #20154232.

ABSTRACT: OBJECTIVE: To characterize patients diagnosed with multiple chemical sensitivity (MCS), chronic fatigue syndrome (CFS), or fibromyalgia (FM), to compare their level of function with Canadian population average values, and to assess factors associated with function. DESIGN: Chart review and abstraction of clinical information. SETTING: The Environmental Health Clinic (EHC) at Women's College Hospital in Toronto, Ont, which is a provincial referral centre for patients with illnesses with suspected environmental links, especially MCS, CFS, and FM. PARTICIPANTS: A total of 128 consecutive patients diagnosed with 1 or more of MCS, CFS, or FM, seen between January 2005 and March 2006 at the EHC. MAIN OUTCOME MEASURES: Demographic and socioeconomic characteristics, comorbid diagnoses, duration of illness, health services usage, life stresses, helpful therapeutic strategies, and functional impairment measured by the Short Form-36, compared with Canadian population average values. Factors significantly associated with function in bivariate analyses were included in multiple linear and logistic regression models. RESULTS: The patient population was predominantly female (86.7%), with a mean age of 44.6 years. Seventy-eight patients had discrete diagnoses of 1 of MCS, CFS, or FM, while the remainder had 2 or 3 overlapping diagnoses. Most (68.8%) had stopped work, and on average this had occurred 3 years after symptom onset. On every Short Form-36 subscale, patients had markedly lower functional scores than population average values, more so when they had 2 or 3 of these diagnoses. Having FM, younger age at onset, and lower socioeconomic status were most consistently associated with poor function. CONCLUSION: Patients seen at the EHC demonstrated marked functional impairment, consistent with their reported difficulties working and caring for their homes and families during what should be their peak productive years. Early comprehensive assessment, medical management, and social and financial support might avoid the deterioration of function associated with prolonged illness. Education and information resources are required for health care professionals and the public, along with further etiologic and prognostic research.