Background It has been suggested that spinal manipulation may alter sensorimotor integration in the central nervous system and therefore may be used to treat central sensitization syndromes. Objective To investigate the effectiveness of spinal manipulation in addition to pharmacological treatment in patients with fibromyalgia. Design A single‐center, randomized, and placebo‐controlled trial with three parallel arms Setting Outpatient clinics at a tertiary health care facility. Participants Female patients aged 18‐55 years receiving pharmacological treatment. Interventions Spinal manipulation, sham manipulation, and control groups. Patients in the spinal manipulation group received high‐velocity low‐amplitude manipulation treatment twice a week for 3 weeks. Patients in the sham group received an application that was very similar to the active treatment but was not expected to have any real therapeutic effect. Patients in the control group continued to receive pharmacological therapy. Main Outcome Measures The primary outcome, pain score (visual analog scale), and secondary outcomes, pressure pain threshold (PPT), Revised Fibromyalgia Impact Questionnaire (FIQR), Widespread Pain Index (WPI), and Fibromyalgia Severity Score (FSS) were measured before, 1 month, and 3 months after randomization. Results Sixty patients with a mean age of 41.7 years (SD = 8.0) were enrolled in the study. A mixed‐design repeated analysis of covariance was used to test the data. At 1 month after randomization, pain scores did not differ between groups. At 3 months after randomization, the spinal manipulation group had a significantly lower pain score (adjusted mean = 4.3 cm, SE: 0.4) than the control group (adjusted mean = 6.8 cm, SE: 0.4) and the sham manipulation group (adjusted mean = 5.7 cm, SE: 0.4). PPT did not differ between groups at any time point. FIQR, WPI, and FSS showed some improvement 1 or 3 months after randomization in favor of the spinal manipulation group. Conclusions Spinal manipulation used in addition to pharmacological treatment in young/middle‐aged female patients with fibromyalgia could be an effective treatment for pain, disease severity, and functionality.
Aim: To compare the muscle strength of muscle groups in axial spondyloarthritis (axSpA) patients with the muscle powers of healthy volunteers and to examine the relationship of muscle strengths with disease activity, functionality, and disability.Method: One hundred males (50 axSpA, 50 healthy) were included in the study. Bath Disease Activity Index (BASDAI), Functional Index (BASFI), and Health Assessment Questionnaire-Disability Index (HAQ-DI) scores were recorded. The maximum (max) and mean cervical flexion, extension, lateral flexion (CF, CE, CLF), truncal flexion, extension (TF, TE), root joint flexion, extension, abduction, internal and external rotation (SF, SE, SAB, SIR and SER for the shoulder; HF, HE, HAB, HIR and HER for the hip) muscle strengths of the patients in both groups were measured by a handheld dynamometer. Total muscle strength (CT, TT, ST, HT) was found according to the sum of the max and mean values for each region.Results: All muscle strengths were lower in the axSpA group compared to the healthy volunteers. The symptom duration was found to have a weak-moderate negative correlation with CT, TT, ST, HT and all individual muscle strengths except for the TE, CF, HIR, and HER. BASDAI and HAQ-DI had weak-moderate negative correlations with HIR and HER. BASFI had a weak-moderate negative correlation with cervical measurements, TE, TF, SF, SER, SIR, and hip measurements. Conclusion:All muscle strengths were lower in patients compared to healthy volunteers. Strengthening specific muscle groups for the desired goal can be a reasonable strategy. The study is prospectively registered and available at www.clini caltr ials.gov (NCT04435860).
Objectives The relationship between clinical and laboratory parameters associated with the neuropathic pain presence in Psoriatic Arthritis is not well known and has not been adequately studied. Based on these assumptions, the aim of our study is to investigate how often neuropathic pain occurs in Psoriatic Arthritis patients and how much it is related to the clinical and laboratory parameters of the disease. Methods In the cross-sectional study, 45 Psoriatic Arthritis patients diagnosed according to The Classification Criteria for Psoriatics were included. In our study, Pain Detect Questionnaire (PDQ) was used to assess the neuropathic pain characteristics. Presence of enthesitis was determined by SPARCC to ensure objective measurements. Functional status was evaluated with the Health Assessment Questionnaire (HAQ). The Short Form-36 (SF-36) questionnaire was used to evaluate the quality of life. Results A total of 45 patients were included in the study. The mean duration of symptoms was 78.91 ± 95.8 months. There are 16 patients receiving Nsaid treatment, 28 patients receiving DMARD treatment, and 13 patients receiving biological therapy. Among the patients included in the study, 30 patients with neuropathic pain and 15 without neuropathic pain were found according to the Pain Detect questionnaire. A significant difference was observed between these two groups in the results of DAPSA, VAS movement, HAQ, morning stiffness, and SF-36 Body pain. Conclusion Our study has shown that neuropathic pain has a high prevalence in Psoriatic Arthritis patients. This association was observed to be related to functional limitation. Additionally, the DAPSA score was found to be significantly higher in patients with neuropathic pain due to pain sensation which suggests that it may be a factor reducing treatment success. It is conceivable that the recognition and treatment of neuropathic pain may increase the success of Psoriatic Arthritis treatment.
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