An Observational Study Comparing Fibromyalgia and Chronic Low Back Pain in Somatosensory Sensitivity, Motor Function and Balance

Mingorance, José Antonio; Montoya, Pedro; Miranda, José García Vivas; Riquelme, Inmaculada

doi:10.3390/healthcare9111533

Cited by 9 publications

(8 citation statements)

References 56 publications

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“…Chronic pain and fatigue are the primary symptoms of FMS [23]. Previous research indicates that several populations, including those with neck pain, proprioceptive, and postural disturbances, are associated with pain and muscle fatigue [24,25]. In addition, different authors showed that proprioceptive retraining enhanced postural control [26,27].…”

Section: Introductionmentioning

confidence: 99%

Cervical Joint Position Sense and Its Correlations with Postural Stability in Subjects with Fibromyalgia Syndrome

Reddy

Tedla

Dixit

et al. 2022

Life

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Cervical joint position sense (JPS) and postural stability are vital to maintaining balance and preventing falls in fibromyalgia syndrome (FMS). Impaired cervical JPS may influence postural stability, and understanding the relationship between them can aid in formulating treatment strategies in individuals with FMS. This study aims to (1) assess cervical JPS and postural stability between FMS and control group and (2) determine the correlation between cervical JPS and postural stability in the FMS group. This cross-sectional study recruited 92 FMS patients (mean age: 51.52 ± 7.7 yrs.) and 92 healthy controls (mean age: 49.36 ± 6.9 yrs.). A cervical range of motion (CROM) unit was utilized to assess cervical JPS. The postural stability was assessed using an IsoFree force platform, and anterior-posterior (A/P) and medial-lateral (M/L) directions of sway and ellipse area were measured. Cervical JPS and postural stability tests were assessed and compared between FMS and control groups. Cervical JPS was significantly impaired in FMS compared to the control group (p < 0.001). The JPS errors in FMS group were larger in flexion (FMS = 5.5°, control = 2.4°), extension (FMS = 6.4°, control = 3.0°), and rotation in left (FMS = 5.4°, control = 2.2°) and right directions (FMS = 5.1°, control = 2.8°). FMS individuals demonstrated statistically significant impaired postural stability compared to control in both the dominant and non-dominant legs tested (p < 0.001). The cervical JPS test showed moderate to strong positive correlations with postural stability variables. Statistically significant correlations were observed in all the JPS directions tested with all the postural stability variables (A/P and M/L sway and ellipse area). The correlation coefficients ranged between r =0.37 (moderate) to 0.75 (strong). Cervical JPS and postural stability are impaired in FMS individuals. A moderate to strong relationship existed between JPS and postural stability. Individuals with FMS who had a greater magnitude of cervical JPS errors exhibited more severe postural control deficits. Therefore, cervical JPS and postural stability tests should be incorporated into routine clinical practice when assessing or formulating treatment strategies for patients with FMS.

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Section: Introductionmentioning

confidence: 99%

Cervical Joint Position Sense and Its Correlations with Postural Stability in Subjects with Fibromyalgia Syndrome

Reddy

Tedla

Dixit

et al. 2022

Life

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“…The framework that defines motor dysfunction as a feature of FM syndrome has been initially supported by data showing that FM patients perform worse in clinical parameters of motor functionality than controls – as evidenced by worse motor and walking speed and other kinematics of gait and balance 33 – 36 . A recent experimental trial found FM to be even more severely impaired in these metrics than chronic low back pain subjects 37 . Moreover, this composition has been supported by neurophysiological data pointing to deficits specifically in psychomotor processing during motor control/inhibition tasks.…”

Section: Discussionmentioning

confidence: 99%

Motor cortex inhibition as a fibromyalgia biomarker: a meta-analysis of transcranial magnetic stimulation studies

Pacheco‐Barrios

Lima

Pimenta

et al. 2022

Brain Netw Modulation

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Fibromyalgia (FM) is a common and refractory chronic pain condition with multiple clinical phenotypes. The current diagnosis is based on a syndrome identification which can be subjective and lead to under or over-diagnosis. Therefore, there is a need for objective biomarkers for diagnosis, phenotyping, and prognosis (treatment response and follow-up) in fibromyalgia. Potential biomarkers are measures of cortical excitability indexed by transcranial magnetic stimulation (TMS). However, no systematic analysis of current evidence has been performed to assess the role of TMS metrics as a fibromyalgia biomarker. Therefore, this study aims to evaluate evidence on corticospinal and intracortical motor excitability in fibromyalgia subjects and to assess the prognostic role of TMS metrics as response biomarkers in FM. We conducted systematic searches on PubMed/Medline, Embase, and Cochrane Central databases for observational studies and randomized controlled trials on fibromyalgia subjects that used TMS as an assessment. Three reviewers independently selected and extracted the data. Then, a random-effects model meta-analysis was performed to compare fibromyalgia and healthy controls in observational studies. Also, to compare active versus sham treatments, in randomized controlled trials. Correlations between changes in TMS metrics and clinical improvement were explored. The quality and evidence certainty were assessed following standardized approaches. We included 15 studies (696 participants, 474 FM subjects). The main findings were: (1) fibromyalgia subjects present less intracortical inhibition (mean difference (MD) = −0.40, 95% confidence interval (CI) −0.69 to −0.11) and higher resting motor thresholds (MD = 6.90 μV, 95% CI 4.16 to 9.63 μV) when compared to controls; (2) interventions such as exercise, pregabalin, and non-invasive brain stimulation increased intracortical inhibition (MD = 0.19, 95% CI 0.10 to 0.29) and cortical silent period (MD = 14.92 ms, 95% CI 4.86 to 24.98 ms), when compared to placebo or sham stimulation; (3) changes on intracortical excitability are correlated with clinical improvements – higher inhibition moderately correlates with less pain, depression, and pain catastrophizing; lower facilitation moderately correlates with less fatigue. Measures of intracortical inhibition and facilitation indexed by TMS are potential diagnostic and treatment response biomarkers for fibromyalgia subjects. The disruption in the intracortical inhibitory system in fibromyalgia also provides additional evidence that fibromyalgia has some neurophysiological characteristics of neuropathic pain. Treatments inducing an engagement of sensorimotor systems (e.g., exercise, motor imagery, and non-invasive brain stimulation) could restore the cortical inhibitory tonus in FM and induce clinical improvement.

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“…Also, joint hypermobility is three times more frequent in fibromyalgia than in control groups [ 60 ]. And, importantly, upon specific proprioception testing in fibromyalgia cohorts, significant alterations have been demonstrated in muscle contraction [ 61 , 62 ], muscle relaxation [ 63 ], vibration perception [ 61 ], joint position sense [ 64 – 67 ], and the proprioceptive component of postural control [ 61 , 65 , 68 – 71 ] with frequent falls [ 68 , 72 , 73 ]. Problems in postural control or balance are also related to altered vestibular and visual dysfunction [ 68 , 73 , 74 ], which may indicate that sensory weakness is not limited to proprioception in fibromyalgia [ 50 , 51 ].…”

Section: Discussionmentioning

confidence: 99%

Distinctive alterations in the functional anatomy of the cerebral cortex in pain-sensitized osteoarthritis and fibromyalgia patients

et al. 2022

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Background Pain-sensitized osteoarthritis and fibromyalgia patients characteristically show nociceptive system augmented responsiveness as a common feature. However, sensitization can be originally related to the peripheral injury in osteoarthritis patients, whereas pain and bodily discomfort spontaneously occur in fibromyalgia with no apparent origin. We investigated the distinct functional repercussion of pain sensitization in the cerebral cortex in both conditions. Methods Thirty-one pain-sensitized knee osteoarthritis patients and 38 fibromyalgia patients were compared with matched control groups. And new samples of 34 sensitized knee osteoarthritis and 63 fibromyalgia patients were used to directly compare each condition. A combined measure of local functional connectivity was estimated to map functional alterations in the cerebral cortex at rest. Results In osteoarthritis, weaker local connectivity was identified in the insula, which is a cortical area processing important aspects of the brain response to painful stimulation. In contrast, fibromyalgia patients showed weaker connectivity in the sensorimotor cortex extensively affecting the cortical representation of the body. Conclusions In osteoarthritis, weaker insular cortex connectivity is compatible with reduced neural activity during metabolic recovery after repeated activation. In the fibromyalgia neurophysiological context, weaker connectivity may better express both reduced neural activity and increased excitability, particularly affecting the sensorimotor cortex in patients with spontaneous body pain. Such a combination is compatible with a central gain enhancement mechanism, where low sensory tolerance results from the over-amplification of central sensory reception to compensate a presumably weak sensory input. We propose that deficient proprioception could be a factor contributing to weak sensory input.

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An Observational Study Comparing Fibromyalgia and Chronic Low Back Pain in Somatosensory Sensitivity, Motor Function and Balance

Cited by 9 publications

References 56 publications

Cervical Joint Position Sense and Its Correlations with Postural Stability in Subjects with Fibromyalgia Syndrome

Cervical Joint Position Sense and Its Correlations with Postural Stability in Subjects with Fibromyalgia Syndrome

Motor cortex inhibition as a fibromyalgia biomarker: a meta-analysis of transcranial magnetic stimulation studies

Distinctive alterations in the functional anatomy of the cerebral cortex in pain-sensitized osteoarthritis and fibromyalgia patients

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