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(1) Background: Mitochondrial dysfunction and redox imbalance seem to be involved in fibromyalgia (FM) pathogenesis. The results of our previous studies suggest that whole-body vibration training (WBVT) would improve redox status markers, increase blood irisin levels, and ameliorate the body composition of women with FM. (2) Objective: The current study aimed to investigate WBVT on oxidative stress markers, plasma irisin levels, and body composition in women with FM. (3) Methods: Forty women with FM were randomized into WBVT or untrained (UN) groups. Before and after 6 weeks of WBVT, body composition was assessed by dual-energy radiological absorptiometry (DXA), and inflammatory marker activities were measured by enzymatic assay. (4) Results: Body composition, blood irisin levels, and oxidative stress markers were similar between UN and WBVT groups before the intervention. After 6 weeks of intervention, the WBVT group presented higher irisin levels (WBVT: 316.98 ± 109.24 mg·dL3 , WBVT: 477.61 ± 267.92 mg·dL3 , p = 0.01) and lower TBARS levels (UN: 0.39 ± 0.02 nmol MDA/mg protein, WBVT: 0.24 ± 0.06 nmol MDA/mg protein, p = 0.001) and visceral adipose tissue mass (UN: 1.37 ± 0.49 kg, WBVT: 0.69 ± 0.54 kg, p = 0.001) compared to the UN group. (5) Conclusions: Six weeks of WBVT improves blood redox status markers, increases irisin levels, and reduces visceral adipose tissue mass, favoring less cell damage and more outstanding oxidative balance in women with FM.

ObjectiveTo describe the current literature on functional neurological disorder and functional somatic syndromes among sexual and gender minority people (SGM).MethodsA search string with descriptors of SGM identity and functional disorders was entered into PubMed, Embase, Web of Science, PsycInfo, and CINAHL for articles published before May 24, 2022, yielding 3121 items entered into Covidence, where 835 duplicates were removed. A neurologist and neuropsychiatrist screened titles and abstracts based on predefined criteria, followed by full-text review. A third neurologist adjudicated discrepancies. Eligible publications underwent systematic data extraction and statistical description.ResultsOur search identified 26 articles on functional disorders among SGM people. Most articles were case (13/26, 46%) or cross-sectional (4/26, 15%) studies. Gender minority people were represented in 50% of studies. Reported diagnoses included fibromyalgia (n = 8), functional neurological disorder (n = 8), somatic symptom disorder (n = 5), chronic fatigue syndrome (n = 3), irritable bowel syndrome (n = 2), and other functional conditions (n = 3). Three cohort studies of fibromyalgia or somatic symptom disorder reported an overrepresentation of gender minority people compared to cisgender cohorts or general population measures. Approximately half of case studies reported pediatric or adolescent onset (7/13, 54%), functional neurological disorder diagnosis (7/13, 54%), and symptom improvement coinciding with identity-affirming therapeutic interventions (7/13, 58%).ConclusionDespite a methodologically rigorous literature search, there are limited data on functional neurological disorder and functional somatic syndromes among SGM people. Several studies reported increased prevalence of select conditions among transgender people. More observational studies are needed regarding the epidemiology and clinical course of functional di

Nocebo effects are adverse treatment outcomes that are not ascribed to active treatment components. Potentially, their magnitude might be higher in patients with chronic pain compared to healthy controls since patients likely experience treatment failure more frequently. The current study investigated group differences in the induction and extinction of nocebo effects on pressure pain at baseline (N = 69) and 1-month follow-up (N = 56) in female patients with fibromyalgia and matched healthy controls. Nocebo effects were first experimentally induced via classical conditioning combined with instructions on the pain-increasing function of a sham transcutaneous electrical nerve stimulation device, then decreased via extinction. One month later, the same procedures were repeated to explore their stability. Results suggest that nocebo effects were induced in the healthy control group during baseline and follow-up. In the patient group, nocebo effects were only induced during follow-up, without clear group differences. Extinction was only observed during baseline in the healthy control group. Further comparisons of nocebo effects and extinction indicated no significant changes across sessions, possibly suggesting their overall magnitudes were stable over time and across groups. In conclusion, contrary to our expectations, patients with fibromyalgia did not have stronger nocebo hyperalgesia; instead, they might be less responsive to nocebo manipulations than healthy controls. Perspective: The current study is the first to investigate group differences in experimentally manipulated nocebo hyperalgesia between chronic pain and healthy populations at baseline and 1-month follow-up. Since nocebo effects are common in clinical settings, their investigation in different populations is essential to explain and minimize their adverse effects during treatment., Applied Ergonomics and Design

Fibromyalgia is a chronic condition of unknown etiology unrelated to specific laboratory markers for diagnosis because of poor etiopathogenesis. In general, the changes common to fibromyalgia are also seen in other chronic pain conditions, making the pathogenesis controversial among different pathological conditions. The unknown etiology makes the diagnosis difficult and consequently has repercussions on a not so effective treatment of patients with fibromyalgia. The restoration of systemic disorders provides a wide spectrum of therapeutic possibilities with the potential to guide professionals in establishing goals and evaluation methods. Therefore, this narrative review discusses the etiological and pathophysiological hypotheses involved in the development of fibromyalgia., A fibromialgia é uma condição crônica de etiologia desconhecida e desvinculada de marcadores laboratoriais específicos para diagnóstico, devido à pobre caracterização da etiopatogenia. Em geral, as alterações comuns à fibromialgia também são observadas em outras condições de dor crônica, tornando a patogênese controversa entre diferentes condições patológicas. A etiologia desconhecida dificulta o diagnóstico e, consequentemente, repercute em um tratamento não tão eficaz de pacientes com fibromialgia. A restauração de desordens sistêmicas confere amplo espectro de possibilidades terapêuticas com potencial de orientar profissionais a estabelecer metas e métodos de avaliação. Diante disso, essa revisão narrativa se volta para debater hipóteses etiológicas e fisiopatológicas no desenvolvimento da fibromialgia.

Fibromyalgia is a chronic condition of unknown etiology unrelated to specific laboratory markers for diagnosis because of poor etiopathogenesis. In general, the changes common to fibromyalgia are also seen in other chronic pain conditions, making the pathogenesis controversial among different pathological conditions. The unknown etiology makes the diagnosis difficult and consequently has repercussions on a not so effective treatment of patients with fibromyalgia. The restoration of systemic disorders provides a wide spectrum of therapeutic possibilities with the potential to guide professionals in establishing goals and evaluation methods. Therefore, this narrative review discusses the etiological and pathophysiological hypotheses involved in the development of fibromyalgia., A fibromialgia é uma condição crônica de etiologia desconhecida e desvinculada de marcadores laboratoriais específicos para diagnóstico, devido à pobre caracterização da etiopatogenia. Em geral, as alterações comuns à fibromialgia também são observadas em outras condições de dor crônica, tornando a patogênese controversa entre diferentes condições patológicas. A etiologia desconhecida dificulta o diagnóstico e, consequentemente, repercute em um tratamento não tão eficaz de pacientes com fibromialgia. A restauração de desordens sistêmicas confere amplo espectro de possibilidades terapêuticas com potencial de orientar profissionais a estabelecer metas e métodos de avaliação. Diante disso, essa revisão narrativa se volta para debater hipóteses etiológicas e fisiopatológicas no desenvolvimento da fibromialgia.

Fibromyalgia is a chronic condition of unknown etiology unrelated to specific laboratory markers for diagnosis because of poor etiopathogenesis. In general, the changes common to fibromyalgia are also seen in other chronic pain conditions, making the pathogenesis controversial among different pathological conditions. The unknown etiology makes the diagnosis difficult and consequently has repercussions on a not so effective treatment of patients with fibromyalgia. The restoration of systemic disorders provides a wide spectrum of therapeutic possibilities with the potential to guide professionals in establishing goals and evaluation methods. Therefore, this narrative review discusses the etiological and pathophysiological hypotheses involved in the development of fibromyalgia., A fibromialgia é uma condição crônica de etiologia desconhecida e desvinculada de marcadores laboratoriais específicos para diagnóstico, devido à pobre caracterização da etiopatogenia. Em geral, as alterações comuns à fibromialgia também são observadas em outras condições de dor crônica, tornando a patogênese controversa entre diferentes condições patológicas. A etiologia desconhecida dificulta o diagnóstico e, consequentemente, repercute em um tratamento não tão eficaz de pacientes com fibromialgia. A restauração de desordens sistêmicas confere amplo espectro de possibilidades terapêuticas com potencial de orientar profissionais a estabelecer metas e métodos de avaliação. Diante disso, essa revisão narrativa se volta para debater hipóteses etiológicas e fisiopatológicas no desenvolvimento da fibromialgia.

Bakgrund: Fibromyalgi omfattar upp till tre procent av befolkningen och cirka 90 procent är kvinnor som drabbas av FM. Orsaken till sjukdomen är ännu okänd. Det finns inte någon specifik diagnostisk metod utan diagnosen ställs utifrån patientens subjektiva upplevelser. Behandlingen är individuell och anpassas till patientens specifika symptom såsom smärta, depression eller sömnsvårigheter. Sjuksköterskor behöver öka sin kunskap om fibromyalgi för att främja patienternas hälsa och psykiska välmående. Syfte: Studiens syfte var att belysa personens upplevelser att leva med fibromyalgi. Metod: En litteraturstudie gjordes av åtta vetenskapliga artiklar från databaserna PubMed och Cinahl Complete. De åtta valda artiklarna analyserades och sammanställdes med avseende på likheter och skillnader. Det bildade fyra huvudteman och fem underteman. Resultat: I resultatet framträdde att personer med FM upplevde olika fysiska och psykiska utmaningar och svårigheter som påverkade deras familjeliv, sociala liv och arbetsliv. Vidare att de möttes av misstro, bristande kunskap och förståelse och stigmatisering g ällande deras tillstånd, både från sin omgivning och vården. Vikten av familjens stöd, både praktiskt och emotionellt, betonades av deltagarna. Könsaspekter indikerade att både män och kvinnor hade liknande upplevelser av FM, även om deras perspektiv och å sikter skiljde sig åt. Slutsats: Sammanfattningsvis, från patientens perspektiv, är FM mer än bara ett smärtsamt tillstånd, det är kopplat till flera symtom och har en betydande negativ inverkan på psykisk och fysisk hälsa. Sjukdomen tvingar de som lever m ed FM att omstrukturera sina familjeliv, yrkesliv och sociala identiteter. Ett holistiskt tillvägagångssätt vad gäller behandling och omvårdnad skulle omfatta personens somatiska och psykiska symtom på ett bättre sätt och leda till effektivare vård., Background Fibromyalgia affects up to three percent of the population, with approximately 90 percent of women being affected by FM. The cause of the disease is still unknown. There is no specific diagnostic method, and the diagnosis is based on the patient's subjective experiences. Treatment is individualized and tailored to the patient's specific symptoms such as pain, depression, or sleep difficulties. Nurses need to increase their knowledge about fibromyalgia to promote the health and mental well-being of patients. Aim The aim of the study was to illuminate the individual's experience of living with fibromyalgia. Method A literature review was conducted on eight scientific articles from the databases PubMed and Cinahl Complete. The eight selected articles were analyzed and compiled in terms of similarities and differences. Four main themes and five subthemes were identified. Results In the results, it emerged that individuals with FM experienced various physical and mental challenges and difficulties that affected their family, social, and work lives. Additionally, they faced distrust, lack of knowledge and understanding, and stigma regarding their condition, both from their surroundings and healthcare providers. The participants emphasized the importance of family support, both practical and emotional. Gender aspects indicated that both men and women had similar experiences with FM, although their perspectives and opinions differed. Conclusions In summary, from the patients perspective, FM is more than just a painful condition; it is associated with multiple symptoms and has a significant negative impact on mental and physical health. The disease forces those living with FM to restructure their family lives, careers, and social identities. A holistic approach to treatment and care would better address the individual's somatic and mental symptoms and result in more effective healthcare.

Bakgrund: Fibromyalgi är ett primärt smärttillstånd, vilket innebär att smärtan utgör själva sjukdomen. Individer med fibromyalgi drabbas ofta av fördomar och ifrågasättande då sjukdomen inte går att bevisa med blodprov eller röntgen samt frågetecken kring etiologin. Behandling riktad mot sjukdomens orsak finns ännu inte, den behandling som erbjuds är endast symtomlindrande. Sjuksköterskan har en viktig roll i att hjälpa patienten att hitta strategier för minskad smärta, stötta patienten i att identifiera och ägna sig åt hälsofrämjande åtgärder, dela med sig av kunskap och information gällande smärttillståndet samt enligt ordination genomföra farmakologisk och icke-farmakologisk behandling. Syfte: Syftet var att beskriva personers upplevelser av att leva med fibromyalgi. Metod: En litteraturöversikt genomfördes baserad på tio kvalitativa vetenskapliga artiklar. Databaserna Pubmed och Cinahl Complete användes till datainsamlingen och resultatet analyserades enligt Fribergs metod. Resultat: Utifrån dataanalysen framkom fyra huvudteman: kroppen som ett fängelse, en ny identitet, att anpassa sitt liv till sjukdomen och erfarenheter av bemötande. Resultatet visade att fibromyalgi innebar stora förändringar i privatliv, arbetsliv, i relation till andra och i relationen till sig själv. Slutsats: Bristande bemötande inom vården och begränsningar i vardagen hade störst inverkan på livskvaliteten och skapade isolering, lidande och psykisk ohälsa. Resultatet kan kopplas till bristande kunskap och forskning kring sjukdomen vilket resulterar i en ifrågasättande attityd, stigmatisering och ineffektiva behandlingar. Genom att öka medvetenhet och kunskap inom ämnet kan vården förbättras avsevärt, vilket i sin tur kan leda till en förbättrad livskvalitet för dem som lever med fibromyalgi., Background: Fibromyalgia is a primary pain condition, meaning the pain constitutes the illness itself. Individuals with fibromyalgia often suffer from prejudice and questioning as the disease cannot be proven by blood tests or X-rays and lack of knowledge regarding etiology. There is yet no treatment for the illness, only symptom relief. The nurse has an important role in helping the patient find strategies for reduced pain, supporting the patient in identifying and engaging in health-promoting measures, sharing knowledge and information regarding the illness and, according to prescription, implement pharmacological and non- pharmacological treatment. Aim: The aim was to describe people’s experiences of living with fibromyalgia. Method: A literature review based on ten qualitative scientific articles was conducted. Databases Pubmed and Cinahl Complete were used for data collection and the results were analyzed according to Friberg’s method. Results: Based on the data analysis, four themes emerged: the body as a prison, a new identity, adapting life to the disease and experiences of social interactions. The results showed that fibromyalgia led to big changes in private life, work life, in relation to others and in relation to oneself. Conclusions: Inadequate approach in healthcare and limitations in everyday life had the biggest impact on the quality of life and created isolation, suffering and mental illness. The result can be linked to a lack of knowledge and research about the illness, which results in a questioning attitude, stigmatization and ineffective treatments. By increasing awareness and knowledge on the subject, healthcare can be significantly improved, which can lead to an improved quality of life for those living with fibromyalgia.

OBJECTIVE: Individuals with fibromyalgia report alarming levels of suicidal ideation, and comorbidity with other chronic health conditions such as obesity - a risk factor for suicidal ideation per se- could further complicate the clinical picture. The aim of this study is to determine, in a sample of women with fibromyalgia and comorbid obesity, the prevalence of suicidal ideation and to evaluate clinical, pain-related and psychological factors associated with suicidal ideation. METHODS: 156 female individuals with fibromyalgia and obesity were recruited and completed a series of self-report measures that assessed i) the level of pain intensity, ii) depressive symptomatology, iii) sleep quality, and iv) pain catastrophizing. Suicidal ideation was evaluated by item #9 of the Beck Depression Inventory. In addition, information regarding previous suicide attempts and current opioid use was collected. RESULTS: 37.8% of participants reported presence of suicidal ideation. According to the results of the multiple logistic regression, depressive symptomatology, sleep quality, and pain catastrophizing were associated with the presence of suicidal ideation. DISCUSSION: The presence of suicidal ideation in our sample was significantly associated with depressive symptomatology, sleep quality, and pain catastrophizing. Our findings are the first to suggest a unique (i.e., independent of depressive symptomatology, and sleep quality) association between pain catastrophizing and suicidal ideation in the context of fibromyalgia and comorbid obesity. In order to prevent and reduce suicidal ideation, these factors should be assessed and targeted in interventions for pain management. Future research should investigate the extent to which addressing depressive symptoms, sleep quality, and pain catastrophizing reduces suicidal ideation., Research funded by the Italian Ministry of Health.

The ability to accurately predict pain is an adaptive feature in healthy individuals. However, in chronic pain, this mechanism may be selectively impaired and can lead to increased anxiety and excessive avoidance behavior. Recently, we reported the first data demonstrating brain activation in fibromyalgia (FM) patients during conditioned pain responses, in which FM patients revealed a tendency to form new pain-related associations rather than extinguishing irrelevant ones. The aim of the present study was to extend our previous analysis, to elucidate potential neural divergences between subjects with FM (n = 65) and healthy controls (HCs) (n = 33) during anticipatory information (ie, prior to painful stimulus onset). Using functional magnetic resonance imaging (fMRI), the current analyses include 1) a congruently cued paradigm of low and high pain predictive cues, followed by 2) an incongruently cued paradigm where low and high pain predictive cues were followed by an identical mid-intensity painful pressure. During incongruently cued high-pain associations, FM exhibited reduced left dorsolateral prefrontal cortex (dlPFC) activation compared to HCs, which was followed by an altered subsequent pain experience in FM, as patients continued to rate the following painful stimuli as high, even though the pressure had been lowered. During congruently cued low pain anticipation, FM exhibited decreased right dlPFC activation compared to HCs, as well as decreased brain connectivity between brain regions implicated in cognitive modulation of pain (dlPFC) and nociceptive processing (primary somatosensory cortex/postcentral gyrus [S1] and supplementary motor area [SMA]/midcingulate cortex [MCC]). These results may reflect an important feature of validating low pain expectations in HCs and help elucidate behavioral reports of impaired safety processing in FM patients. PERSPECTIVE: FM exhibited a stronger conditioned pain response for high-pain associations, which was associated w

Background: Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) and fibromyalgia have overlapping neurologic symptoms particularly disabling fatigue. This has given rise to the question whether they are distinct central nervous system (CNS) entities or is one an extension of the other. Material and methods: To investigate this, we used unbiased quantitative mass spectrometry-based proteomics to examine the most proximal fluid to the brain, cerebrospinal fluid (CSF). This was to ascertain if the proteome profile of one was the same or different from the other. We examined two separate groups of ME/CFS, one with (n = 15) and one without (n = 15) fibromyalgia. Results: We quantified a total of 2083 proteins using immunoaffinity depletion, tandem mass tag isobaric labelling and offline two-dimensional liquid chromatography coupled to tandem mass spectrometry, including 1789 that were quantified in all the CSF samples. ANOVA analysis did not yield any proteins with an adjusted p value <.05. Conclusion: This supports the notion that ME/CFS and fibromyalgia as currently defined are not distinct entities.

Purpose of reviewThis review focuses on the role of psychologists in the assessment and treatment of fibromyalgia syndrome (FMS), a highly prevalent condition characterized by chronic widespread pain, fatigue, cognitive problems, distress, and disability.Recent findingsA large body of work supports the effectiveness and cost-utility of psychological therapies for the improvement of a wide range of symptoms associated with FMS. However, patients with FMS are best assessed and treated by a multidisciplinary team, in which psychologists have an important role. Multidisciplinary treatment, in which each healthcare professional offers his or her own expertise to the patient, has been shown to produce more ubiquitous treatment effects for this complex syndrome than single discipline treatments. Considering the empirical evidence and documented experience of patients, people with FMS can benefit from integrated care, combining education, exercise, and psychotherapeutic approaches, including cognitive-behavioral therapy.There has been a call for more health economics research to demonstrate the cost-effectiveness of psychological therapies. In this paper, we highlight the added value of psychologists as members of multidisciplinary treatment teams, who can assess and treat the maladaptive cognitive, emotional, and behavioral symptoms that are commonly seen in individuals with FMS.

La fibromialgia (FM) es una enfermedad crónica caracterizada por la presencia de un historial clínico de dolor diseminado y dolor a la presión, sin una lesión orgánica evidente, que afecta al 2,4% de la población general adulta en España, con una prevalencia significativamente más alta en mujeres que en hombres. Una de las principales problemáticas que presentan los pacientes con FM es la alteración del funcionamiento cognitivo, junto con la alta prevalencia de síntomas depresivos asociados a esta enfermedad. El objetivo de esta revisión sistemática es buscar evidencias de la relación de los síntomas depresivos y el bajo rendimiento cognitivo en pacientes con FM. Para ello, se realizó una búsqueda sistemática en la que se seleccionan 14 estudios que analizan la relación de los síntomas depresivos y el funcionamiento cognitivo en pacientes con FM. Tras la revisión de los artículos, se observó una mayor prevalencia de síntomas depresivos en pacientes con FM que en personas sanas, así como su relación con la memoria, atención, impulsividad e inhibición de respuesta, planificación y organización, flexibilidad cognitiva y tiempo de reacción en estos pacientes. Se encontraron resultados contradictorios sobre la relación de los síntomas de depresión con la función ejecutiva, velocidad de procesamiento y cálculo mental en pacientes con FM; y no se halló relación entre los síntomas depresivos y la habilidad visoconstructiva, aprendizaje y toma de decisiones, Fibromyalgia (FM) is a chronic disorder characterised by the presence of a clinical history of disseminated pain and pain on pressure and without an evident organic lesion, which affects 2.4% of the general adult population in Spain, with a significantly higher prevalence in women than in men. One of the main problems presented by patients with FM is impaired cognitive functioning, which is coupled with the high prevalence of depressive symptoms associated with this disease. The aim of this systematic review is to search for evidence of the relationship between depressive symptoms and poor cognitive performance in patients with FM. To this end, a systematic search was carried out in which 14 studies that analysed the relationship between depressive symptoms and cognitive functioning in patients with FM were selected. After reviewing the articles, a higher prevalence of depressive symptoms was observed in patients with FM than in healthy people, as well as their relationship with memory, attention, impulsivity and response inhibition, planning and organisation, cognitive flexibility, and reaction time. Contradictory results were found for the relationship between depressive symptoms and executive function, processing speed, and mental calculation in FM patients; and no relationship was found between depressive symptoms and visoconstructive ability, learning ability, and decision making

The ability to accurately predict pain is an adaptive feature in healthy individuals. However, in chronic pain, this mechanism may be selectively impaired and can lead to increased anxiety and excessive avoidance behavior. Recently, we reported the first data demonstrating brain activation in fibromyalgia (FM) patients during conditioned pain responses, in which FM patients revealed a tendency to form new pain-related associations rather than extinguishing irrelevant ones. The aim of the present study was to extend our previous analysis, to elucidate potential neural divergences between subjects with FM (n = 65) and healthy controls (HCs) (n = 33) during anticipatory information (ie, prior to painful stimulus onset). Using functional magnetic resonance imaging (fMRI), the current analyses include 1) a congruently cued paradigm of low and high pain predictive cues, followed by 2) an incongruently cued paradigm where low and high pain predictive cues were followed by an identical mid-intensity painful pressure. During incongruently cued high-pain associations, FM exhibited reduced left dorsolateral prefrontal cortex (dlPFC) activation compared to HCs, which was followed by an altered subsequent pain experience in FM, as patients continued to rate the following painful stimuli as high, even though the pressure had been lowered. During congruently cued low pain anticipation, FM exhibited decreased right dlPFC activation compared to HCs, as well as decreased brain connectivity between brain regions implicated in cognitive modulation of pain (dlPFC) and nociceptive processing (primary somatosensory cortex/postcentral gyrus [S1] and supplementary motor area [SMA]/midcingulate cortex [MCC]). These results may reflect an important feature of validating low pain expectations in HCs and help elucidate behavioral reports of impaired safety processing in FM patients. PERSPECTIVE: FM exhibited a stronger conditioned pain response for high-pain associations, which was associated w

Background: Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) and fibromyalgia have overlapping neurologic symptoms particularly disabling fatigue. This has given rise to the question whether they are distinct central nervous system (CNS) entities or is one an extension of the other. Material and methods: To investigate this, we used unbiased quantitative mass spectrometry-based proteomics to examine the most proximal fluid to the brain, cerebrospinal fluid (CSF). This was to ascertain if the proteome profile of one was the same or different from the other. We examined two separate groups of ME/CFS, one with (n = 15) and one without (n = 15) fibromyalgia. Results: We quantified a total of 2083 proteins using immunoaffinity depletion, tandem mass tag isobaric labelling and offline two-dimensional liquid chromatography coupled to tandem mass spectrometry, including 1789 that were quantified in all the CSF samples. ANOVA analysis did not yield any proteins with an adjusted p value <.05. Conclusion: This supports the notion that ME/CFS and fibromyalgia as currently defined are not distinct entities.

[Resumo] Descrición da experiencia. O seguinte traballo constitúe un proxecto de Aprendizaxe e Servizo (ApS), que combina o servizo á comunidade co aprendizaxe, cunha finalidade pedagóxica, solidaria e reflexiva. Trátase dunha intervención baseada no exercicio terapéutico e na neuroeducación da dor crónica, levada a cabo coa Asociación Coruñesa de Fibromialxia (ACOFIFA), no marco da asignatura Traballo de Fin de Grao (TFG). Obxectivo xeral. O obxectivo xeral para a alumna é adquirir as competencias da materia TFG, mentres que o das participantes é completar un programa de exercicio terapéutico acompañado dunhas píldoras formativas, enfocado á mellora da dor, da funcionalidade e da calidade de vida. Desenvolvemento da experiencia. Esta experiencia subdivídese en diferentes accións: (i) revisión bibliográfica sobre a prevalencia da fibromialxia (FM), as medidas de análise de resultado empregadas no seu estudo e a eficacia do exercicio terapéutico no seu manexo; (ii) deseño e realización da valoración inicial e final dos participantes; (iii) deseño e aplicación dun programa de exercicio terapéutico grupal en combinación coas distintas píldoras formativas. Resultados da experiencia. Tras o desenvolvemento do proxecto obtéñense como principais resultados: (i) unha diminución da intensidade da dor, así como do número de rexións anatómicas simultáneas nos que se refiren síntomas; (ii) mellorías importantes nas puntuacións acadadas no Fibromyalgia Impact Questionnaire - Revised, de xeito que o nivel de impacto da FM na calidade de vida pasa de ser severo a moderado; (iii) un incremento no nivel de actividade física e horas de descanso nocturno das participantes, así como un elevado nivel de satisfacción de cara ao programa aplicado e percepción positiva de cambios. Non se atoparon cambios significativos sobre o estado ansioso-depresivo ou a capacidade física. Conclusións. Con este proxecto de ApS foron acadados os principais obxectivos propostos, tratándose dunha experienci, [Abstract] Description of the experience. The following work is a Learning-Service type project (ApS), that combines community service with a learning experience, with a pedagogical, supportive and reflective purpose. This is an intervention based on therapeutic exercise and neuroeducation of chronic pain, which was performed together with the ACOFIFA association, as a final degree project (TFG). Objective. The main objective for the student is to acquire the competences related with TFG subject, while the objective for the participants is to complete a therapeutic exercise program combined with some “educational pills”, focused on pain, function and quality of life improvement. Development of experience. This experience can be divided into different actions: (i) literature review about the prevalence of fibromyalgia (FM), the outcomes used for its evaluation and the effectiveness of therapeutic exercise in its management; (ii) design and implementation of the initial and final evaluation of the participants; (iii) design and implementation of a group therapeutic exercise program combined with the different “educational pills”. Results of experience. After having developed the project, the main results obtained were: (i) a decrease in pain intensity, as well as a reduction of the number of simultaneous anatomical regions in which the symptoms are referred; (ii) an important improvement in the Fibromyalgia Impact Questionnaire - Revised scores, so that the level of the impact of FM on quality of life goes from severe to moderate; (iii) an increase of physical activity and hours of night rest of the participants, and a high satisfaction and positive change perception. No significant changes in anxiety-depressive state or physical capacity were found. Conclusions. The main proposed objectives were fulfilled at the end of this project. It was an enriching experience on an academic, personal and professional level., [Resumen] Descripción de la experiencia. El siguiente trabajo constituye un proyecto de Aprendizaje y Servicio (ApS), que combina el servicio a la comunidad con el aprendizaje, con una finalizad pedagógica, solidaria y reflexiva. Se trata de una intervención basada en el ejercicio terapéutico y en la neuroeducación del dolor crónico, llevada a cabo con la Asociación Coruñesa de Fibromialgia (ACOFIFA), en el marco de la asignatura Trabajo de fin de grado (TFG). Objetivo general. El objetivo general para la alumna es adquirir las competencias de la materia TFG, mientras que el de las participantes es completar un programa de ejercicio terapéutico acompañado de unas píldoras formativas, enfocado a la mejora del dolor, la funcionalidad y la calidad de vida. Desarrollo de la experiencia. Esta experiencia se subdivide en diferentes acciones: (i) revisión bibliográfica sobre la prevalencia de la fibromialgia (FM), las medidas de análisis de resultados empleadas en su estudio y la eficacia del ejercicio terapéutico en su manejo; (ii) diseño y realización de la valoración inicial y final de los participantes; (iii) diseño y aplicación de un programa de ejercicio terapéutico grupal en combinación con las distintas píldoras formativas. Resultados de la experiencia. Tras el desarrollo del proyecto se obtienen como principales resultados: (i) una disminución de la intensidad del dolor, así como del número de regiones anatómicas simultáneas en que se refieren los síntomas; (ii) mejoras importantes en las puntuaciones del Fibromyalgia Impact Questionnaire - Revised, de forma que el nivel de impacto de la FM sobre la calidad de vida pasa de severo a moderado; (iii) un incremento en el nivel de actividad física y horas de descanso nocturno de las participantes, así como un elevado nivel de satisfacción de cara al programa aplicado y percepción positiva de cambios. No se encontraron cambios significativos sobre el estado ansioso-depresivo o la capacidad física. Conclusiones. Con este

[Resumen] Introducción La fibromialgia se define como una afección crónica idiopática que constituye un síndrome caracterizado por dolor musculoesquelético no inflamatorio difuso y generalizado, con baja tolerancia al dolor, hiperalgesia y alodinia. Además de estos síntomas, nos encontramos con otros como fatiga, trastornos del sueño, problemas de salud mental, rigidez o problemas cognitivos, suponiendo por tanto una afectación multisistémica. La fisioterapia se encuadra como uno de los tratamientos principales en el manejo de la enfermedad, abordándola desde una perspectiva multidisciplinar. Objetivo. Analizar y actualizar los valores en cuanto a función pulmonar, fuerza y resistencia de la musculatura respiratoria en sujetos con fibromialgia, comparando los resultados con sujetos sanos. Material y método. Se plantea un estudio descriptivo observacional de corte transversal en el que se reclutarán a 60 sujetos, 30 sujetos sanos en el grupo control y 30 sujetos con fibromialgia en el grupo experimental, obteniéndose la muestra del último grupo a través de la Asociación Coruñesa de Fibromialgia, Síndrome de Fatiga Crónica y Sensibilidad Química Múltiple. Se busca comparar la función pulmonar, la fuerza y resistencia de la musculatura respiratoria entre ambos grupos, apareados por sexo y edad, y con su propio valor de referencia. Los participantes de ambos grupos realizarán las siguientes pruebas: espirometría simple y forzada, presiones respiratorias máximas, pruebas de resistencia de la musculatura inspiratoria, máxima ventilación voluntaria y test de seis minutos marcha. Además, cumplimentarán un test multidimensional sobre la fatiga, una escala sobre la disnea, un cuestionario sobre el impacto de la fibromialgia, y otro sobre el nivel de actividad física, con el fin de caracterizar la muestra. Al finalizar el período de estudio, se compararán los resultados obtenidos entre ambos grupos y se valorará la relación entre las variables de estudio con la fibromialgia., [Abstract] Background. Fibromyalgia is defined as a chronic idiopathic condition that constitutes a syndrome characterized by diffuse and generalized non-inflammatory musculoskeletal pain, with low pain tolerance, hyperalgesia and allodynia. In addition to these symptoms, we find others such as fatigue, sleep disorders, mental health problems, stiffness or cognitive problems, thus assuming a multisystemic affectation. Physiotherapy is framed as one of the main treatments in the management of the disease, approaching it from a multidisciplinary perspective. Objetive. To analyze and update the values of pulmonary function, strength and endurance of the respiratory muscles in subjects with fibromyalgia, comparing the results with healthy subjects. Methods. A descriptive observational cross-sectional study is proposed in which 60 subjects will be recruited, 30 healthy subjects in the control group and 30 subjects with fibromyalgia in the experimental group, the sample of the latter group being obtained through the Asociación Coruñesa de Fibromialgia, Síndrome de Fatiga Crónica y Sensibilidad Química Múltiple (Coruña Association of Fibromyalgia, Chronic Fatigue Syndrome and Multiple Chemical Sensitivity). The aim is to compare the pulmonary function, strength and endurance of the respiratory musculature between both groups, matched by sex and age, and with their own reference value. The participants of both groups will perform the following tests: simple and forced spirometry, maximum respiratory pressures, inspiratory muscle resistance tests, maximum voluntary ventilation and six-minute walk test. They will also complete a multidimensional fatigue test, a dyspnea scale, a questionnaire on the impact of fibromyalgia, and another on the level of physical activity, in order to characterize the sample. At the end of the study period, the results obtained between the two groups will be compared and the relationship between the study variables and fibromyalgia will be assesse, [Resumo] Introdución. A fibromialxia defínese como unha afección crónica idiopática que constitúe un síndrome caracterizado por dor musculoesquelética non inflamatoria difusa e xeneralizada, con baixa tolerancia á dor, hiperalxia e alodinia. Ademais destes síntomas, atópanse outros como fatiga, trastornos do sono, problemas de saúde mental, rixidez ou problemas cognitivos, supoñendo por tanto unha afectación multisistémica. A fisioterapia encádrase como un dos tratamentos principais no manexo da enfermidade, abordándoa dende unha perspectiva multidisciplinar. Obxectivo. Analizar e actualizar os valores en canto á función pulmonar, forza e resistencia da musculatura respiratoria en suxeitos con fibromialxia, comparando os resultados con suxeitos sans. Material e método. Planifícase un estudo descritivo observacional de corte transversal no que se reclutarán a 60 suxeitos, 30 suxeitos sanos no grupo control e 30 suxeitos con fibromialxia no grupo experimental, obténdose a mostra do último grupo a través da Asociación Coruñesa de Fibromialxia, Síndrome de Fatiga Crónica e Sensibilidade Química Múltiple. Buscase comparar a función pulmonar, a forza e resistencia da musculatura respiratoria entre ambos os grupos, aparellados por sexo e idade, e co seu propio valor de referencia. Os participantes de ambos os grupos realizarán as seguintes probas: espirometría simple e forzada, presións respiratorias máximas, probas de resistencia da musculatura inspiratoria, máxima ventilación voluntaria e teste de seis minutos de marcha. Ademais, cumprimentarán un teste multidimensional sobre a fatiga, unha escala sobre a dispnea, un cuestionario sobre o impacto da fibromialxia e outro sobre o nivel de actividade física, co fin de caracterizar a mostra. Ao rematar o período de estudo, compararanse os resultados obtidos entre ambos os grupos e valorarase a relación entre as variables de estudo e a fibromialxia.

[Resumen] La fibromialgia es un complejo síndrome que se caracteriza por la presencia de diversos signos y síntomas de evolución variable como dolor crónico generalizado y múltiples alteraciones sistémicas. Sumado a lo anterior se presentan dificultades para su diagnóstico, pobre conocimiento por parte del personal sanitario sobre la patología y respuesta limitada a los tratamientos disponibles. El abordaje actual se dirige al tratamiento sintomático de carácter multimodal. El modelo biopsicosocial del dolor establece que los causales de dolor se originan en la parte física así como en las creencias y estrategias de afrontamiento ante situaciones estresantes. De esta forma, la educación en neurociencias del dolor presenta una esperanzadora respuesta ayudando a los pacientes a reconceptualizar sus creencias y actitudes ante el dolor. Objetivo: Evaluar el efecto de un programa de educación en neurociencias del dolor y ejercicio terapéutico sobre la severidad de los síntomas de la fibromialgia en comparación con un programa basado exclusivamente en ejercicio terapéutico. Métodos y materiales: se presenta un proyecto de investigación para un estudio experimental, tipo ensayo clínico controlado, simple ciego con aleatorización simple. En el cual participará un número de 80 pacientes con diagnósticos de fibromialgia. El grupo control recibirá un programa de ejercicio terapéutico de 12 semanas de duración y con una frecuencia de 2 sesiones por semana de 45 minutos por sesión entre tanto, el grupo experimental recibirá un programa de PNE, que se desarrollará en 12 semanas, con una frecuencia de 1 sesión semanal y una duración de 1 hora al día. Así mismo recibirán el mismo programa de ejercicio terapéutico impartido en el grupo control, con una frecuencia de 1 vez a la semana y una duración de 45 minutos por sesión., [Abstract] Fibromyalgia is a complex syndrome that is characterized by the presence of various signs and symptoms of variable evolution such as wide sprain chronic pain and multiple systemic alterations. In addition, there are difficulties for an accurate diagnosis, poor knowledge of the health professionals about the pathology and limited response to the treatments currently available. The current approach has been directed at symptomatic treatment through multimodal intervention. The biopsychosocial model of pain establishes the causes of pain are physical as well as beliefs and coping strategies in stressful situations. In this way, pain neuroscience education presents a hopeful response by helping patients reconceptualize their beliefs and attitudes toward pain. Objective: To evaluate the effect of a pain neuroscience education program and therapeutic exercise on the severity of fibromyalgia symptoms compared to a program based exclusively on therapeutic exercise. Methods and materials: It is presented a research project for an experimental research, controlled clinical trial type, single blind with simple randomization. In which the 80 patients with fibromyalgia will participate. The control group will receive a therapeutic exercise program of 12 weeks duration and a frequency of 2 sessions per week of 45 minutes per session. Meanwhile the experimental group will receive a PNE program, that will be developed in 12 weeks with a frequency of 1 weekly session and a duration of 1 hour a day. They will also receive the same therapeutic exercise program taught in the control group, with a frequency of once a week and a duration of 45 minutes per session.

Indicator report of survey respondents aged 18 and older who reported being told by a doctor or other health professional that they had some form of arthritis, rheumatoid arthritis, gout, lupus, or fibromyalgia in Utah.

Purpose of reviewThis review focuses on the role of psychologists in the assessment and treatment of fibromyalgia syndrome (FMS), a highly prevalent condition characterized by chronic widespread pain, fatigue, cognitive problems, distress, and disability.Recent findingsA large body of work supports the effectiveness and cost-utility of psychological therapies for the improvement of a wide range of symptoms associated with FMS. However, patients with FMS are best assessed and treated by a multidisciplinary team, in which psychologists have an important role. Multidisciplinary treatment, in which each healthcare professional offers his or her own expertise to the patient, has been shown to produce more ubiquitous treatment effects for this complex syndrome than single discipline treatments. Considering the empirical evidence and documented experience of patients, people with FMS can benefit from integrated care, combining education, exercise, and psychotherapeutic approaches, including cognitive-behavioral therapy.There has been a call for more health economics research to demonstrate the cost-effectiveness of psychological therapies. In this paper, we highlight the added value of psychologists as members of multidisciplinary treatment teams, who can assess and treat the maladaptive cognitive, emotional, and behavioral symptoms that are commonly seen in individuals with FMS.

Around twenty-six percent of US adults have a disability. It can impair their physical and mental health forcing many to adjust their everyday life. Fibromyalgia is a chronic pain disorder that is considered a disability. As someone who has been living with Fibromyalgia for three years, I have a first-hand account of how this condition affects one’s outlook on life. By speaking with professionals, we become aware of both the physical and mental effects of Fibromyalgia. A side of the medical world also begins to appear, one where those with invisible disabilities, like Fibromyalgia, lack access to proper care and providers. They face geographical and financial barriers as well as lack of understanding from doctors, friends, and family. This creates an environment that prevents proper healing and long term management of Fibromyalgia symptoms. I argue that by sharing my story able-bodied individuals can get a better understanding of the day-to-day life with chronic pain and how having providers focused on co-production aids in the process of healing. I then propose that by creating a health system focused on co-production we can provide the necessary resources to help those with Fibromyalgia manage their symptoms and even live a fulfilling life.

OBJECTIVES: Neuropeptide Y is associated with stress in animal and human laboratory studies. However, data from clinical studies are scarce and no clinical longitudinal studies have been published. The aim of this clinical study was to assess the possible association between changes in the levels of pain, depression, and stress measures, on the one hand, and plasma neuropeptide Y levels, on the other. METHODS: Forty-four women with the fibromyalgia syndrome were exposed to a Cognitive Behavioral Therapy intervention. Levels of the plasma neuropeptide Y as well as pain, depression, and stress measures were obtained at the start and at the end of the intervention, and after a further six month follow-up. Based on these data, a before-and-after analysis was performed. RESULTS: Almost all measures of pain, depression, and stress improved during the study; specifically, variables measuring life control (coping), depression, and stress-related time urgency improved significantly. Moreover, during the same time period, the mean plasma neuropeptide Y level was reduced from 93.2 ± 38.8 fmol/mL before the Cognitive Behavioral Therapy to 75.6 ± 42.9 fmol/mL (p<0.001) at the end of the study. CONCLUSIONS: After exposure to a Cognitive Behavioral Therapy intervention, levels of most of the pain, depression, and stress measures improved, half of them significantly, as did the levels of neuropeptide Y. This circumstance indicates a possible functional relationship between pain-depression-stress and neuropeptide Y.

Bakgrund: Sjukdomen fibromyalgi (FM) karaktäriseras främst av långvarig smärta och trötthet tillsammans med psykiska och kognitiva påfrestningar. Främst drabbas kvinnor. Den vanligaste åtgärden utgörs av farmakologisk behandling tillsammans med multimodal smärtrehabilitering. Det finns bristande kunskap om upplevelserna av att leva med fibromyalgi som kvinna. Syfte: Att sammanställa vuxna kvinnors upplevelser kring att leva med fibromyalgi. Metod: Vald design utgjordes av en begränsad systematisk litteraturöversikt baserad på tolv artiklar med kvalitativ ansats från PubMed och CINAHL. Artiklar med intervju som metod och som inkluderade kvinnor över 18 år diagnostiserade med fibromyalgi inkluderades. Artiklar där kvinnorna självdiagnostiserats exkluderades. Artiklarna granskades genom SBU:s mall och analyserades genom integrerad analys. Resultat: Resultatet grundar sig i fem huvudteman: att leva med kroniska symtom; invalidering, misstro och stigmatisering; vikten av att klara av vardagen och arbetet; sociala relationer; sexualitet och partnerskap, och tio underteman. Konklusion: Kvinnor med fibromyalgi upplever att sjukdomens fysiska och psykiska symtom har inverkan på vardagslivet, arbetet och sociala relationer. Många kvinnor kämpar dessutom med stigmatisering och invalidering kring sin sjukdom. Ytterligare forskning behövs för att öka kunskap om sjukdomen inom vården och samhället.

Bakgrund: Sjukdomen fibromyalgi (FM) karaktäriseras främst av långvarig smärta och trötthet tillsammans med psykiska och kognitiva påfrestningar. Främst drabbas kvinnor. Den vanligaste åtgärden utgörs av farmakologisk behandling tillsammans med multimodal smärtrehabilitering. Det finns bristande kunskap om upplevelserna av att leva med fibromyalgi som kvinna. Syfte: Att sammanställa vuxna kvinnors upplevelser kring att leva med fibromyalgi. Metod: Vald design utgjordes av en begränsad systematisk litteraturöversikt baserad på tolv artiklar med kvalitativ ansats från PubMed och CINAHL. Artiklar med intervju som metod och som inkluderade kvinnor över 18 år diagnostiserade med fibromyalgi inkluderades. Artiklar där kvinnorna självdiagnostiserats exkluderades. Artiklarna granskades genom SBU:s mall och analyserades genom integrerad analys. Resultat: Resultatet grundar sig i fem huvudteman: att leva med kroniska symtom; invalidering, misstro och stigmatisering; vikten av att klara av vardagen och arbetet; sociala relationer; sexualitet och partnerskap, och tio underteman. Konklusion: Kvinnor med fibromyalgi upplever att sjukdomens fysiska och psykiska symtom har inverkan på vardagslivet, arbetet och sociala relationer. Många kvinnor kämpar dessutom med stigmatisering och invalidering kring sin sjukdom. Ytterligare forskning behövs för att öka kunskap om sjukdomen inom vården och samhället.

Research into the neurobiological and psychosocial mechanisms involved in fibromyalgia has progressed remarkably in recent years. Despite this, current accounts of fibromyalgia fail to capture the complex, dynamic, and mutual crosstalk between neurophysiological and psychosocial domains. We conducted a comprehensive review of the existing literature in order to: a) synthesize current knowledge on fibromyalgia; b) explore and highlight multi-level links and pathways between different systems; and c) build bridges connecting disparate perspectives. An extensive panel of international experts in neurophysiological and psychosocial aspects of fi-bromyalgia discussed the collected evidence and progressively refined and conceptualized its interpretation. This work constitutes an essential step towards the development of a model capable of integrating the main factors implicated in fibromyalgia into a single, unified construct which appears indispensable to foster the under-standing, assessment, and intervention for fibromyalgia.

Transferring fibromyalgia patient immunoglobulin G (IgG) to mice induces pain-like behaviour, and fibromyalgia IgG binds mouse and human satellite glia cells (SGCs). These findings suggest that autoantibodies could be part of fibromyalgia pathology. However, it is unknown how frequently fibromyalgia patients have anti-SGC antibodies and how anti-SGC antibodies associate with disease severity. Here, we quantified serum or plasma anti-SGC IgG levels in 2 fibromyalgia cohorts from Sweden and Canada using an indirect immunofluorescence murine cell culture assay. Fibromyalgia serum IgG binding to human SGCs in human dorsal root ganglia tissue sections was also assessed by immunofluorescence. In the cell culture assay, anti-SGC IgG levels were increased in both fibromyalgia cohorts compared with control group. Elevated anti-SGC IgG was associated with higher levels of self-reported pain in both cohorts, and higher fibromyalgia impact questionnaire scores and increased pressure sensitivity in the Swedish cohort. Anti-SGC IgG levels were not associated with fibromyalgia duration. Swedish fibromyalgia (FM) patients were clustered into FM-severe and FM-mild groups, and the FM-severe group had elevated anti-SGC IgG compared with the FM-mild group and control group. Anti-SGC IgG levels detected in culture positively correlated with increased binding to human SGCs. Moreover, the FM-severe group had elevated IgG binding to human SGCs compared with the FM-mild and control groups. These results demonstrate that a subset of fibromyalgia patients have elevated levels of anti-SGC antibodies, and the antibodies are associated with more severe fibromyalgia symptoms. Screening fibromyalgia patients for anti-SGC antibodies could provide a path to personalized treatment options that target autoantibodies and autoantibody production.

OBJECTIVES: Neuropeptide Y is associated with stress in animal and human laboratory studies. However, data from clinical studies are scarce and no clinical longitudinal studies have been published. The aim of this clinical study was to assess the possible association between changes in the levels of pain, depression, and stress measures, on the one hand, and plasma neuropeptide Y levels, on the other. METHODS: Forty-four women with the fibromyalgia syndrome were exposed to a Cognitive Behavioral Therapy intervention. Levels of the plasma neuropeptide Y as well as pain, depression, and stress measures were obtained at the start and at the end of the intervention, and after a further six month follow-up. Based on these data, a before-and-after analysis was performed. RESULTS: Almost all measures of pain, depression, and stress improved during the study; specifically, variables measuring life control (coping), depression, and stress-related time urgency improved significantly. Moreover, during the same time period, the mean plasma neuropeptide Y level was reduced from 93.2 ± 38.8 fmol/mL before the Cognitive Behavioral Therapy to 75.6 ± 42.9 fmol/mL (p<0.001) at the end of the study. CONCLUSIONS: After exposure to a Cognitive Behavioral Therapy intervention, levels of most of the pain, depression, and stress measures improved, half of them significantly, as did the levels of neuropeptide Y. This circumstance indicates a possible functional relationship between pain-depression-stress and neuropeptide Y.

Objective: Several psychological factors have been proposed to be associated with functional somatic disorders (FSD) including functional somatic syndromes, such as irritable bowel, chronic widespread pain, and chronic fatigue. However, large randomly selected population-based studies of this association are sparse. This study aimed to investigate the association between FSD and perceived stress and self-efficacy, respectively, and to investigate if FSD differed from severe physical diseases on these aspects. Methods: This cross-sectional study included a random sample of the adult Danish population (n = 9656). FSD were established using self-reported questionnaires and diagnostic interviews. Perceived stress was measured with Cohen’s Perceived Stress Scale and self-efficacy with the General Self-Efficacy Scale. Data were analysed with generalized linear models and linear regression models. Results: FSD were associated with higher perceived stress and lower self-efficacy, especially for the multi-organ and the general symptoms/fatigue FSD types and for chronic fatigue. However, controlling for the personality trait neuroticism altered the associations with self-efficacy so it became insignificant. The analysis did not support an important interaction between perceived stress and self-efficacy on the likelihood of having FSD. Individuals with FSD presented levels of perceived stress that were not equal, ie higher, to those in individuals with severe physical diseases. Conclusion: FSD were positively associated with perceived stress and negatively associated with self-efficacy. Our study may point to stress being part of the symptomatology of FSD. This underlines the severity of having FSD and stresses the relevance of the resilience theory in the understanding of the condition., Objective: Several psychological factors have been proposed to be associated with functional somatic disorders (FSD) including functional somatic syndromes, such as irritable bowel, chronic widespread pain, and chronic fatigue. However, large randomly selected population-based studies of this association are sparse. This study aimed to investigate the association between FSD and perceived stress and self-efficacy, respectively, and to investigate if FSD differed from severe physical diseases on these aspects.Methods: This cross-sectional study included a random sample of the adult Danish population (n = 9656). FSD were established using self-reported questionnaires and diagnostic interviews. Perceived stress was measured with Cohen's Perceived Stress Scale and self-efficacy with the General Self-Efficacy Scale. Data were analysed with generalized linear models and linear regression models.Results: FSD were associated with higher perceived stress and lower self-efficacy, especially for the multi-organ and the general symptoms/fatigue FSD types and for chronic fatigue. However, controlling for the personality trait neuroticism altered the associations with self-efficacy so it became insignificant. The analysis did not support an important interaction between perceived stress and self -efficacy on the likelihood of having FSD. Individuals with FSD presented levels of perceived stress that were not equal, ie higher, to those in individuals with severe physical diseases.Conclusion: FSD were positively associated with perceived stress and negatively associated with self-efficacy. Our study may point to stress being part of the symptomatology of FSD. This underlines the severity of having FSD and stresses the relevance of the resilience theory in the understanding of the condition.

Objective: Several psychological factors have been proposed to be associated with functional somatic disorders (FSD) including functional somatic syndromes, such as irritable bowel, chronic widespread pain, and chronic fatigue. However, large randomly selected population-based studies of this association are sparse. This study aimed to investigate the association between FSD and perceived stress and self-efficacy, respectively, and to investigate if FSD differed from severe physical diseases on these aspects. Methods: This cross-sectional study included a random sample of the adult Danish population (n = 9656). FSD were established using self-reported questionnaires and diagnostic interviews. Perceived stress was measured with Cohen’s Perceived Stress Scale and self-efficacy with the General Self-Efficacy Scale. Data were analysed with generalized linear models and linear regression models. Results: FSD were associated with higher perceived stress and lower self-efficacy, especially for the multi-organ and the general symptoms/fatigue FSD types and for chronic fatigue. However, controlling for the personality trait neuroticism altered the associations with self-efficacy so it became insignificant. The analysis did not support an important interaction between perceived stress and self-efficacy on the likelihood of having FSD. Individuals with FSD presented levels of perceived stress that were not equal, ie higher, to those in individuals with severe physical diseases. Conclusion: FSD were positively associated with perceived stress and negatively associated with self-efficacy. Our study may point to stress being part of the symptomatology of FSD. This underlines the severity of having FSD and stresses the relevance of the resilience theory in the understanding of the condition., Objective: Several psychological factors have been proposed to be associated with functional somatic disorders (FSD) including functional somatic syndromes, such as irritable bowel, chronic widespread pain, and chronic fatigue. However, large randomly selected population-based studies of this association are sparse. This study aimed to investigate the association between FSD and perceived stress and self-efficacy, respectively, and to investigate if FSD differed from severe physical diseases on these aspects.Methods: This cross-sectional study included a random sample of the adult Danish population (n = 9656). FSD were established using self-reported questionnaires and diagnostic interviews. Perceived stress was measured with Cohen's Perceived Stress Scale and self-efficacy with the General Self-Efficacy Scale. Data were analysed with generalized linear models and linear regression models.Results: FSD were associated with higher perceived stress and lower self-efficacy, especially for the multi-organ and the general symptoms/fatigue FSD types and for chronic fatigue. However, controlling for the personality trait neuroticism altered the associations with self-efficacy so it became insignificant. The analysis did not support an important interaction between perceived stress and self -efficacy on the likelihood of having FSD. Individuals with FSD presented levels of perceived stress that were not equal, ie higher, to those in individuals with severe physical diseases.Conclusion: FSD were positively associated with perceived stress and negatively associated with self-efficacy. Our study may point to stress being part of the symptomatology of FSD. This underlines the severity of having FSD and stresses the relevance of the resilience theory in the understanding of the condition.

OBJECTIVES: Neuropeptide Y is associated with stress in animal and human laboratory studies. However, data from clinical studies are scarce and no clinical longitudinal studies have been published. The aim of this clinical study was to assess the possible association between changes in the levels of pain, depression, and stress measures, on the one hand, and plasma neuropeptide Y levels, on the other. METHODS: Forty-four women with the fibromyalgia syndrome were exposed to a Cognitive Behavioral Therapy intervention. Levels of the plasma neuropeptide Y as well as pain, depression, and stress measures were obtained at the start and at the end of the intervention, and after a further six month follow-up. Based on these data, a before-and-after analysis was performed. RESULTS: Almost all measures of pain, depression, and stress improved during the study; specifically, variables measuring life control (coping), depression, and stress-related time urgency improved significantly. Moreover, during the same time period, the mean plasma neuropeptide Y level was reduced from 93.2 ± 38.8 fmol/mL before the Cognitive Behavioral Therapy to 75.6 ± 42.9 fmol/mL (p<0.001) at the end of the study. CONCLUSIONS: After exposure to a Cognitive Behavioral Therapy intervention, levels of most of the pain, depression, and stress measures improved, half of them significantly, as did the levels of neuropeptide Y. This circumstance indicates a possible functional relationship between pain-depression-stress and neuropeptide Y.

Around twenty-six percent of US adults have a disability. It can impair their physical and mental health forcing many to adjust their everyday life. Fibromyalgia is a chronic pain disorder that is considered a disability. As someone who has been living with Fibromyalgia for three years, I have a first-hand account of how this condition affects one’s outlook on life. By speaking with professionals, we become aware of both the physical and mental effects of Fibromyalgia. A side of the medical world also begins to appear, one where those with invisible disabilities, like Fibromyalgia, lack access to proper care and providers. They face geographical and financial barriers as well as lack of understanding from doctors, friends, and family. This creates an environment that prevents proper healing and long term management of Fibromyalgia symptoms. I argue that by sharing my story able-bodied individuals can get a better understanding of the day-to-day life with chronic pain and how having providers focused on co-production aids in the process of healing. I then propose that by creating a health system focused on co-production we can provide the necessary resources to help those with Fibromyalgia manage their symptoms and even live a fulfilling life.

54 p., [EN] Introduction: The American College of Rheumatology (ACR) defines fibromyalgia (FM) as a neurologic chronic disorder. Widespread musculoskeletal pain is accompanied by a wide range of symptoms and co-morbid health problems. Studies suggest that prevalence in the general population vary between 2% and 4% with a peak incidence in middle-aged females. FM is considered a public health problem, due to its high incidence among adult population, the lack of knowledge concerning etiology in addition to the non-curative available treatments. There is none specific drug for FM and as medical management is usually partially successful, non-pharmacological treatments are accomplished for a bio-psycho-social approach, comprising the biological, psychological and social factors that encompass the syndrome. The combination of approaches such as education, exercise and psychotherapeutic interventions seem to create synergy together with pharmacological therapies so multidisciplinary treatment programs have been recommended for FM syndrome.__ Objective: The main objective of this study is to determine the efficacy of multidisciplinary treatments for FM. __ Methodology:119 articles were obtained from both MEDLINE and Cochrane databases and 19 clinical trials were extracted from two systematic reviews obtained from an overview of treatments for FM. Finally, 17 suitable RCTs were included in the present systematic review. Improvement on pain, fatigue, quality of sleep, physical function, depression and/or anxiety were measured. GRADEpro GDT was used to assess the quality of the evidence. __ Results: Low evidence was found for physical function and anxiety while very low evidence was found for pain, fatigue, quality of sleep and depression. No clinically meaningful results were found for any of the assessed outcomes. __ Conclusions:The evidence is very uncertain about the effectiveness of multidisciplinary treatments in FM. A great heterogeneity was found with regard to multidisicip, [ES] Introducción: El Colegio Americano de Reumatología (ACR) define fibromialgia (FM) como un trastorno neurológico crónico. Dolor musculo-esquelético generalizado se acompaña de una gran variedad de síntomas y problemas de salud co-mórbidos. La literatura revela que la prevalencia en la población general varía entre 2-4%, presentando un pico de incidencia en mujeres de mediana edad. La FM es considerada un problema de salud pública debida a su alta incidencia entre la población adulta, la falta de conocimiento sobre su etiología además de los tratamientos no-curativos disponibles para paliar los síntomas de la enfermedad. No existe un fármaco específico para ésta afección, y ya que las terapias farmacológicas suelen ser parcialmente exitosas, se llevan a cabo tratamientos no farmacológicos para un abordaje bio-psico-social, que abordan los factores biológicos, psicológicos y sociales que constituyen el síndrome. La combinación de abordajes parece crear sinergia junto con terapias farmacológicas así que programas de tratamiento multidisciplinares han sido recomendados para el síndrome de FM. __ Objetivo: El objetivo principal de este estudio es determinar la eficacia de tratamientos multidisciplinares para FM.__ Metodología: Se obtuvieron 119 artículos de las bases de datos MEDLINE y Cochrane y se extrajeron 19 ensayos clínicos de dos revisiones sistemáticas obtenidas de una revisión de mapeo realizada anteriormente. Finalmente, se incluyeron 17 ECAs en la presente revisión sistemática. Se midió la mejoría en dolor, fatiga, calidad del sueño, función física depresión y/o ansiedad. Para evaluar la calidad de la evidencia se utilizó GRADEpro GDT.__ Resultados: Se encontró baja evidencia para función física y ansiedad mientras que la calidad fue muy baja para dolor, fatiga, calidad de sueño y depresión. No se encontraron resultados clínicamente significativos para ninguno de los dominios.__ Conclusiones: La evidencia sobre la efectividad de los tratamientos multidisci

OBJECTIVES: Neuropeptide Y is associated with stress in animal and human laboratory studies. However, data from clinical studies are scarce and no clinical longitudinal studies have been published. The aim of this clinical study was to assess the possible association between changes in the levels of pain, depression, and stress measures, on the one hand, and plasma neuropeptide Y levels, on the other. METHODS: Forty-four women with the fibromyalgia syndrome were exposed to a Cognitive Behavioral Therapy intervention. Levels of the plasma neuropeptide Y as well as pain, depression, and stress measures were obtained at the start and at the end of the intervention, and after a further six month follow-up. Based on these data, a before-and-after analysis was performed. RESULTS: Almost all measures of pain, depression, and stress improved during the study; specifically, variables measuring life control (coping), depression, and stress-related time urgency improved significantly. Moreover, during the same time period, the mean plasma neuropeptide Y level was reduced from 93.2 ± 38.8 fmol/mL before the Cognitive Behavioral Therapy to 75.6 ± 42.9 fmol/mL (p<0.001) at the end of the study. CONCLUSIONS: After exposure to a Cognitive Behavioral Therapy intervention, levels of most of the pain, depression, and stress measures improved, half of them significantly, as did the levels of neuropeptide Y. This circumstance indicates a possible functional relationship between pain-depression-stress and neuropeptide Y.

Background: Fibromyalgia patients can benefit from music approaches as complementary treatments. In the literature, it was shown that these interventions managed pain conditions as well as reduced complaints, increased relaxation, and improved moods. Objective: This study aimed at evaluating music therapy, in the form of therapeutic music listening, specifically for patients with fibromyalgia, to treat chronic pain by reducing pain perception, increasing well-being, and improving quality of life. Methods: Twenty-four patients with fibromyalgia were recruited to take part in this feasibility pilot study that adopted a between-subject and within-subject design. Participants were randomised into three groups: (1) standard care, (2) standard care plus preferred music listening, (3) standard care plus Melomics-Health music listening, composed by an algorithm. Participants in experimental groups listened to 30 min of music at home, twice a day for a month. Patients’ perceptions of changes following the listening, the intensity of pain and its interference in their lives, physical and mental well-being, and reported attitudes towards listening to music were evaluated respectively through the patients’ global impression of change, the brief pain inventory, the Short Form Healthy Survey-12, and the cognitive behavioural assessment-outcome evaluation. Results: The study showed that music listening can significantly affect mental well-being compared to no music. Moreover, the effects in the Melomics-Health group are maintained at follow-up. No significant effect on pain perception was noted. Conclusions: The study provides information supporting a possible role of music listening in improving well-being of patients with fibromyalgia.

Background: Quantitative data on longitudinal associations between catastrophizing and pain or physical function are patchy. The study aimed to quantify the prognostic value of catastrophizing for pain and function in fibromyalgia and low back pain before and after rehabilitation. Methods: The associations of state and change on the Multidimensional Pain Inventory (MPI) Pain severity scale, the Short Form 36 (SF-36) Physical functioning scale and the Six-Minute Walking Distance (6MWD) with the Coping Strategies Questionnaire (CSQ) Catastrophizing scale were quantified by multiple regression modelling to adjust for confounders. Results: Sex- and age-matched cohorts (n = 71 each) were compared. Pain and catastrophizing were worse in fibromyalgia than in low back pain, whereas the function levels were comparable. Baseline catastrophizing predicted pain change by adjusted correlations of 0.552 (fibromyalgia) and 0.450 (low back pain), self-rated function by 0.403 and 0.308, and the 6MWD by 0.270 and - 0.072. The change in catastrophizing was associated to the change in pain by 0.440 (fibromyalgia) and 0.614 (low back pain), self-rated function by 0.122 and 0.465, and the 6MWD by 0186 and 0.162. Conclusions: Catastrophizing (pain-related worrying) was a potential prognostic factor, especially for pain and somewhat less for self-rated physical function but it was only weakly predictive for the walking distance in both conditions, independently of potential confounders, such as sex, age, baseline severity and others. Reduction of maladaptive coping should be integrated into the management of chronic pain. Significance: Our study showed surprisingly high associations between state and change in catastrophizing to pain relief and functional improvement in chronic pain patients. This is supported by clinical experience and research data, even if the construct and measurement of catastrophizing is under debate. Our findings and those of literature point to more pessimistic sel

OBJECTIVES: Neuropeptide Y is associated with stress in animal and human laboratory studies. However, data from clinical studies are scarce and no clinical longitudinal studies have been published. The aim of this clinical study was to assess the possible association between changes in the levels of pain, depression, and stress measures, on the one hand, and plasma neuropeptide Y levels, on the other. METHODS: Forty-four women with the fibromyalgia syndrome were exposed to a Cognitive Behavioral Therapy intervention. Levels of the plasma neuropeptide Y as well as pain, depression, and stress measures were obtained at the start and at the end of the intervention, and after a further six month follow-up. Based on these data, a before-and-after analysis was performed. RESULTS: Almost all measures of pain, depression, and stress improved during the study; specifically, variables measuring life control (coping), depression, and stress-related time urgency improved significantly. Moreover, during the same time period, the mean plasma neuropeptide Y level was reduced from 93.2 ± 38.8 fmol/mL before the Cognitive Behavioral Therapy to 75.6 ± 42.9 fmol/mL (p<0.001) at the end of the study. CONCLUSIONS: After exposure to a Cognitive Behavioral Therapy intervention, levels of most of the pain, depression, and stress measures improved, half of them significantly, as did the levels of neuropeptide Y. This circumstance indicates a possible functional relationship between pain-depression-stress and neuropeptide Y.

The evidence points to an increase in oxygen reactive species as one of the possible causes of fibromyalgia (FM). In addition, it is plausible that an imbalance in redox markers can be associated with pain amplification and dynapenia in FM patients. The aim of our study was to investigate possible factors associated with muscle pain and lean body mass in FM patients. (2) Methods: This was a quantitative, exploratory and cross-sectional study of 47 patients with FM (53.45 + 7.32 years). We evaluated self-perceptions of muscle pain, lean body mass, body composition, quality of life, sleep quality, depression index, muscle performance and oxidative stress biomarkers. (3) Results: We observed that lower blood levels of antioxidants and poor quality of life explained 21% of the greater muscle pain. In addition, high blood levels of oxidative stress, worse muscle performance and poor quality of life explained 27% of the lower lean mass in patients with FM. (4) Conclusions: Larger amounts of lipid peroxidation and reductions in antioxidant levels, in addition to lower muscle performance and poor life quality, are possible independent contributors to greater muscle pain and lower lean body mass in FM patients

The evidence points to an increase in oxygen reactive species as one of the possible causes of fibromyalgia (FM). In addition, it is plausible that an imbalance in redox markers can be associated with pain amplification and dynapenia in FM patients. The aim of our study was to investigate possible factors associated with muscle pain and lean body mass in FM patients. (2) Methods: This was a quantitative, exploratory and cross-sectional study of 47 patients with FM (53.45 + 7.32 years). We evaluated self-perceptions of muscle pain, lean body mass, body composition, quality of life, sleep quality, depression index, muscle performance and oxidative stress biomarkers. (3) Results: We observed that lower blood levels of antioxidants and poor quality of life explained 21% of the greater muscle pain. In addition, high blood levels of oxidative stress, worse muscle performance and poor quality of life explained 27% of the lower lean mass in patients with FM. (4) Conclusions: Larger amounts of lipid peroxidation and reductions in antioxidant levels, in addition to lower muscle performance and poor life quality, are possible independent contributors to greater muscle pain and lower lean body mass in FM patients

Producción Científica, In recent years, antioxidant supplements have become popular to counteract the effects of oxidative stress in fibromyalgia and one of its most distressing symptoms, pain. The aim of this systematic review was to summarize the effects of antioxidant supplementation on pain levels perceived by patients diagnosed with fibromyalgia. The words used respected the medical search terms related to our objective including antioxidants, fibromyalgia, pain, and supplementation. Seventeen relevant articles were identified within Medline (PubMed), Scopus, Web of Science (WOS), the Cochrane Database of Systematic Review, and the Cochrane Central Register of Controlled Trials. This review found that antioxidant supplementation is efficient in reducing pain in nine of the studies reviewed. Studies with a duration of supplementation of at least 6 weeks showed a benefit on pain perception in 80% of the patients included in these studies. The benefits shown by vitamins and coenzyme Q10 are remarkable. Further research is needed to identify the effects of other types of antioxidants, such as extra virgin olive oil and turmeric. More homogeneous interventions in terms of antioxidant doses administered and duration would allow the effects on pain to be addressed more comprehensively.

Producción Científica, (1) Background: Telerehabilitation allows health professionals to monitor patients without face-to-face contact. The objective was to analyze the effects of a telerehabilitation program based on aerobic exercise in women with fibromyalgia at 6-month follow-up. (2) Methods: Participants were randomized into the telerehabilitation group (n = 17) or the control group (n = 17). The telerehabilitation group performed 30 sessions of exercise for 15 weeks. The exercises were guided by video and adjusted by videocalls. Pain intensity, fibromyalgia impact, physical function, isometric strength and quality of life were measured at baseline and at 6 months after the end of the intervention. (3) Results: There were no between-group differences in pain intensity, fibromyalgia impact, physical function, isometric strength or quality of life at 6-month follow-up (p > 0.05). (4) Conclusion: A telerehabilitation exercise program based on aerobic exercises may not be an effective treatment for women with fibromyalgia at 6 months of follow-up due to the lack of between-group differences in any variable.

Purpose: Fibromyalgia (FM) is a chronic pain syndrome with a strong impact on quality of life (QoL). Treatment of this condition remains a challenge, due to the scarce evidence for the effectiveness of the therapeutic approaches available. Current attention is focused on transcranial direct current stimulation (tDCS), which has yielded promising results for pain treatment. Rather than focusing only on pain relief, in this study, we aimed to determine how active or sham tDCS (over three cortical targets -the primary motor cortex, the dorsolateral prefrontal cortex and the operculo-insular cortex-) affect QoL in patients with FM. Methods: Using a double-blind, placebo-controlled design, we applied fifteen tDCS sessions of 20’ to initial 130 participants (randomized to any of the four treatment groups). We evaluated the QoL (assessed by SF-36) and the symptoms’ impact (assessed by FIQ-R) in baseline, after treatment and at 6 months follow-up. Results All groups were comparable as regards age, medication pattern and severity of symptoms before the treatment. We found that QoL and symptoms’ impact improved in all treatment groups (including the sham) and this improvement lasted for up to 6 months. However, we did not observe any group effect nor group*treatment interaction. Conclusions: After the intervention, we observed a non-specific effect that may be due to placebo, favoured by the expectations of tDCS efficacy and psychosocial variables inherent to the intervention (daily relationship with therapists and other patients in the clinic). Therefore, active tDCS is not superior to sham stimulation in improving QoL in FM

Objectives: To develop evidence-based expert recommendations for non-pharmacological treatments for pain, fatigue, sleep problems, and depression in fibromyalgia. Methods: An international, multidisciplinary Delphi exercise was conducted. Authors of EULAR and the Canadian Fibromyalgia Guidelines Group, members of the American Pain Society and clinicians with expertise in fibromyalgia were invited. Participants were asked to select non-pharmacological interventions that could be offered for specific fibromyalgia symptoms and to classify them as either core or adjunctive treatments. An evidence summary was provided to aid the decision making. Items receiving >70% votes were accepted, those receiving <30% votes were rejected and those obtaining 30-70% votes were recirculated for up to two additional rounds. Results: Seventeen experts participated (Europe (n = 10), North America (n = 6), and Israel (n = 1)) in the Delphi exercise and completed all three rounds. Aerobic exercise, education, sleep hygiene and cognitive behavioural therapy were recommended as core treatments for all symptoms. Mind-body exercises were recommended as core interventions for pain, fatigue and sleep problems. Mindfulness was voted core treatment for depression, and adjunctive treatment for other symptoms. Other interventions, namely music, relaxation, hot bath, and local heat were voted as adjunctive treatments, varying between symptoms. Conclusions: This study provided evidence-based expert consensus recommendations on non-pharmacological treatments for fibromyalgia that may be used to individualise treatments in clinical practice targeting the diverse symptoms associated with fibromyalgia.

Objectives: To develop evidence-based expert recommendations for non-pharmacological treatments for pain, fatigue, sleep problems, and depression in fibromyalgia. Methods: An international, multidisciplinary Delphi exercise was conducted. Authors of EULAR and the Canadian Fibromyalgia Guidelines Group, members of the American Pain Society and clinicians with expertise in fibromyalgia were invited. Participants were asked to select non-pharmacological interventions that could be offered for specific fibromyalgia symptoms and to classify them as either core or adjunctive treatments. An evidence summary was provided to aid the decision making. Items receiving >70% votes were accepted, those receiving <30% votes were rejected and those obtaining 30-70% votes were recirculated for up to two additional rounds. Results: Seventeen experts participated (Europe (n = 10), North America (n = 6), and Israel (n = 1)) in the Delphi exercise and completed all three rounds. Aerobic exercise, education, sleep hygiene and cognitive behavioural therapy were recommended as core treatments for all symptoms. Mind-body exercises were recommended as core interventions for pain, fatigue and sleep problems. Mindfulness was voted core treatment for depression, and adjunctive treatment for other symptoms. Other interventions, namely music, relaxation, hot bath, and local heat were voted as adjunctive treatments, varying between symptoms. Conclusions: This study provided evidence-based expert consensus recommendations on non-pharmacological treatments for fibromyalgia that may be used to individualise treatments in clinical practice targeting the diverse symptoms associated with fibromyalgia.

Objectives: To develop evidence-based expert recommendations for non-pharmacological treatments for pain, fatigue, sleep problems, and depression in fibromyalgia. Methods: An international, multidisciplinary Delphi exercise was conducted. Authors of EULAR and the Canadian Fibromyalgia Guidelines Group, members of the American Pain Society and clinicians with expertise in fibromyalgia were invited. Participants were asked to select non-pharmacological interventions that could be offered for specific fibromyalgia symptoms and to classify them as either core or adjunctive treatments. An evidence summary was provided to aid the decision making. Items receiving >70% votes were accepted, those receiving <30% votes were rejected and those obtaining 30-70% votes were recirculated for up to two additional rounds. Results: Seventeen experts participated (Europe (n = 10), North America (n = 6), and Israel (n = 1)) in the Delphi exercise and completed all three rounds. Aerobic exercise, education, sleep hygiene and cognitive behavioural therapy were recommended as core treatments for all symptoms. Mind-body exercises were recommended as core interventions for pain, fatigue and sleep problems. Mindfulness was voted core treatment for depression, and adjunctive treatment for other symptoms. Other interventions, namely music, relaxation, hot bath, and local heat were voted as adjunctive treatments, varying between symptoms. Conclusions: This study provided evidence-based expert consensus recommendations on non-pharmacological treatments for fibromyalgia that may be used to individualise treatments in clinical practice targeting the diverse symptoms associated with fibromyalgia.

Objectives: To develop evidence-based expert recommendations for non-pharmacological treatments for pain, fatigue, sleep problems, and depression in fibromyalgia. Methods: An international, multidisciplinary Delphi exercise was conducted. Authors of EULAR and the Canadian Fibromyalgia Guidelines Group, members of the American Pain Society and clinicians with expertise in fibromyalgia were invited. Participants were asked to select non-pharmacological interventions that could be offered for specific fibromyalgia symptoms and to classify them as either core or adjunctive treatments. An evidence summary was provided to aid the decision making. Items receiving >70% votes were accepted, those receiving <30% votes were rejected and those obtaining 30-70% votes were recirculated for up to two additional rounds. Results: Seventeen experts participated (Europe (n = 10), North America (n = 6), and Israel (n = 1)) in the Delphi exercise and completed all three rounds. Aerobic exercise, education, sleep hygiene and cognitive behavioural therapy were recommended as core treatments for all symptoms. Mind-body exercises were recommended as core interventions for pain, fatigue and sleep problems. Mindfulness was voted core treatment for depression, and adjunctive treatment for other symptoms. Other interventions, namely music, relaxation, hot bath, and local heat were voted as adjunctive treatments, varying between symptoms. Conclusions: This study provided evidence-based expert consensus recommendations on non-pharmacological treatments for fibromyalgia that may be used to individualise treatments in clinical practice targeting the diverse symptoms associated with fibromyalgia.