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1. Early Relationships of a Low‐Energy Diet With Symptoms of Fibromyalgia

Author

Aaron Stubbs, Steve Harte, Daniel J. Clauw, David A. Williams, Jenna McAfee, Nicole Miller, Megan Brown, Catherine Nay Med, Amy Rothberg, and Andrew Schrepf

Subjects
Diseases of the musculoskeletal system, RC925-935
Abstract

Objective Previous studies have demonstrated that weight loss has been shown to improve pain in weight‐bearing joints, and more recent studies suggest that weight loss may be accompanied by improvements in pain in non–weight‐bearing regions. In previous work, we demonstrated that these symptoms improve substantially in patients with obesity undergoing 12 weeks of a very low‐energy diet (VLED) restricted to 800 kcal as part of a weight‐loss program. Preclinical models also have shown analgesic effects of calorie restriction. The purpose of the current observational study was to determine the time course and trajectory of improvement in pain and other symptoms, especially during the early phase of a VLED intervention, prior to major weight loss. Methods Participants were 195 individuals with obesity who had elevated levels of pain and associated symptoms at baseline (score of ≥4 on Fibromyalgia Survey Criteria) and completed a minimum of 3 weeks of a VLED intervention. The primary outcome was improvement in Fibromyalgia Survey Criteria at week 3. In secondary analyses, we created groups of those showing little/no improvement, moderate improvement, and high improvement (little/no improvement mean, 2.21; SD, 1.02; moderate improvement mean, 2.25; SD, 0.81; high improvement mean, 2.42; SD, 0.95; F2,189 = 1.01, P = 0.37), then compared baseline characteristics. Results A large proportion of study participants (72%) experienced symptom reductions of 30% or greater by week 3, but there were no differences in the amount of weight lost at this time point. Those who showed little or no improvement (less than 30%) had a higher body mass index at baseline and were more likely to report a diagnosis of depression (both P

Published
2022
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2. Symptom Variability and Early Symptom Regression in the MAPP Study, a Prospective Study of Urologic Chronic Pelvic Pain Syndrome

Author

Georg Deutsch, Alisa Stephens, Robert Dayton, Carol S. North, Frank F. Tu, Yanli Wang, Nancy Robinson, Gerald L. Andriole, Susan K. Lutgendorf, Yi Luo, Karen R. Jonscher, Clara Grayhack, Wei Yang, Jeffry R. Alger, Eric Ichesco, Jennifer T. Anger, Ted Barrell, Holly T. Sullivan, Fornessa Randal, Lisa A. Kilpatrick, Theresa Spitznagle, Jean Michniewicz, J. Quentin Clemens, Noorulain Noor, John T. Farrar, Jeena Cha, Philip M. Hanno, Kevin A. Johnson, Rebecca L. Bristol, Siobhan Sutcliffe, Claire C. Yang, Jane L. Miller, Katherine A. Scott, Garth D. Ehrlich, Stephanie Richey, Michel A. Pontari, Xingmei Wang, Susan O. Ross, Rebecca McCue, Sandra H. Berry, Monisha Sachdev, Laura Gallagher, M. Scott Lucia, TJ Sundsvold, Sean Mackey, Daniel J. Clauw, David Cella, Kelly Robertson, Tamara Bavendam, Jason J. Kutch, Mary Eno, Michael A. O’Donnell, Nuwanthi Heendeniya, Rachel R. Moericke, Ben Ellingson, Robert M. Moldwin, John W. Kusek, John N. Krieger, Epifanio Bagarinao, Suzanne R. Smith, Graham A. Colditz, David J. Klumpp, Barbara Ziegler, Vincent Funari, Karl J. Kreder, Eric Strachan, Thomas Jemielita, Barry A. Hong, Bruce D. Naliboff, H. Henry Lai, Lauren C. Foster, Richard E. Harris, Steve Harte, Keith R. Solomon, Niloofar Afari, Catherine S. Bradley, J. Richard Landis, Ro Pauline Doe, David R. Williams, Thomas M. Hooton, Ann Oldendorf, Alisa J. Stephens-Shields, Hanno Steen, A. Nilakantan, Sandra Smith, Emily Hubbard, Todd B. Parrish, Cody Ashe-McNalley, Dedra Buchwald, Vivien Gardner, Darlene S. Marko, Roberta Spiro, Kris Greiner, Richard Gershon, Chris Mullins, James W. Griffith, Robert W. Gereau, Michael F. Freeman, Apkar Vania Apkarian, Suzie As-Sanie, Anthony J. Schaeffer, Megan E. Halvorson, Emeran A. Mayer, John W. Froehlich, Timothy J. Ness, Andrew C. Briscoe, Colleen Fitzgerald, Jennifer S. Labus, R. Storey Wilson, Tamara Howard, Charles J. Heckman, M. C. Jiang, Melissa A. Farmer, Karyn S. Eilber, David Briscoe, Marsha A. Moses, Xiaoling Hou, Cara Kulbacki, Richard S. Lee, Katherine T. Martucci, J. Curtis Nickel, Larissa V. Rodriguez, Jeffrey P. Henderson, Jayoung Kim, Andrea A. Osypuk, Jennifer Van Eyk, Ziya Kirkali, Adrie van Bokhoven, Laurie Keefer, and Adam S. Curatolo

Subjects
Pelvic pain syndrome, Adult, Male, medicine.medical_specialty, Time Factors, Urology, 030232 urology & nephrology, Prostatitis, Symptom assessment, Article, 03 medical and health sciences, 0302 clinical medicine, Regression toward the mean, Internal medicine, Medicine, Humans, Prospective Studies, Prospective cohort study, business.industry, Patient specific, medicine.disease, Regression, Physical therapy, Female, Symptom Assessment, business, 030217 neurology & neurosurgery
Abstract

We examined symptom variability in men and women with urological chronic pelvic pain syndrome. We describe symptom fluctuations as related to early symptom regression and its effect on estimated 1-year symptom change. We also describe a method to quantify patient specific symptom variability.Symptoms were assessed biweekly in 424 subjects with urological chronic pelvic pain syndrome during 1 year. To evaluate the impact of early symptom regression subjects were classified as improved, no change or worse according to the rate of change using 1) all data, 2) excluding week 0 and 3) excluding weeks 0 and 2. Patient specific, time varying variability was calculated at each interval using a sliding window approach. Patients were classified as high, medium or low variability at each time and ultimately as high or low variability overall based on the variability for the majority of contacts.Prior to excluding early weeks to adjust for early symptom regression 25% to 38% and 5% to 6% of patients were classified as improved and worse, respectively. After adjustment the percent of patients who were improved or worse ranged from 15% to 25% and 6% to 9%, respectively. High and low variability phenotypes were each identified in 25% to 30% of participants.Patients with urological chronic pelvic pain syndrome show symptom variability. At study enrollment patients had worse symptoms on average, resulting in a regression effect that influenced the estimated proportion of those who were improved or worse. Prospective studies should include a run-in period to account for regression to the mean and other causes of early symptom regression. Further, symptom variability may be quantified and used to characterize longitudinal symptom profiles of urological chronic pelvic pain syndrome.

Published
2016

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