Schiller S1,2, Maguire C1,2, Keel P3
1Bildungszentrum Gesundheit Basel-Stadt, Physiotherapy, Muenchenstein, Switzerland, 2Bern University of Applied Sciences, Health, Bern, Switzerland, 3University of Basel, Medicine, Basel, Switzerland
Background:
Fibromyalgia (FM) syndrome is a chronic disease with unknown aetiology, characterised by widespread pain, fatigue and functional symptoms such as non-restorative sleep. FM is associated in some patients with an exacerbation of symptoms with exertion (effort intolerance). However aerobic exercise programs can attenuate clinical pain also in some FM sufferers. Some attempts have been made to indentify which sub-group of people with FM show exercise induced analgesia.We have previously identified subgoups of physically very active or under active FM sufferers. Improved knowledge may help to inform the type of exercise recommended for specific patients.
Purpose: To investigate differences in pain thresholds and global pain intensity during and after physical exertion between two previousy identified subgroups of people with fibromyalgia(FM): those with 1.high levels of physical activity and low levels of impairment 2. low levels of physical activity and high levels of impairment and 3. healthy controls.
Methods: Design: non-randomised control study. 20 FM subjects and 10 healthy subjects were recruited. Groups were defined according to results of a 2 week activity diary 1. active group(HA) were employed and active hours equalled at least 50% of those accomplished by healthy individuals Group 2. low activity (LA) active hours per day equalled a maximum of 25% of those accomplished by healthy individuals. Group3: healthy volunteers. Inclusion criteria: Diagnosis according to the American College of Rheumatology . Exclusion criteria coronary disorders, polyarthritis, asthma and other rheumatoid disorders. Outcome Measures Pain threshold determined by electrical stimulation applied to the dominant hand. Two adhesive electrodes, measuring 48x34 mm were taped to the middle joint of the middle and ring fingers. The selected frequency was 8000Hz/100Hz on a Galva 4 measuring device. The system measured at baseline, during and after exercise (2,4 and 30 mins). Intervention: V02 Peak test with a bicycle ergonometer.
Results: No significant differences were found in pain thresholds between patient groups and healthy individuals at baseline.
No significant differences in pain thresholds were detected between the two patient groups during exercise (p=0.993) but following exercise the LA group experienced subjectively higher levels of discomfort than the HA group. Significant differences were seen at three different time points following exercise in the recovery period: 2/4/30 minutes (p 0.006; p 0.025 and p 0.013). HA returned to their initial pain levels during recovery where as LA pain levels remained elevated.
The increase in the pain threshold during exercise in the healthy group was significant (p=0.05), this did not occur in the FM groups.
Conclusion(s): The present study demonstrates that fibromyalgia patients do not become less sensitive to pain during activity as healthy subjects do. The response of the pain modulation system differs within the patient sample. LA subjects showed higher fear of pain and increased global pain intensity after physical exertion.
Implications: People with FM demonstrating low levels of physical activity may need a more gradual exercise prescription which includes factors such as patient-education and psychological support than FM patients who participate in high levels of physical activity.
Keywords: Fybromyalgia, pain threshold, exercise
Funding acknowledgements: No additional funding
Fibromyalgia (FM) syndrome is a chronic disease with unknown aetiology, characterised by widespread pain, fatigue and functional symptoms such as non-restorative sleep. FM is associated in some patients with an exacerbation of symptoms with exertion (effort intolerance). However aerobic exercise programs can attenuate clinical pain also in some FM sufferers. Some attempts have been made to indentify which sub-group of people with FM show exercise induced analgesia.We have previously identified subgoups of physically very active or under active FM sufferers. Improved knowledge may help to inform the type of exercise recommended for specific patients.
Purpose: To investigate differences in pain thresholds and global pain intensity during and after physical exertion between two previousy identified subgroups of people with fibromyalgia(FM): those with 1.high levels of physical activity and low levels of impairment 2. low levels of physical activity and high levels of impairment and 3. healthy controls.
Methods: Design: non-randomised control study. 20 FM subjects and 10 healthy subjects were recruited. Groups were defined according to results of a 2 week activity diary 1. active group(HA) were employed and active hours equalled at least 50% of those accomplished by healthy individuals Group 2. low activity (LA) active hours per day equalled a maximum of 25% of those accomplished by healthy individuals. Group3: healthy volunteers. Inclusion criteria: Diagnosis according to the American College of Rheumatology . Exclusion criteria coronary disorders, polyarthritis, asthma and other rheumatoid disorders. Outcome Measures Pain threshold determined by electrical stimulation applied to the dominant hand. Two adhesive electrodes, measuring 48x34 mm were taped to the middle joint of the middle and ring fingers. The selected frequency was 8000Hz/100Hz on a Galva 4 measuring device. The system measured at baseline, during and after exercise (2,4 and 30 mins). Intervention: V02 Peak test with a bicycle ergonometer.
Results: No significant differences were found in pain thresholds between patient groups and healthy individuals at baseline.
No significant differences in pain thresholds were detected between the two patient groups during exercise (p=0.993) but following exercise the LA group experienced subjectively higher levels of discomfort than the HA group. Significant differences were seen at three different time points following exercise in the recovery period: 2/4/30 minutes (p 0.006; p 0.025 and p 0.013). HA returned to their initial pain levels during recovery where as LA pain levels remained elevated.
The increase in the pain threshold during exercise in the healthy group was significant (p=0.05), this did not occur in the FM groups.
Conclusion(s): The present study demonstrates that fibromyalgia patients do not become less sensitive to pain during activity as healthy subjects do. The response of the pain modulation system differs within the patient sample. LA subjects showed higher fear of pain and increased global pain intensity after physical exertion.
Implications: People with FM demonstrating low levels of physical activity may need a more gradual exercise prescription which includes factors such as patient-education and psychological support than FM patients who participate in high levels of physical activity.
Keywords: Fybromyalgia, pain threshold, exercise
Funding acknowledgements: No additional funding
Topic: Pain & pain management; Musculoskeletal
Ethics approval required: Yes
Institution: Ethics Committee Northwest Siitzerland
Ethics committee: Ethics Committee Northwest Switzerland
Ethics number: ID: 2017564
All authors, affiliations and abstracts have been published as submitted.
