The aim of the present study was to perform a systematic review and meta-analysis comparing walking test performance and gait pattern between individuals with and without fibromyalgia (FM).
This systematic review was registered in PROSPERO with the following reference: CRD42018116200.The search for the scientific articles in this systematic review was carried out using the MEDLINE, SCOPUS, PEDRO, CINHAL and WEB OF SCIENCE databases. A combination of three conceptual groups of terms was used: (1) fibromyalgia; (2) walk (performance) tests; and (3) gait analysis. The included articles were analyzed for both functional and pattern of walking data of patients with FM. In order to provide a better estimate of the difference between individuals with and without FM on gait, a meta-analysis was performed on the 6MWT (6-minute walk test).
Thirty-six studies were analyzed, with a total population of 4.078 participants (3.369 FM and 709 individuals without FM). From a functional point of view, the 6MWT distance covered by the group of individuals without FM was significantly greater than that of the individuals with FM in all the analyzed studies. In addition, when comparing the results obtained in the gait pattern analysis, it was observed that individuals with FM walked slower, with a shorter stride length and lower cadence compare to individuals without FM.
It is possible to affirm that individuals with FM perform walking tests differently than individuals without FM. It was observed that individuals with FM walk performing a cycle of shorter length and lower frequency, producing a slower gait, which results in a shorter distance traveled, in the same period of time, with respect to healthy subjects.

OBJECTIVE: To prevent the impairment of fibromyalgia patients due to harmful actions in daily clinical practice that are potentially avoidable.
METHODS: A multidisciplinary team identified the main areas of interest and carried out an analysis of scientific evidence and established recommendations based on the evidence and \"formal evaluation\" or \"reasoned judgment\" qualitative analysis techniques.
RESULTS: A total of 39 recommendations address diagnosis, unsafe or ineffective treatment interventions and patient and healthcare workers\' education. This part I shows the first 27 recommendations on the first 2 areas.
CONCLUSIONS: Establishing a diagnosis improves the patient\'s coping with the disease and reduces healthcare costs. NSAIDs, strong opioids and benzodiazepines should be avoided due to side effects. There is no good evidence to justify the association of several drugs. There is also no good evidence to recommend any complementary medicine. Surgeries show a greater number of complications and a lower degree of patient satisfaction and therefore should be avoided if the surgical indication is not clearly established.

[Purpose] The aim of this study was to compare Visual Analog Scale (VAS) values with the Shear Wave Elastography (SWE) values of rhomboid major muscles in fibromyalgia (FM) patients with those of a normal healthy population. [Participants and Methods] Evaluation was made of 53 female patients diagnosed with FM according to the American Collage of Rheumatology criteria, and a control group of 47 healthy volunteers with a VAS score of 0. All the patients were applied with ultrasonography. The severity of pain was measured using a VAS. [Results] Mean age was calculated as 39 years (range, 23-60 years) in the patient group and 37 years (range, 21-58 years) in the control group. The mean SWE value of the rhomboid major muscle of the patients was 4.74 m/sn and 70.21 kPa on the right side and 4.46 m/sn and 58.78 kPa on the left side. In the control group, these values were 4.18m/sn and 55.03 kPa on the right side and 3.78 m/sn and 44.21 kPa on the left side. The mean VAS score of the patients was 7.3. [Conclusion] The use of SWE values could be more objective than the subjective parameter of the VAS score in the evaluation of the severity of pain in fibromyalgia.

The aim of this paper is to explore the connection between symptom and symbol in the body of women suffering from chronic pain, diagnosed as fibromyalgia. The working hypothesis has been that the symbol that emerges from the symptom in the body can bridge the gap to a deeper meaning of pain and suffering, thereby becoming the agent of change for healing of the bodymind and the experience of pain in the physical body. To explore this subject I will introduce some recent research from the field of fibromyalgia, and the concepts of agency and affect systems in the body, which are important cornerstones in my work. I will briefly present my clinical concept of \'Form and Freedom\'. From this theoretical base I give some clinical examples of what I see as an alchemical journey towards soul, presented through vignettes, images and the words of three women - Maria, Riba and Ishtar. I conclude with how I see analytical psychology taking its rightful place alongside, informing or in conjunction with, as in my case, other psychotherapeutic modalities, working in creative ways that enhance healing in patients who suffer from chronic pain.
Le but de cet article est d’explorer le lien entre le symptôme et le symbole dans le corps de femmes souffrant de douleurs chroniques, diagnostiquées comme fibromyalgie. L’hypothèse de travail a été que le symbole qui émerge du symptôme dans le corps peut fournir une passerelle pour aller vers un sens plus profond de la douleur et de la souffrance, devenant ainsi l’élément du changement dans la guérison du corps-esprit et de l’expérience de la douleur dans le corps physique. Afin d’explorer ce sujet je présenterai des recherches récentes dans le champ de la fibromyalgie. Je présenterai aussi le concept des systèmes d’affect et d’éléments de changement dans le corps, qui sont des pierres angulaires dans mon travail. Je présenterai brièvement mon concept clinique « Forme and Liberté ». A partir de ce support théorique je donnerai quelques exemples cliniques de ce que je vois comme un voyage alchimique vers l’âme, ceci par des vignettes, images et paroles de trois femmes - Maria, Riba et Ishtar. Je conclue en évoquant comment je vois la psychologie analytique prendre sa place légitime parmi d’autres modalités psychothérapeutiques, informant celles-ci ou leur apportant simplement son concours, comme c’est le cas dans mon travail, travaillant de manière créative à soutenir la guérison chez des patientes souffrant de douleurs chroniques.
Das Ziel dieser Arbeit ist es, den Zusammenhang zwischen Symptom und Symbol im Körper von Frauen zu untersuchen, die an chronischen Schmerzen leiden, der als Fibromyalgie diagnostiziert wurde. Die Arbeitshypothese war, daß das Symbol, das aus dem Symptom im Körper hervorgeht, die Lücke zu einer tieferen Bedeutung von Schmerz und Leiden schließen kann und so zum Mittel der Veränderung für die Heilung des Körpergeistes und der Erfahrung des Schmerzes im physischen Körper wird. Um dieses Thema zu untersuchen werde ich einige neuere Forschungen aus dem Bereich der Fibromyalgie sowie die Konzepte der Selbstbestimmtheit und der Affektsysteme des Körpers vorstellen, die wichtige Eckpfeiler meiner Arbeit sind. Ich werde kurz mein klinisches Konzept von \'Form und Freiheit\' vorstellen. Von dieser theoretischen Grundlage ausgehend gebe ich einige klinische Beispiele für das, was ich als eine alchemistische Reise in Richtung Seele ansehe, die durch Vingetten, Bilder und die Worte von drei Frauen - Maria, Riba und Ishtar - dargestellt wird. Ich schließe mit meiner Sicht darauf, wie die analytische Psychologie, wie in meinem Fall informierend oder in Verbindung stehend, ihren rechtmäßigen Platz neben anderen psychotherapeutischen Modalitäten einnimmt, auf kreative Weise arbeitend, um die Heilung von Patienten mit chronischen Schmerzen zu unterstützen.
Lo scopo di questo articolo è quello di esplorare la connessione tra sintomo e simbolo nel corpo di donne che soffrono di dolore cronico, diagnosticato come fibromialgia. L\'ipotesi di lavoro è che il simbolo che emerge dal sintomo fisico può offrire un\'accezione più profonda del dolore e della sofferenza, diventando così l\'agente del cambiamento per la guarigione dell’unità mente/corpo e per l\'esperienza del dolore fisico. Per esplorare questo argomento introdurrò alcune recenti ricerche dal campo della fibromialgia e i concetti di “agente” e “sistema di affetti “nel corpo, che sono elementi fondamentali nel mio lavoro. Presenterò brevemente il mio concetto clinico di \"Forma e Libertà\". Da questa base teorica fornisco alcuni esempi clinici di quello che vedo come un viaggio alchemico verso l\'anima, che viene presentato attraverso vignette, immagini e le parole di tre donne - Maria, Riva e Ishtar. Concludo con il modo in cui vedo la psicologia analitica prendere il suo legittimo posto accanto, informando o in combinazione con -come nel mio caso- altre modalità psicoterapeutiche, anche lavorando in modi creativi che migliorano la guarigione nei pazienti che soffrono di dolore cronico.
Цель этой статьи - исследовать связи между симптомом и символом в теле женщин, страдающих от хронической боли и имеющих диагноз фибромиалгия. Рабочая гипотеза заключается в том, что символ, который появляется из симптома в теле, может преодолеть разрыв с более глубоким смыслом боли и страдания, таким образом становясь агентом изменений для исцеления тела и психики и ощущения боли в физическом теле. Чтобы исследовать эту тему, я проведу обзор последних исследований в области фибромиалгии, а также системы субъекта действия и аффекта в организме, которые являются важными краеугольными камнями в моей работе. Я кратко изложу свою клиническую концепцию «Формы и свободы». Опираясь на эту теоретическую базу, я привожу клинические примеры алхимического путешествия к душе. Они представлены виньетками, образами и словами трех женщин - Марии, Рибы и Иштар. В заключение я делаю вывод о том, что аналитическая психология занимает свое законное место в ряду психотерапевтических подходов, дополняя их или работая в твореческом сочетании с ними, способствуя исцелению пациентов, страдающих от хронической боли.
El objetivo de este trabajo es explorar la conexión entre síntoma y símbolo en el cuerpo de mujeres que padecen dolor crónico, diagnosticado como fibromialgia. La hipótesis de trabajo es que el símbolo que emerge desde el síntoma en el cuerpo puede tender un puente hacia un sentido más profundo del dolor y el sufrimiento, por lo tanto volviéndose un agente de cambio para la sanación del cuerpomente y la experiencia de dolor en el cuerpo físico. Para explorar este tema, voy a introducir algunas investigaciones recientes del campo de la fibromialgia, y los conceptos de sistemas de agencia y de emoción en el cuerpo, los cuales son piedras fundamentales en mi trabajo. Introduciré brevemente mi concepto clínico de ‘Forma y Libertad’. A partir de esta base teórica, presento ejemplos clínicos de aquello que comprendo como un viaje alquímico hacia el alma, presentado a través de viñetas, imágenes y el trabajo de tres mujeres - María, Riba e Ishtar. Concluyo con mi percepción respecto a cómo la psicología analítica puede tomar su debido lugar, informando o en forma conjunta con, otras modalidades psicoterapéuticas, trabajando de maneras creativas para enaltecer la curación en pacientes que sufren de dolor crónico.
走向灵魂-一个炼金术之旅。通过临床和荣格分析从慢性疼痛中康复的女性 本文目标是探讨一位遭受慢性疼痛, 被诊断为纤维肌痛症的女性身体中的症状与象征间的关系。文章假设, 从身体症状中浮现的象征, 可以作为跨越鸿沟的桥梁, 为疼痛与苦难带来更深的意义, 由此成为一种动因, 带来改变, 促进身心和生理身体的疼痛经验的疗愈。为了探索这个主题, 我引入了一些涉及纤维肌痛症的近期研究, 以及引入身体中动因和情绪系统的概念, 它们是我工作的基石。我将简要地呈现我的临床概念“形态与自由”。从这个理论基础出发, 我给出一些临床案例, 在其中我看到这些案例呈现了一个通往灵魂的炼金术之旅。文章用三位女性-玛丽娅, 瑞巴, 伊师塔的插画、意象和文字来进行呈现。文章结束时, 我把分析心理学看作是, 占据公正的立场, 联合其它心理治疗的模型, 正如我的个案, 以一种创造性的方式来促进承受疼痛的病人的治愈。.

BACKGROUND: Fibromyalgia syndrome (FM) is a chronic pathology characterized by widespread pain commonly associated with psychological distress affecting quality of life. In recent years, transcranial direct current stimulation (tDCS) and transcranial magnetic stimulation (TMS) have been investigated to treat chronic pain. The aim of the current review is to determine the effects of tDCS and TMS on the main symptoms of patients with FM.
METHODS: A systematic review based on PRISMA guidelines was carried out. The search strategy was performed in Medline, Scopus, PEDro and Cochrane Library. Randomized controlled trials based on the effects of tDCS and TMS on pain, pressure pain threshold, fatigue, anxiety and depression, catastrophizing and quality of life in patients with FM were analysed. Fourteen studies were included.
CONCLUSIONS: The application of tDCS to the motor cortex is the only intervention shown to decrease pain in the short and medium-term in patients with FM. The application of both interventions showed improvements in pressure pain threshold, catastrophizing and quality of life when applied to the motor cortex, and in fatigue when applied to the dorsolateral prefrontal cortex. The effects of these interventions on anxiety and depression are unclear.

To evaluate the effectiveness of a group intervention in Primary Care in patients with fibromyalgia (FM) based on pain neuroscience education (PNE).
Pre-post study.
Urban Primary Health Centre in Bilbao.
Patients with FM (2010 American College of Rheumatology Diagnostic Criteria for fibromyalgia), ≥18 years.
5 weekly sessions (2hours each), and a reminder session one month later.
Compliance with FM criteria, assessed using the WPI (Widespread Pain Index, number of pain areas) and the SS (severity of symptoms) questionnaires. An assessment was also made on the impact of FM on functional capacity (FIQ:≥20% and ≥50% reduction in the FIQ total score from baseline to after treatment, and proportion of patients with FIQ<39 at the end of the study). Assessments were made at baseline, one month following the 5th session, and during the 6- and 12-month follow-up.
All the study evaluations were completed by 85/98 patients. A statistically significant improvement was observed in the 3 studied categories (WPI, SS, and FIQ) since the first visit, and was maintained until the final visit (12 months later). A total of 45 patients (53%, 95% CI: 42%-63%), more than those at baseline, scored FIQ<39 (no worse than mild functional impairment). One month following the 5th session there were 44 patients (52%, 95% CI: 41%-62%) that no longer met FM criteria and, at the end of follow-up, there were 56 patients (66%, 95% CI: 55%-75%).
An intervention based on PNE has shown to be feasible in Primary Care, with results in the upper range of those published with other treatments for FM.

To determine whether transcutaneous electrical nerve stimulation (TENS) has an analgesic effect greater than placebo or other treatments in patients with fibromyalgia. Furthermore, it was intended to analyze the optimal application parameters to achieve a greater reduction of pain.
A systematic review.
Randomized clinical trials on the effect of TENS on fibromyalgia in the databases Pubmed, Cochrane and PEDro until November 2016.
8 studies out of a total of 62 were selected. Controlled clinical trials in which TENS was applied in patients with fibromyalgia were included.
Pain was analyzed as the main variable, although other variables such as fatigue, quality of life and impact, range of motion and depression were also included.
6 out of 8 studies obtained a significant decrease of pain. In 2 studies, TENS was applied as complementary treatment to therapeutic exercise with results evidencing a decrease in pain. The rest of the variables studied presented a great variability and conclusive results could not be established.
Treatment with TENS is effective for reducing pain in people with fibromyalgia. In addition, the inclusion of TENS in therapeutic exercise programs seems to have a greater effect than practicing therapeutic exercise in isolation. However, no efficacy has been demonstrated in other variables different to pain. Further studies are needed to investigate the optimization of the parameters of the TENS and a greater consensus among the variables used.

To assess the effectiveness, on people with chronic pain, of an intervention (Time In) designed to reduce pain and to improve psychological symptoms.
A randomized clinical trial with a control group, taking three measurements over three months.
Granada, Spain.
A sample of 40 women aged 18 or older with a history (over 6 months) of chronic pain. The recruitment was in the Fibromyalgia Association of Granada, Spain (AGRAFIM).
Time In is a sensorimotor intervention that combines biomechanical physiotherapeutic procedures and psychological strategies. A weekly session of 3h was planned and the total of the program was developed during five weeks.
Independent variables: sociodemographic information, clinical history and Time In intervention. Dependent variables: Brief Pain Inventory (BPI-S), Short-Form Health Survey (SF-12), Symptom Check List-90-R (SCL-90-R) and Clinical Outcome in Routine Evaluation (CORE-OM).
Significant differences were observed between control group and intervention group of most of the scales used in postintervention and follow up measurements. Thus, significantly lower mean scores were obtained in intensity, interference and areas of pain, quality of life, psychological symptoms and behavioural change. Similar results were observed on d Cohen scores. They were \'very important\' on intensity of pain (d=-1.01, d=-0.97) and interference of pain (d=-0.85, d=-0.74), with an improvement percentage from 21% to 30%.
Time In intervention reduces pain and improves psychological symptoms in patients with fibromyalgia; this results in a better quality of life.

Fibromyalgia (FM) is a chronic pain syndrome characterized by generalized pain. It is known that obese patients have more skeletal muscle pain and physical dysfunction than normal weight patients. Therefore, it is important that the early diagnosis of FM be attained in obese patients.
To determine the prevalence of FM in a group of obese patients with indication of bariatric surgery.
The patients were recruited from the Bariatric Surgery outpatient clinic of Hospital de Clínicas of UFPR (HC-UFPR) before being submitted to surgery. Patient assessment consisted in verifying the presence or absence of FM using the 1990 and 2011 ACR criteria, as well as the presence of comorbidities.
98 patients were evaluated, of which 84 were females. The mean age was 42.07 years and the BMI was 45.39. The prevalence of FM was 34% (n=29) according to the 1990 criteria and 45% (n=38) according to the 2011 criteria. There was no difference in age, BMI, Epworth score and prevalence of other diseases among patients who met or not the 1990 criteria. Only depression was more common in patients with FM. (24.14% vs. 5.45%). The same findings were seen in patients that met the 2011 criteria.
The prevalence of FM in patients with morbid obesity is extremely high. However, BMI does not differ in patients with or without FM. The presence of depression may be a risk factor for the development of FM in these patients.

To compare DMARD use in patients with and without FM over time, including overtreatment and undertreatment rates in both groups.
A prospective cohort study with patients attending an RA outpatient clinic was conducted. Participants were consecutively recruited between March 2006 and June 2007 and were followed through December 2013. Data on DMARD use (prevalences, doses and escalation rates), DAS28, HAQ and radiographic progression were compared among RA patients with FM and without FM. Mistreatment clinical scenarios were allegedly identified and compared between groups.
256 RA patients (32 with FM) were followed for 6.2±2.0 (mean±SD) years comprising 2986 visits. At baseline, RA duration was 11.1±7.4 years. DAS28 and HAQ were greater in RA with FM group, and were closer to RA without FM group towards the end. RA patients with FM used higher doses of tricyclic antidepressants, leflunomide and prednisone, and lower doses of methotrexate. When compared to RA patients without FM, participants with RA and FM used more often tricyclic antidepressants, leflunomide, prednisone, continuous analgesics and less often methotrexate. Groups presented similar 7-year biologic-free survival, and radiographic progression-free survival in Cox regression. RA patients with FM had greater proportions of visits in mistreatment scenarios when compared to RA patients without FM (28.4 vs. 19.8%, p<0.001).
RA patients with FM used more leflunomide and prednisone, and RA mistreatment was more frequent in FM patients. Certainly, RA patients with FM will benefit from a personalized T2T strategy, including ultrasound (when suitable) and proper FM treatment.