Abstracts
(188) Transcutaneous Electrical Nerve Stimulation (TENS)
reduces pain and improves function in people with
Fibromyalgia
D Dailey, B Rakel, C Vance, J Lee, R Liebano, A Anand, and K Sluka; University
of Iowa, Iowa City, IA
Fibromyalgia is a condition defined by chronic widespread pain and associated
with central excitability and loss of descending inhibition. Pain associated with
fibromyalgia interferes with daily function. TENS produces its effects primarily
by reducing central excitability and activating descending inhibitory pathways.
The primary objective of this study was to test the effect of TENS on pain, func-
tion and descending inhibition in people with fibromyalgia. The study used
a crossover design of 43 Fibromyalgia patients (42F; 1M), aged 25-76 years
(mean 49.2 6 12.9yrs) with random assignment to three treatments: Active
TENS (100 Hz, 200 ms), Placebo TENS and No Treatment Control. Pain was as-
sessed with a visual analog scale (VAS) at rest and during the six minute walk
test (6MWT) and pain sensitivity was assessed with pressure pain thresholds
(PPT). Function was assessed with 6MWT at each session before/after TENS
treatment. Descending inhibition was tested with foot ice water bath (4 C).
Results indicated there was no difference in pain at rest between TENS condi-
tions. However, there was a significant decrease in pain with movement
(6MWT) for Active TENS compared to Placebo TENS (p # .05) or No Treatment
condition (p# .05). Further, there was increased distance walked (ft 6 41.85) in
the 6MWT Active TENS group when compared to Placebo TENS (p#.05) or No
Treatment groups (p# .05). PPTs increased in the cervical region (p# .05) during
Active TENS. During DNIC, changes in both PPT and pain intensity during the
6MWT (r2=0.4, p=0.02) were correlated with changes in PPT (r2=0.03, p=0.03)
for active TENS but not Placebo or No treatment groups. Our data suggest
that TENS reduces pain sensitivity, decreases pain during movement, improves
function during routine walking and the DNIC response predicts the response
to active TENS. Grant from the Orthopedic Section of the American Physical
Therapy Association
(189) Fatigue and fibromyalgia
D Dailey, B Rakel, A Anand, J Lee, and K Sluka; The University of Iowa, Iowa
City, IA
Fibromyalgia is a condition defined by chronic widespread muscular pain and
fatigue and is associated with central excitability and loss of descending inhibi-
tion. Pain and fatigue with Fibromyalgia interfere with daily function. Thus,
the primary objective of this study was to determine the relationships between
pain and pain sensitivity, fatigue and function in patients with Fibromyalgia.
Forty three (42F; 1M), aged 25-76 years (mean 49.2 6 12.9yrs) individuals diag-
nosed with Fibromyalgia completed several fatigue and pain measures. Fatigue
was assessed with a visual analog scale (VAS) at rest and with movement during
the six minute walk test (6MWT), the Multidimensional Assessment of Fatigue
(MAF) questionnaire, the Modified Fatigue Impact Scale (MFIS) questionnaire
and the Fibromyalgia Impact Questionnaire (FIQ). Function was assessed with
the 6MWT, five time sit to stand test (FTSTS), and range of motion at the cervical
and lumbar regions. Pain sensitivity was assessed with pain VAS at rest and dur-
ing movement and pressure pain thresholds (PPTs) in the cervical and lumbar
regions. Results demonstrate a strong positive correlation r2=.61-.93 between
the MFIS Physical Function and MAF ADL subscales, suggesting these scales are
measuring similar constructs. Moderate positive correlations r2=.36-.44 were
observed between fatigue during movement and PPTs, and MAF Total and
the distance walked during the 6MWT, suggesting fatigue contributes to hy-
peralgesia and function. These data suggest that fatigue influences hyperalge-
sia (PPT changes) and function in patients with Fibromyalgia.
Acknowledgements: Supported by the Orthopedic Section of the American
Physical Therapy Association.
The Journal of Pain P23
(190) Fibromyalgia with and without positional cervical cord
compression: predictors of clinical pain
P Wood and A Holman; Pacific Rheumatology Associates, Renton, WA
Positional cervical cord compression (PC3) is common among fibromyalgia (FM)
patients. We therefore investigated whether patients with (FM/PC3+) or with-
out (FM/PC3-) this abnormality differ with regard to clinical variables and their
potential relationship to pain. A convenience sample of 130 female FM patients
was analyzed, among whom 50% (n=65) were selected from a pool of patients
with: (1) a history of cervical trauma and/or exacerbation of symptoms on cer-
vical extension; and (2) PC3 on dynamic magnetic resonance imaging (dMRI).
The other 50% (n=65) were selected from among patients who either (1) de-
nied a history of cervical trauma and had no exacerbation of symptoms on cer-
vical extension, or (2) had undergone cervical dMRI and were negative for PC3.
Composite indices of clinical pain and psychological symptoms were derived
from a scaled review of systems, and screening blood work was evaluated at
clinical intake. Student’s t-test was used to compare clinical variables between
groups. A stepwise regression model was used to determine predictors of pain
within groups. We found that FM/PC3+ were significantly older than FM/PC3-
(50.4 6 10.9 years vs. 44.0 6 13.0 years, p = 0.003) but did not differ with regard
to other clinical factors. Among FM/PC3+, patient age and the severity of psy-
chological symptoms predicted 32% of the variability in pain (F = 14.64, p
<.0001), whereas a combination of serum ferritin and duration of illness pre-
dicted 22% of the variability in pain among FM/PC3- (F = 8.57, p = .0005). While
the clinical phenotype appears to be similar among FM/PC3+ and FM/PC3-,
there are differences concerning the relationship of pain to other variables.
These data provide further evidence for the existence of physiological subtypes
within the greater FM population and suggest that consideration of cervical
abnormalities may play an important role in patient evaluation and treatment.
(191) A new procedure for the evaluation of DNIC’s efficacy in
clinical practice
E Paul-Savoie, P Bourgault, V Rattanavong, N Brissette, and S Marchand;
Universite de Sherbrooke, Sherbrooke, Quebec, Canada
In 1990, the American College of Rheumatology (ACR) published a standard for
the classification of FM1 that have been review recently.2 Even with the new cri-
teria, there are limitations to the ACR diagnostic criteria. Moreover, several hy-
pothesis have been advanced to explain the widespread pain in FMS. One of
the hypothesis supports a reduction of diffuse noxious inhibitory controls
(DNIC) in patients suffering from FMS.3 DNIC were activated and measured
by using the immersion of the hand in cold circulating water to trigger the
DNIC. 4 However, the procedure is too long and requires sophisticated and ex-
pensive equipments that prevent its use in a clinical setting. The goal of this
study was to develop a short, simple and valid procedure that could permit
to measure DNIC’s efficacy in a clinical environment. We measured DNIC’s re-
cruitment using our new procedure compared with our previous technique
in 20 subjects with FMS and 20 healthy subjects. The new procedure proceeds
in 3 steps : 1) application of algometer on the left trapezoid during 30 seconds
to a pressure corresponding to pain threshold, 2) application of a cuff inflated
to 200 mmHg on the right arm, 3) first step’s repetition. As previously demon-
strated with our first procedure, we found a DNIC’s deficit in FMS subjects but
not in healthy subjects with our new procedure. Moreover, the DNIC’s efficacy
was comparable in both procedures. Considering the simplicity of the new pro-
cedure, we suggest that it could be used in a clinical environment to measure
DNIC’s efficacy in patients to better characterize the pathophysiology and re-
lated treatments. (1. Wolfe et al., Arthritis Rheum, 1990; 2. Wolfe et al., Arthri-
tis Care Res, 2010; 3. Julien et al., Pain, 2005; 4. Tousignant-Laflamme et al.,
Brain Research, 2008)