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Item Differences in Dopamine Function in Fibromyalgia(Office of the Vice Chancellor for Research, 2014-04-11) Albrecht, D. A.; Christian, B. T.; MacKie, P.; Yoder, K. K.Objective: Fibromyalgia (FM) is a debilitating pain disorder that affects 2% of the population. Many of the drugs prescribed to fibromyalgia sufferers are highly addictive, have limited clinical efficacy, and do not treat the cognitive symptoms of fibromyalgia. The neurobiological substrates of fibromyalgia are unknown, but there is evidence for involvement of altered dopaminergic transmission in pain disorders. Given that dopamine is essential for proper cognitive function, it is possible that fibromyalgia symptoms are partly mediated by abnormal dopaminergic functioning. However, the in vivo dopamine system in fibromyalgia patients has not been assessed. Thus, the objective of the current study was to ascertain how the dopamine system in fibromyalgia differs from healthy controls. Methods: [18F]-Fallypride (FAL) PET scanning was used to assess DA changes during a working memory task relative to a baseline task. Twelve patients with FM and twelve controls completed study procedures. Subjects received one FAL PET scan during a 2-back working-memory condition and one during a 0-back (attentional control) task. Results: Fibromyalgia subjects had higher baseline FAL binding potential (BPND) in the right amygdala and ventral pallidum relative to controls. FM subjects had lower baseline FAL BPND in frontal, temporal, and cingulate cortices. Voxel-wise paired t-tests were used to infer increases or decreases in FAL BPND (indicative of decreases or increases in dopamine, respectively) during 2-back performance. Fibromyalgia subjects had significant dopamine release in the ACC, left insula, OFC, and bilateral hippocampus during the 2-back task. Conversely, decreases in DA were detected in the posterior parietal cortex and vmPFC. In controls, dopamine appeared to decrease in the posterior parietal lobe, left hippocampus, and vmPFC during the 2-back task. No significant DA release was detected in controls. Self-reported pain ratings in fibromyalgia subjects were significantly associated with baseline FAL BPND in the ACC, bilateral ventral pallidum, amygdalae, and PAG. Conclusion: These data suggest that in fibromyalgia, abnormalities in dopamine function may be associated with both working memory and pain perception. Further studies are needed to further explore the potential associations between dopamine and cognitive performance and pain perception in FM.Item Fibromyalgia: management strategies for primary care providers(Wiley, 2016-02) Arnold, L. M.; Gebke, Kevin B.; Choy, E. H. S.; Department of Family Medicine, IU School of MedicineAims Fibromyalgia (FM), a chronic disorder defined by widespread pain, often accompanied by fatigue and sleep disturbance, affects up to one in 20 patients in primary care. Although most patients with FM are managed in primary care, diagnosis and treatment continue to present a challenge, and patients are often referred to specialists. Furthermore, the lack of a clear patient pathway often results in patients being passed from specialist to specialist, exhaustive investigations, prescription of multiple drugs to treat different symptoms, delays in diagnosis, increased disability and increased healthcare resource utilisation. We will discuss the current and evolving understanding of FM, and recommend improvements in the management and treatment of FM, highlighting the role of the primary care physician, and the place of the medical home in FM management. Methods We reviewed the epidemiology, pathophysiology and management of FM by searching PubMed and references from relevant articles, and selected articles on the basis of quality, relevance to the illness and importance in illustrating current management pathways and the potential for future improvements. Results The implementation of a framework for chronic pain management in primary care would limit unnecessary, time-consuming, and costly tests, reduce diagnostic delay and improve patient outcomes. Discussion The patient-centred medical home (PCMH), a management framework that has been successfully implemented in other chronic diseases, might improve the care of patients with FM in primary care, by bringing together a team of professionals with a range of skills and training. Conclusion Although there remain several barriers to overcome, implementation of a PCMH would allow patients with FM, like those with other chronic conditions, to be successfully managed in the primary care setting.Item Medication Adherence Prediction Through Online Social Forums: A Case Study of Fibromyalgia(JMIR, 2019) Haas, Kyle; Ben Miled, Zina; Mahoui, Malika; Electrical and Computer Engineering, School of Engineering and TechnologyBackground: Medication nonadherence can compound into severe medical problems for patients. Identifying patients who are likely to become nonadherent may help reduce these problems. Data-driven machine learning models can predict medication adherence by using selected indicators from patients’ past health records. Sources of data for these models traditionally fall under two main categories: (1) proprietary data from insurance claims, pharmacy prescriptions, or electronic medical records and (2) survey data collected from representative groups of patients. Models developed using these data sources often are limited because they are proprietary, subject to high cost, have limited scalability, or lack timely accessibility. These limitations suggest that social health forums might be an alternate source of data for adherence prediction. Indeed, these data are accessible, affordable, timely, and available at scale. However, they can be inaccurate. Objective: This paper proposes a medication adherence machine learning model for fibromyalgia therapies that can mitigate the inaccuracy of social health forum data. Methods: Transfer learning is a machine learning technique that allows knowledge acquired from one dataset to be transferred to another dataset. In this study, predictive adherence models for the target disease were first developed by using accurate but limited survey data. These models were then used to predict medication adherence from health social forum data. Random forest, an ensemble machine learning technique, was used to develop the predictive models. This transfer learning methodology is demonstrated in this study by examining data from the Medical Expenditure Panel Survey and the PatientsLikeMe social health forum. Results: When the models are carefully designed, less than a 5% difference in accuracy is observed between the Medical Expenditure Panel Survey and the PatientsLikeMe medication adherence predictions for fibromyalgia treatments. This design must take into consideration the mapping between the predictors and the outcomes in the two datasets. Conclusions: This study exemplifies the potential and limitations of transfer learning in medication adherence–predictive models based on survey data and social health forum data. The proposed approach can make timely medication adherence monitoring cost-effective and widely accessible. Additional investigation is needed to improve the robustness of the approach and extend its applicability to other therapies and other sources of data. [JMIR Med Inform 2019;7(2):e12561]Item Obesity Moderates the Effects of Motivational Interviewing Treatment Outcomes in Fibromyalgia(Wolters Kluwer, 2017-03) Kaleth, Anthony S.; Slaven, James E.; Ang, Dennis C.; Kinesiology, School of Physical Education and Tourism ManagementObjective: Obesity is a common comorbid condition among patients with fibromyalgia (FM). Our objective was to assess if obesity moderates the treatment benefits of exercise-based motivational interviewing (MI) for FM. Methods: This is a secondary data analysis of a completed clinical trial of 198 FM patients who were randomized to receive either MI or attention control (AC). Using body mass index (BMI) to divide participants into obese (BMI >=30 kg/m2) and non-obese (BMI <30 kg m2) groups, mixed linear models were used to determine interaction between treatment arms and obesity status with regards to the primary outcome of global FM symptom severity (Fibromyalgia Impact Questionnaire, FIQ). Secondary measures included pain intensity (Brief Pain Inventory, BPI), 6-minute walk test, and self-reported physical activity (Community Health Activities Model Program for Seniors). Results: Of the 198 participants, 91 (46%) were non-obese and 107 (54%) were obese. On global FM symptom severity (FIQ), the interaction between treatment arms and obesity status was significant (P=0.02). In the non-obese group, MI was associated with a greater improvement in FIQ than AC. In the obese group, MI participants reported less improvement in FIQ compared to AC. The interaction analysis was also significant for BPI pain intensity (P=0.01), but not for the walk test and self-reported physical activity. Discussion: This is the first study to show that obesity negatively affects the treatment efficacy of MI in patients with FM. Our findings suggest that exercise-based MI may be more effective if initiated after weight loss is achieved.Item Peer Support in the Treatment of Chronic Pain in Adolescents: A Review of the Literature and Available Resources(MDPI, 2020-09-07) Tolley, James A.; Michel, Marti A.; Williams, Amy E.; Renschler, Janelle S.; Anesthesia, School of MedicinePeer support has found applications beyond the mental health field and is useful for managing several chronic disorders and supporting healthy lifestyle choices. Communication through telephone and the Internet allows for greater access to those who cannot meet in person. Adolescent chronic pain would seem ideally suited to benefit from online peer support groups. Research is lacking, however, to characterize benefit in terms of pain and function, despite a clear desire among adolescents for access to such programs. More rapid development of online applications is needed for peer support, and research into the associated outcomes will be necessary to optimally design such programs.Item Role Strains and Mood in Husbands of Women with Fibromyalgia Syndrome: A Test of the Stress Process Model(2008) Bigatti, Silvia M.; Lydon, Jennifer R.; Brothers, Brittany M.Spouses of patients experience role strains as a result of informal caregiving, which has been associated with mood in numerous research studies. However, most research is on female caregivers, and little is known about the experience of male spouses, or of the caregiving provided to fibromyalgia patients. The Stress Process Model was used to examine mediators and moderators of the relation between role strain and mood among 135 husbands of women with fibromyalgia. Results indicated that the more activities of daily living and instrumental activities of daily living performed by the husband, the greater the role strain. Role strain was associated with worse mood. A test of the Stress Process Model supported a partial mediation model, where social support and emotion-focused coping partially mediated the relation between role strain and mood. No evidence was found for a moderation model or for problem-focused coping as a mediator. Our research suggests significant impairment and caregiving needs among this patient population, which in turn relates to the mood of the husband who is also an informal caregiver. Our findings also support the Stress Process Model in explaining the complexity of caregiving effects. The results of the study suggest avenues for intervention for individuals strained by their partners’ illness.Item Sleep Disturbances in Fibromyalgia Syndrome: Relationship to Pain and Depression(2008-07) Bigatti, Silvia M.; Hernandez, Ann Marie; Cronan, Terry A.; Rand, Kevin L.Objective This study is an examination of sleep, pain, depression, and physical functioning at baseline and 1-year followup among patients with fibromyalgia syndrome (FMS). Although it is clear that these symptoms are prevalent among FMS patients and that they are related, the direction of the relationship is unclear. We sought to identify and report sleep problems in this population and to examine their relationship to pain, depression, and physical functioning. Methods Patients diagnosed with fibromyalgia were recruited from a Southern California health maintenance organization and evaluated according to American College of Rheumatology criteria in the research laboratory. Six hundred patients completed the baseline assessment and 492 completed the 1-year assessment. Measures included the Center for Epidemiologic Studies Depression Scale, the McGill Pain Questionnaire, the Pittsburgh Sleep Quality Index, and the Fibromyalgia Impact Questionnaire. Results The majority of the sample (96% at baseline and 94.7% at 1 year) scored within the range of problem sleepers. Path analyses examined the impact of baseline values on 1-year values for each of the 4 variables. No variable of interest predicted sleep, sleep predicted pain (β = 0.13), pain predicted physical functioning (β = −0.13), and physical functioning predicted depression (β = −0.10). Conclusion These findings highlight the high prevalence of sleep problems in this population and suggest that they play a critical role in exacerbating FMS symptoms. Furthermore, they support limited existing findings that sleep predicts subsequent pain in this population, but also extend the literature, suggesting that sleep may be related to depression through pain and physical functioning.Item Values-based action in fibromyalgia: results from a randomized pilot of acceptance and commitment therapy(2013-09) Steiner, Jennifer L; Bogusch, Leah; Bigatti, Silvia M.Fibromyalgia Syndrome (FMS) is a chronic pain condition characterized by pain, fatigue, and nonrestorative sleep. The disruptive symptoms of FMS are associated with reductions in quality of life related to family, intimate relationships, and work. The present study was part of a randomized pilot study of an 8-week Acceptance and Commitment Therapy (ACT) intervention compared to education in a sample of 28 women with FMS. The Chronic Pain Values Inventory was administered at baseline, postintervention, and 12 week follow-up. Both groups showed significant improvements in family success, which were maintained at follow-up. Groups showed a differential pattern of success in work. The ACT group demonstrated significant, maintained improvements in success in intimate relationships, while the education group reported no changes over time. Findings suggest that both interventions may lead to improvements in valued living; however different interventions may be best suited for certain valued domains. The results of this study indicate that FMS patients are able to improve their success in family and intimate relationships and losses in these areas are not necessarily permanent.