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      A New Rehabilitation Tool in Fibromyalgia: The Effects of Perceptive Rehabilitation on Pain and Function in a Clinical Randomized Controlled Trial

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          Abstract

          Introduction/ Objective. Fibromyalgia might benefit from a specific tactile and proprioceptive rehabilitation approach. The aim of this study was to perform a randomized controlled trial to determine the efficacy of perceptual surfaces (PS) and physical exercises with regard to chronic pain and physical function in fibromyalgia compared with a control group. Methods. Data from 54 females (18–60 years old) with a diagnosis of fibromyalgia and scoring >5 on the visual analog scale were divided into 3 groups and analyzed: group treated with perceptual surfaces (PS-group), physical exercises group (PE-group), and control group (CG). The Fibromyalgia Impact Questionnaire (FIQ), Health Assessment Questionnaire (HAQ), and Fibromyalgia Assessment Scale (FAS) were administered at baseline (T0), at the end of the treatment (T1) (after 10 rehabilitation sessions over a 5-week period), and at the 12-week follow-up (T2). Results. The PS-group experienced a statistically significant improvement versus the CG in FAS and HAQ scores. Good efficacy with respect to pain and function in the PE-group compared with the CG in terms of FAS, HAQ, and FIQ scores was observed. The adherence ratio was 86% for the PE-group and CG and 90% for the PS-group. Conclusions. According to the results, the PS are as promising as the physical exercises, since results were similar.

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          Most cited references43

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          EULAR evidence-based recommendations for the management of fibromyalgia syndrome.

          To develop evidence-based recommendations for the management of fibromyalgia syndrome. A multidisciplinary task force was formed representing 11 European countries. The design of the study, including search strategy, participants, interventions, outcome measures, data collection and analytical method, was defined at the outset. A systematic review was undertaken with the keywords "fibromyalgia", "treatment or management" and "trial". Studies were excluded if they did not utilise the American College of Rheumatology classification criteria, were not clinical trials, or included patients with chronic fatigue syndrome or myalgic encephalomyelitis. Primary outcome measures were change in pain assessed by visual analogue scale and fibromyalgia impact questionnaire. The quality of the studies was categorised based on randomisation, blinding and allocation concealment. Only the highest quality studies were used to base recommendations on. When there was insufficient evidence from the literature, a Delphi process was used to provide basis for recommendation. 146 studies were eligible for the review. 39 pharmacological intervention studies and 59 non-pharmacological were included in the final recommendation summary tables once those of a lower quality or with insufficient data were separated. The categories of treatment identified were antidepressants, analgesics, and "other pharmacological" and exercise, cognitive behavioural therapy, education, dietary interventions and "other non-pharmacological". In many studies sample size was small and the quality of the study was insufficient for strong recommendations to be made. Nine recommendations for the management of fibromyalgia syndrome were developed using a systematic review and expert consensus.
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            Pain mechanisms: labeled lines versus convergence in central processing.

            The issue of whether pain is represented by specific neural elements or by patterned activity within a convergent somatosensory subsystem has been debated for over a century. The gate control theory introduced in 1965 denied central specificity, and since then most authors have endorsed convergent wide-dynamic-range neurons. Recent functional and anatomical findings provide compelling support for a new perspective that views pain in humans as a homeostatic emotion that integrates both specific labeled lines and convergent somatic activity.
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              Effect of sensory discrimination training on cortical reorganisation and phantom limb pain.

              Phantom limb pain is a frequent consequence of the amputation of a body part. Based on the finding that phantom limb pain is closely associated with plastic changes in the primary somatosensory cortex and animal data showing that behaviourally relevant training alters the cortical map, we devised a sensory discrimination training programme for patients with intractable phantom limb pain. Compared with a control group of medically treated patients, the training group had significant reductions in phantom limb pain (p=0.002) and cortical reorganisation (p=0.05) that were positively associated with improved sensory discrimination ability.
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                Author and article information

                Journal
                Evid Based Complement Alternat Med
                Evid Based Complement Alternat Med
                ECAM
                Evidence-based Complementary and Alternative Medicine : eCAM
                Hindawi Publishing Corporation
                1741-427X
                1741-4288
                2016
                13 January 2016
                13 January 2016
                : 2016
                : 7574589
                Affiliations
                1Physical Medicine and Rehabilitation Unit, Policlinico Umberto I, “Sapienza” University of Rome, 00185 Rome, Italy
                2Department of Movement, Human, and Health Sciences, Foro Italico University, Rome, Italy
                3Department of Internal Medicine and Medical Specialities, Rheumatology Unit, “Sapienza” University of Rome, 00185 Rome, Italy
                4Research Center for Sport, Health, and Human Development, University of Tras-Os-Monte and Alto Douro, Vila Real, Portugal
                5Department of Orthopaedics and Traumatology, Sant'Andrea Hospital, “Sapienza” University of Rome, 00185 Rome, Italy
                6Clinical Laboratory of Experimental Neurorehabilitation, Fondazione Santa Lucia IRCCS, Rome, Italy
                7Physical Medicine and Rehabilitation Unit, Salus infirmorum, S. Filippo Neri Hospital, Rome, Italy
                Author notes

                Academic Editor: Manuel Rosety-Rodriguez

                Article
                10.1155/2016/7574589
                4738703
                26884794
                474e2e13-9924-439b-81d1-bd3994d0e54e
                Copyright © 2016 Teresa Paolucci et al.

                This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 30 July 2015
                : 2 December 2015
                Categories
                Research Article

                Complementary & Alternative medicine
                Complementary & Alternative medicine

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