Öz
Günümüzde fibromiyalji sendromu (FMS) için farklı tedavi yöntemleri vardır, ancak standart bir tedavi
yöntemi konusunda fikir birliği yoktur. Randomize kontrollü çalışmamızda, FMS’de TENS (Transcutaneous
Electrical Nerve Stimulation), hasta eğitimi ve bilişsel davranışçı terapinin (BDT) etkinliği
araştırıldı.
Bu amaçla, American College of Rheumatology (ACR) 1990 tanı kriterlerine göre FMS tanısı konan,
18-60 yaş arası, 60 kadın hasta rastgele yöntemle 20’şer kişilik 3 gruba ayrıldı. 1. gruba (n=20) 10
seans plasebo TENS ve 5 seans hasta eğitimi (HE); 2. gruba (n=20) 10 seans TENS ve 5 seans HE; 3.
gruba (n=20) 10 seans TENS ve 8 seans BDT uygulandı.
Olgular tedavi öncesi ve sonrası, tedavi bitiminden 6 hafta sonra ağrı açısından, vizüel analog skala
(VAS), algometrik ölçüm, ağrılı nokta sayısı, haftalık analjezik kullanım sayısı; uyku kalitesi açısından
VAS ve sabah yorgunluğu (5’li Likert tipi skala); depresyon açısından Beck depresyon ölçeği; genel
değerlendirme açısından hasta ve doktorun genel değerlendirmesi (5’li Likert tipi skala); fonksiyonel
değerlendirme açısından FMS etki sorgulaması formu (FIQ); ve yaşam kalitesi açısından Short Form36
(SF-36) ile değerlendirildiler. Hastalar tedavi sonrasında kendilerine uygulanan tedaviyi 5’li Likert
tipi skala ile değerlendirdiler.
Günümüzde FMS tedavisinde çok değişik yöntemler kullanılmaktadır. Ancak FMS tedavisinde kabul
edilmiş ortak bir tedavi yöntemi bulunmamaktadır. Bu çalışmamızda HE, BDT ve TENS tedavilerinin
FMS üzerine olan etkileri incelendi.
Bu çalışmada FMS’li hastalarda TENS’in ağrı üzerine etkili olduğunu ve grup halinde uygulanan BDT
ve HE’nin ağrı, depresyon, hastalığın genel değerlendirmesi ve yaşam kalitesine olumlu etkileri olduğu,
ayrıca BDT’nin depresyon, hastanın kendini genel değerlendirmesi ve uyku parametrelerinde
HE’ye üstün olduğu saptandı. Ancak FMS’de fizik tedavi ajanları ve BDT’yi değerlendiren daha uzun
takipli ve daha çok olgu içeren çalışmalara ihtiyaç vardır.
Anahtar Kelimeler
Kaynakça
- 1- Akkuş, S., Koşar, A., Beyazıt, O., “Fibromiyalji tanısı konan 220 vakanın klinik özellikleri”, Türkiye Fiziksel Tıp ve Rehabilitasyon Dergisi, 1(1), 41-46, 1998
- 2- Arnold, L.M. & Clauw, D. J., “ Challenges of implementing fibromyalgia treatment guidelines in current clinical practice” , Postgraduate Medicine, (just-accepted), 129(7), 709-714, 2017
- 3- Atlı, A.D., Öztek, F., Erdoğan, S., “Primer Fibromiyalji Sendromu’nda Nokturnal Growth Hormon Sekresyonu”, Fiziksel Tıp ve Rehabilitasyon Dergisi, 22(3), 106-110, 1997
- 4- Bengtsson, A., Henriksson, K.G and Larsson, J., “Muscle biopsy in primary fibromyalgia: Lightmicroscopical and histochemical findings”, Scandinavian Journal Rheumatology, 15(1), 1-6, 1986
- 5- Bennett, R.H., Burckhardt, C.S., Clark, S.R., O’Reilly, C. A., Wiens, A. N., & Campbell, S.M., “Group treatment of fibromyalgia: A 6 month outpatient program”, The Journal of Rheumatology, 23(3), 521-528, 1996
- 6- Buckkelew, S.P., Conway, R., Parker, J., Deuser, W. E., Read, J., Witty, T. E. & McIntosh, M. J., “Biofeedback/ relaxtion training and exercise interventions for fibromialgia: A prospective trial”, Arthritis & Rheumatology, 11(3), 196-209, 1998
- 7- Buckelew, S.P., Huyser, B., Hewett, J.E., Johnson, J. C., Conway, R., Parker, J. C. & Kay, D. R., “Selfefficacy predicting outcome among fibromialgia subjects”, Arthritis & Rheumatology, 9(2), 97- 104, 1996
- 8- Burckhardt, C.S., Clark, S.R., Bennett, R.M., “The fibromyalgia impact questionnaire: development and validation”, J Rheumatol, 18(5), 728-733, 1991
- 9- Burckhardt, C.S., Mannerkorpi, K., Hedenberg, L., Bjelle, A., “A randomized controlled clinical trial of education and physical training for women with fibromyalgia”, The Journal of Rheumatology, 21(4), 714-720, 1994
- 10- Busch, A. J., Barber, K. A., Overend, T. J., Peloso, P.M.J. & Schachter, C.L., “Exercise for treating fibromyalgia syndrome”, The Cochrane Library, 2007, CD003786
- 11- Çeliker, R., “Kronik ağrı sendromları”, 20. Ulusal Fiziksel Tıp ve Rehabilitasyon Kongresi. Konferans Metinleri, 6-7, 2005
- 12- Deyo, R.A., Walsh, N.E., Martin, D.C., Schoenfeld, L.S., & Ramamurthy, S., “A controlled trial of transcuteneous electrical nevre stimülation (TENS) and exercise for chronic low back pain”, New England Journal of Medicine, 322(23), 1627-1634, 1990
- 13- Dunkl, P.R., Taylor, A.G., McConnell, G.G., Alfano, A.P., Conaway, M.R., “Responsiveness of fibromyalgia clinical trial outcome measures”, The Journal of rheumatology, 27(11), 2683-2691, 2000
- 14- Fisher, A., : Pressure algometry in differential diagnosis of muscle pain; Myofascial Pain and Fibromyalgia, Mosby-Year Book, Inc, 121-139, 1994
- 15- Güven, Z., Özaras, N., Babacan, A.G., Kayhan, Ö., “Değişik TENS Modalitelerinin Fibromiyalji Sendromuna Etkileri”, Fizik Tedavi ve Rehabilitasyon Dergisi, 16(1), 32-37, 1992
- 16- Henriksson, K.G., Bengtsson, A., “Fibromyalgia–a clinical entity?”, Canadian journal of physiology and pharmacology, 69(5), 672-677, 1991
- 17- Kılıç, A.M., “Fibromiyalji Sendromlu Hastalarda TENS ve Egzersiz Tedavilerinin Etkinliğinin Karşılaştırılması” Yüksek Lisans Tezi, 1999
- 18- King, S.J., Wessel, J., Bhambhani, Y., Sholter, D., & Maksymowych, W., “The Effects of Exercise and Education, İndividually or Combined, in Women with Fibromyalgia”, The Journal of rheumatology, 29(12), 2620- 2627, 2002
- 19- Korszun, A., Lundden, L.S., Papadopoulos, E., Brucksch, C., Masterson, L., Engelberg, N.C., & Crofford, L. “Melatonin levels in women with fibromyalgia and chronic fatigue syndrome.”, The Journal of rheumatology, 26(12), 2675-2680, 1999
- 20- Moldofsky, H., Lue, F.A., Roth-Schechter, B., & Reynolds, W. J. “The effect of Zolpidem in patients with fibromyalgia; a dose ranging, double blind, placebo controlled, modified crossover study” , The Journal of Rheumatology, 23(3), 529-533, 1996
- 21- Mountz, J.M., Bradley, L.A., Alercon, G.S., “Abnormal functional activity of the central nervous system in fibromialgia syndrome”, The American journal of the medical sciences, 315(6), 385- 396, 1998
- 22- Nicassio, P.M., Radojerevic, V., Weismen, M.H., Schuman, C., Jung, K., Schoenfiel, S.M., Knoll, T., “Cognitive and Behavioral, Interventions for Fibromyalgia”, J. Rheumatol, 24(10), 200-207, 1997
- 23- Nicassio, P.M., Radojevic, V., Weisman, M.H., Schuman, C., Kim, J., Schoenfeld-Smith, K. & Krall, T, “A comparison of behavioral and educational interventions with fibromialgia”, The Journal of Rheumatology, 24(10), 2000-2007, 1997.
- 24- Nusreti, H., Safati, B., Güneri, S., Durmaz, B., Akşit, R. “Primer Fibromiyalji Tedavisinde Akupunktur ve TENS’ in Yeri”, Ege Fiz Tıp Reh Der, 1(3), 175-178, 1995
- 25- Pellegrino, M.J., “A typical chest pain as initial presentation of primary fibromyalgia”, Archieves of Physical Medicine Rehabilitation, 71(7), 526-528, 1990
- 26- Pellegrino, M.J., Waylanis, G.W., & Sommer, A., “Familial occurence of primary fibromyalgia”, Archives of physical medicine and rehabilitation, 70(1), 61-63, 1989
- 27- Vlaeyen, J.W.S., Teken-Gruben, N.J.G., Goosens, M.E.J.B., “Cognitive- educational treatment of fibromyalgia: A randomized clinical trial. I. Clinical effects”, The Journal of Rheumatology, 23, 1237-1245, 1991
- 28- Weigent, D.A., Bradley, L.A., Blalock J.E. & Alarcon, G.S., “Current concepts in the pathophysiology of abnormal pain perception in fibromyalgia”, The American journal of the medical sciences, 315(6), 405-412, 1998
- 29- White, K.P., Speechley, M., Harth, M., “Fibromyalgia in Rheumatology Practice; A survey of Canadian Rheumatologists”, The Journal of Rheumatology, 22(4), 722-726, 1995
- 30- Wolfe, F., Clauw, D. J., Fitzcharles, M. A., Goldenberg, D. L., Katz, R. S., Mease, P. & Yunus, M. B., “The American College of Rheumatology Preliminary Diagnostic Criteria for Fibromyalgia and Measurement of Symptom Severity”, Arthritis care & research , 62(5), 600-610, 2010
- 31- Wolfe, F., Ross, K., Anderson, J., Russell, I.J. “Aspects of fibromyalgia in the general population sex, pain threshold and fibromyalgia symptoms”, The Journal of rheumatology, 22(1), 151-156, 1995
- 32- Yunus, M.B., Masi, A.T., “Fibromyalgia, Restless Legs Syndrome, Periodic Limb, Movement Disorder and Psychogenic Pain; In arthritis and allied Condition, 12th edition, Lea & Febigeredited by D.J. McCartyand , W.J. Kopman, 1992, 1383
- 33- Yunus, M.B., “Research in Fibromyalgia and Myofascial Pain Syndromes: Current Status, Problems and Future Directions”, Journal of Musculoskeletal Pain 1(1), 23-42, 1993
Öz
At the present time, there are different typeS of treatment methods for fibromyalgia syndrome (FMS),
but there is no consensus on a standart treatment method. In our randomized controlled study, we
researched the efficacy of patient’s education, cognitive behavioral therapy (CBT) along with TENS in
FMS.
Sixty women aged between 18-60, who fullfilled the American College of Rheumatology criteria for
FMS, were separated into three groups. The first group (n=20) received plasebo TENS as 10 sessions
and education as 5 sessions; the second group (n=20) received TENS as 10 sessions and education as 5
sessions whereas the third group received TENS 10 sessions and CBT as 8 sessions.
Our evaluation parameters were intensity of pain with algometer, number of the tender points, VAS index
for pain, VAS index for quality of sleep and morning fatigue (5-point Likert-type scale), Beck depression
inventory, fibromyalgia impact questionnaire, SF-36, patient and physican global assesments at the
beginning, at the end of the theraphy, and 6 weeks after. Each patient evaluated the therapy with a
Likert type scale at the end of therapy as well.
It was found TENS is effective on pain in FMS. Patients education and CBT as group therapy format
were also effective on pain, depression, global assesment of disease and quality of life in FMS. CBT was
found more effective on depression, quality of sleep along with patient and physican global assesment
parameters than education alone.
It is obvious that studies with great number of patients and with longer follow up periods on the
effectiveness of physical therapy agents and CBT both together, or in comparative design will answer
further questions.
Anahtar Kelimeler
Kaynakça
- 1- Akkuş, S., Koşar, A., Beyazıt, O., “Fibromiyalji tanısı konan 220 vakanın klinik özellikleri”, Türkiye Fiziksel Tıp ve Rehabilitasyon Dergisi, 1(1), 41-46, 1998
- 2- Arnold, L.M. & Clauw, D. J., “ Challenges of implementing fibromyalgia treatment guidelines in current clinical practice” , Postgraduate Medicine, (just-accepted), 129(7), 709-714, 2017
- 3- Atlı, A.D., Öztek, F., Erdoğan, S., “Primer Fibromiyalji Sendromu’nda Nokturnal Growth Hormon Sekresyonu”, Fiziksel Tıp ve Rehabilitasyon Dergisi, 22(3), 106-110, 1997
- 4- Bengtsson, A., Henriksson, K.G and Larsson, J., “Muscle biopsy in primary fibromyalgia: Lightmicroscopical and histochemical findings”, Scandinavian Journal Rheumatology, 15(1), 1-6, 1986
- 5- Bennett, R.H., Burckhardt, C.S., Clark, S.R., O’Reilly, C. A., Wiens, A. N., & Campbell, S.M., “Group treatment of fibromyalgia: A 6 month outpatient program”, The Journal of Rheumatology, 23(3), 521-528, 1996
- 6- Buckkelew, S.P., Conway, R., Parker, J., Deuser, W. E., Read, J., Witty, T. E. & McIntosh, M. J., “Biofeedback/ relaxtion training and exercise interventions for fibromialgia: A prospective trial”, Arthritis & Rheumatology, 11(3), 196-209, 1998
- 7- Buckelew, S.P., Huyser, B., Hewett, J.E., Johnson, J. C., Conway, R., Parker, J. C. & Kay, D. R., “Selfefficacy predicting outcome among fibromialgia subjects”, Arthritis & Rheumatology, 9(2), 97- 104, 1996
- 8- Burckhardt, C.S., Clark, S.R., Bennett, R.M., “The fibromyalgia impact questionnaire: development and validation”, J Rheumatol, 18(5), 728-733, 1991
- 9- Burckhardt, C.S., Mannerkorpi, K., Hedenberg, L., Bjelle, A., “A randomized controlled clinical trial of education and physical training for women with fibromyalgia”, The Journal of Rheumatology, 21(4), 714-720, 1994
- 10- Busch, A. J., Barber, K. A., Overend, T. J., Peloso, P.M.J. & Schachter, C.L., “Exercise for treating fibromyalgia syndrome”, The Cochrane Library, 2007, CD003786
- 11- Çeliker, R., “Kronik ağrı sendromları”, 20. Ulusal Fiziksel Tıp ve Rehabilitasyon Kongresi. Konferans Metinleri, 6-7, 2005
- 12- Deyo, R.A., Walsh, N.E., Martin, D.C., Schoenfeld, L.S., & Ramamurthy, S., “A controlled trial of transcuteneous electrical nevre stimülation (TENS) and exercise for chronic low back pain”, New England Journal of Medicine, 322(23), 1627-1634, 1990
- 13- Dunkl, P.R., Taylor, A.G., McConnell, G.G., Alfano, A.P., Conaway, M.R., “Responsiveness of fibromyalgia clinical trial outcome measures”, The Journal of rheumatology, 27(11), 2683-2691, 2000
- 14- Fisher, A., : Pressure algometry in differential diagnosis of muscle pain; Myofascial Pain and Fibromyalgia, Mosby-Year Book, Inc, 121-139, 1994
- 15- Güven, Z., Özaras, N., Babacan, A.G., Kayhan, Ö., “Değişik TENS Modalitelerinin Fibromiyalji Sendromuna Etkileri”, Fizik Tedavi ve Rehabilitasyon Dergisi, 16(1), 32-37, 1992
- 16- Henriksson, K.G., Bengtsson, A., “Fibromyalgia–a clinical entity?”, Canadian journal of physiology and pharmacology, 69(5), 672-677, 1991
- 17- Kılıç, A.M., “Fibromiyalji Sendromlu Hastalarda TENS ve Egzersiz Tedavilerinin Etkinliğinin Karşılaştırılması” Yüksek Lisans Tezi, 1999
- 18- King, S.J., Wessel, J., Bhambhani, Y., Sholter, D., & Maksymowych, W., “The Effects of Exercise and Education, İndividually or Combined, in Women with Fibromyalgia”, The Journal of rheumatology, 29(12), 2620- 2627, 2002
- 19- Korszun, A., Lundden, L.S., Papadopoulos, E., Brucksch, C., Masterson, L., Engelberg, N.C., & Crofford, L. “Melatonin levels in women with fibromyalgia and chronic fatigue syndrome.”, The Journal of rheumatology, 26(12), 2675-2680, 1999
- 20- Moldofsky, H., Lue, F.A., Roth-Schechter, B., & Reynolds, W. J. “The effect of Zolpidem in patients with fibromyalgia; a dose ranging, double blind, placebo controlled, modified crossover study” , The Journal of Rheumatology, 23(3), 529-533, 1996
- 21- Mountz, J.M., Bradley, L.A., Alercon, G.S., “Abnormal functional activity of the central nervous system in fibromialgia syndrome”, The American journal of the medical sciences, 315(6), 385- 396, 1998
- 22- Nicassio, P.M., Radojerevic, V., Weismen, M.H., Schuman, C., Jung, K., Schoenfiel, S.M., Knoll, T., “Cognitive and Behavioral, Interventions for Fibromyalgia”, J. Rheumatol, 24(10), 200-207, 1997
- 23- Nicassio, P.M., Radojevic, V., Weisman, M.H., Schuman, C., Kim, J., Schoenfeld-Smith, K. & Krall, T, “A comparison of behavioral and educational interventions with fibromialgia”, The Journal of Rheumatology, 24(10), 2000-2007, 1997.
- 24- Nusreti, H., Safati, B., Güneri, S., Durmaz, B., Akşit, R. “Primer Fibromiyalji Tedavisinde Akupunktur ve TENS’ in Yeri”, Ege Fiz Tıp Reh Der, 1(3), 175-178, 1995
- 25- Pellegrino, M.J., “A typical chest pain as initial presentation of primary fibromyalgia”, Archieves of Physical Medicine Rehabilitation, 71(7), 526-528, 1990
- 26- Pellegrino, M.J., Waylanis, G.W., & Sommer, A., “Familial occurence of primary fibromyalgia”, Archives of physical medicine and rehabilitation, 70(1), 61-63, 1989
- 27- Vlaeyen, J.W.S., Teken-Gruben, N.J.G., Goosens, M.E.J.B., “Cognitive- educational treatment of fibromyalgia: A randomized clinical trial. I. Clinical effects”, The Journal of Rheumatology, 23, 1237-1245, 1991
- 28- Weigent, D.A., Bradley, L.A., Blalock J.E. & Alarcon, G.S., “Current concepts in the pathophysiology of abnormal pain perception in fibromyalgia”, The American journal of the medical sciences, 315(6), 405-412, 1998
- 29- White, K.P., Speechley, M., Harth, M., “Fibromyalgia in Rheumatology Practice; A survey of Canadian Rheumatologists”, The Journal of Rheumatology, 22(4), 722-726, 1995
- 30- Wolfe, F., Clauw, D. J., Fitzcharles, M. A., Goldenberg, D. L., Katz, R. S., Mease, P. & Yunus, M. B., “The American College of Rheumatology Preliminary Diagnostic Criteria for Fibromyalgia and Measurement of Symptom Severity”, Arthritis care & research , 62(5), 600-610, 2010
- 31- Wolfe, F., Ross, K., Anderson, J., Russell, I.J. “Aspects of fibromyalgia in the general population sex, pain threshold and fibromyalgia symptoms”, The Journal of rheumatology, 22(1), 151-156, 1995
- 32- Yunus, M.B., Masi, A.T., “Fibromyalgia, Restless Legs Syndrome, Periodic Limb, Movement Disorder and Psychogenic Pain; In arthritis and allied Condition, 12th edition, Lea & Febigeredited by D.J. McCartyand , W.J. Kopman, 1992, 1383
- 33- Yunus, M.B., “Research in Fibromyalgia and Myofascial Pain Syndromes: Current Status, Problems and Future Directions”, Journal of Musculoskeletal Pain 1(1), 23-42, 1993
Ayrıntılar
| Birincil Dil | Türkçe |
|---|---|
| Konular | Klinik Tıp Bilimleri |
| Bölüm | Makaleler |
| Yazarlar | |
| Yayımlanma Tarihi | 19 Haziran 2017 |
| Yayımlandığı Sayı | Yıl 2017 Cilt: 2 Sayı: 1 |
