Term Paper on "Fibromyalgia More Than 50% of Patients Diagnosed"

Term Paper 19 pages (5095 words) Sources: 4 Style: APA

[EXCERPT] . . . .

Fibromyalgia

More than 50% of patients diagnosed with fibromyalgia (FM) suffer from major depression. In light of this significant statistic, this Evidence-based Practice (EBP) study explores the problem of depression in patients diagnosed with fibromyalgia, the clinical problem selected for this study.

In fibromyalgia, Antai-Otong (2005) stresses, pain management purports a pivotal treatment aspect for patients contending with the disease. To effectively treat FM, a holistic and interdisciplinary team approach focusing on pain management and mitigation of depression, along with other psychiatric symptoms proves pertinent. The most successful treatment strategies integrate: "pharmacotherapy, a graded exercise program, and cognitive behavioral therapy." (Hassett, Cone, Patella, & Sigal, 2000; Millea & Holloway, 2000; Thieme, Turk, & Flor, 2004; cited by Antai-Otong, 2005) Fibromyalgia, not deemed to be a distinct syndrome, reportedly affects approximately five million individuals, primarily women, in the U.S. (APA, 2000; Hudson, Arnold, Keck, Auchenbach, & Pope, 2004; cited by Antai-Otong, 2005) North American research indicates the prevalence estimate of FM to average 3.4% for women and 0.5% for men.

These percentages increase to 7.1 and 1.1%, respectively, for individuals in the 60-69-year age range. (Costal et al., 2005, p. 1422) as a chronic, recurrent, and potentially debilitating syndrome characterized by pain, fatigue and sleep problems, FM appears to constitute "part of an intricate spectrum of other medical conditions classified as somataform disorders," numerous clinicians frequently minimize or misdiagnose and/or under-treated patients. (Antai-Otong, 2005; "FDA Approves First Drug," 2007) in 2005, the FDA had not yet approved any drug for the treatment of FMS. (Antai-Otong, 2005) on June 21, 2007, however, the U.S. Food and Drug Administration approved the first drug to treat fibromyalgia - Lyrica (pregabalin), a disorder characterized by pain, fatigue and sleep problems. "Lyrica reduces pain and improves daily functions for some patients with fibromyalgia."("FDA Approves First Drug," 2007) Steven Galson, M.D., M.P.H., director of FDA's Center for Drug Evaluation and Research, albeit, stresses that more progress needs to be made for treatment of FM, as a number of patients did not experience a pain relief with Lyrica in clinical trials. ("FDA Approves First Drug," 2007) for the diagnoses of fibromyalgia, which affects approximately three to six million to 6 million people (primarily women in early-to-middle adulthood) in the U.S., doctors conduct physical examinations, evaluate symptoms, and rule out other conditions. "Individuals with fibromyalgia have been shown to experience pain differently from other people." ("FDA Approves First Drug," 2007) Diagnostic criteria for FMS include:

Widespread pain for at least 3 months and not localized in one area -- involves both side of body, over and above the waist, and axial skeletal pain

Presence of 11 out of 18 tender points, including Designated occipital sites Lower cervical trapezius, gluteal area Greater trochanter and knees

Sleep disturbances during non-rapid eye movement (NREM) sleep, reduced delta sleep, and increased arousal, leading to sleep deprivation or unrestful sleep

Depression, emotional distress

Fatigue (American Psychiatric Association, 2000; cited by Antai-Otong, 2005)

The specific cause of FMS is not clearly confirmed, albeit, researchers currently suspect abnormalities in neuroendocrine systems such as hypothalamic-pituitary -- adrenal axis (HPA axis) as contributing causes. "Inquiries into FMS indicate the relationship between neurobiologic, psychosocial, and behavioral factors in pain syndromes." (Antai-Otong, 2005)

In addition, ongoing evidence reveals doctors routinely recommend antidepressants in the treatment of FMS. As FM is significantly associated with depression (or symptoms of depression), this researcher contends this consideration merits exploration and serves as significant rationale for further study. Increasing evidence suggests that an individual experiencing depression related to FM may also contend with increased pain, consequently adversely affecting his/her to cope with everyday activities. "Exercise training has been used successfully to address a number of conditions that are also commonly experienced by individuals with FMS. Aerobic and strength training have been shown to improve depression in individuals with clinical depression."(Brosse (2002, Dunn 2001; cited by Busch, Barber, Overend, Peloso, and Schachter, 2007, p. 3) When individuals with sleep complaints exercise moderately, this practice can reportedly improve their sleep. (King 1997, Singh 1997; Busch, Barber, Overend, Peloso, and Schachter, 2007, p. 3) Training-induced improvements in cardio-respiratory fitness appears to suggest fatigue may also be decreased with moderate exercise. As one's maximal aerobic capacity improves, a person will be able to perform activities of daily living at lower absolute percentages of maximal capacity. (Busch, Barber, Overend, Peloso, and Schachter, 2007, p. 3)

Place for participants here ____ treats FM patients or where participants for this study are selected from. During the course of their treatments, nurses fulfill their responsibility to ____ for FM patients, while or something similar? simultaneously seeking to ease pain and decrease depression.

Utilizing the PICO form, this study proposes the relevant practice question: Does the implementation of group therapy sessions contribute to more effective pain management for individuals diagnosed with FM? In the quest to answer this pertinent clinical question, the population (P) is defined as FM patients requiring prescribed medications; the intervention (I) consists of weekly group therapy (support) sessions for 12 weeks; the comparison - constitutes current FM patients not attending weekly group therapy (support) sessions; the outcome (0) denotes decreased pain as a result of participation in the weekly group therapy (support) sessions

II. Methodology

Self-report can be erroneous if the participant wants to be viewed positively by others, or if there is recall bias." (Dobkin, et al., 2006)

To research literature utilized in this study, this researcher chose to utilize Ovid Medline, the Cumulative Index to Nursing and Allied Health and literature one (one CINAHL), and the Cochrane Collection. These databases contain credible, research studies, containing an excellent level of evidence, necessary mandated for evidence-based practice decisions in medicine, as well as in nursing. This researcher initially searched Ovid for information/data for this study. Key words and/or phrases for information/data included "fibromyalgia," "treatment of fibromyalgia," and "fibromyalgia and depression." These key search words and phrases were then connected in a variety of ways, consequently yielding ____ results.

English constituted the language for research studies. Studies completed within last 10 years were selected to review the most contemporary evidence. This researcher purposely focused on studies relating to pain associated with FM as a dearth of literature exists on group thereapy (support) for FM patients. Criteria for exclusion stipulated studies not matching that defined in the PICO question, as well as, studies ____ (need to add what other criteria used to exclude studies). From results retrieved through the literature search, this researcher defined the intervention as the implementation of group therapy (support) with participant journaling.

Ultimately, from retrieved researched results, this researcher identified four studies that met all the established inclusion and exclusion criteria previously identified. An identical search performed in the Cochrane database only yielded one result, which had had been obtained through prior research. This researcher conducted a more intensive search of the Cochrane Database of Systematic Reviews and the Cochrane Central Register of Controlled Trials utilizing the following terms: "____,"

____," and "____," yet found no relevant results such as, meta-analyses, systematic reviews or randomized-controlled clinical trials.

III. Literature Review

Fibromyalgia (FMS) is a syndrome characterized by widespread musculoskeletal pain and multiple tender points (TP)."

Burckhardt, Mannerkorpi, Hedenberg, and Bjelle, (1994)

Study

The first study matching the criteria established for this study: "Exercise for treating fibromyalgia syndrome, an updated systematic review (initially published during 2002), proposes to assess effects evolving from exercise training "including cardio-respiratory (aerobic), muscle strengthening, and/or flexibility exercise on global well-being, selected signs and symptoms, and physical function in individuals with FMS." (Busch, Barber, Overend, Peloso, and Schachter, 2007, p. 1) the research design utilized for this study included the analysis of researched literature secured from "MEDLINE, EMBASE, CINAHL, SportDiscus, PubMed, PEDro, and the Cochrane Central Register for Controlled Trials (CENTRAL, Issue 3, 2005) up to and including July 2005." (Busch, Barber, Overend, Peloso, and Schachter, 2007) in addition, Busch, Barber, Overend, Peloso, and Schachter (2007, p. 1) reviewed

Reference List s, retrieved from reviews and meta-analyses of treatment studies.

The procedure for the study by Busch, Barber, Overend, Peloso, and Schachter (2007, p. 1) consisted of the authors selecting, collecting and analyzing randomized trials focusing on "cardio-respiratory endurance, muscle strength and/or flexibility as treatment for FMS.... Two of four reviewers independently extracted data for each study." The reviewers additionally rechecked any/all observed discrepancies noted in trials and subsequently achieved consensus via discussions. Busch, Barber, Overend, Peloso, and Schachter (2007, p. 1)) assessed the reviewed studies methodological quality utilizing two credible instruments: the Jadad, along with, the van Tulder methodological quality criteria. The authors utilized the American College of SportMedicine (ACSM) guidelines to evaluate whether interventions provided a training stimulus to effect changes in physical fitness. The significant clinical heterogeneity among the studies the authors examined contributed to the inclusion of meta-analyze six aerobic-only studies and two strength-only studies.

The initial 2276 total subjects across the 34 included studies were narrowed to 1264 subjects assigned to exercise interventions.

In this review, 47 interventions included exercise in 34 studies. Utilizing standardized mean differences (SMD), the authors… READ MORE

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