10Fatigue and fibromyalgia syndrome: Clinical and neurophysiologic pattern
Section snippets
Fatigue in FM. a character in search of an author
Six Characters in Search of an Author is a play, written by the Nobel prize-winning Italian writer Luigi Pirandello, in which the director, who is about to begin the play, is unexpectedly interrupted by the arrival of six strange people who are characters in search of an author who can complete their story.
In certain ways, this is the situation with regard to fatigue in the fibromyalgia (FM) syndrome:Is fatigue a real character in the FM play or is it a character in search of its own, separate
Definition of fatigue
A definition of fatigue is essential for developing clinical and experimental measures that concur for diagnosis and treatment of the condition.
The definition of fatigue has been modified over time. Earlier, fatigue was defined as a transient phenomenon caused by physical activity and which lead to an inability to maintain the requisite or expected force [1]; here, fatigue is considered a reduction in the force-generating capacity of the neuromuscular system during an isometric maximal
Clinical features of fatigue in FM
It is surprising that it is quite impossible to identify, in the FM literature, a clear, acceptable and exhaustive definition of fatigue. Furthermore, the Merriam-Webster dictionary cannot be of assistance here because it defines fatigue as a weariness or exhaustion occurring from labour exertion or stress and, also, as the temporary loss of power to respond that is induced in a sensory receptor or motor-end organ by continued stimulation. With regard to the above definition of fatigue, from
Fatigue in the clinical setting
In the clinical setting, fatigue can be measured using different methods of various complexity [6]. The simplest method for assessing fatigue involves the use of the visual analogue scale (VAS). Studies using the VAS have reported that fatigue was identified in 88–98% of patients with rheumatic disease and was clinically relevant in more than 41% of patients with rheumatoid arthritis or osteoarthritis as well as in 76% of patients with FM [7].
In the healthy individual, fatigue is defined as the
Concluding remarks
Fatigue, as perceived and reported in the patient with FM, is the result of at least two different but interconnected mechanisms: a failure of central motor control and the remodelling of the muscle fibres related to an altered suprasegmental control [21]. These two aspects can be differently described in clinics with a range of clinical and neurophysiologic pictures extending from a disabling sensation of fatigue but with preservation of muscle-fibres composition (no or minimal prevalence of
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Cited by (20)
Impact of fatigue on rheumatic diseases
2019, Best Practice and Research: Clinical RheumatologyCitation Excerpt :To extensively assess fatigue and, partially, to avoid confusion among the types of fatigue described above, a number of laboratory tests have been developed; among these, there are multichannel surface electromyography (EMG) recordings. Using this approach, it is possible to estimate the motor unit location within the muscle, the decomposition of the surface EMG (sEMG) interference signal into constituent trains of motor unit action potentials (MUAPs), and the analysis of single unit properties [13]. A recent publication from 2018 [14] to assess EMG parameters of neuromuscular fatigue in knee extensors and their association with clinical, functional, and emotional features in RA patients showed no association between EMG measurements and clinical or treatment features.
Feasibility study of detecting surface electromyograms in severely obese patients
2013, Journal of Electromyography and KinesiologyCitation Excerpt :Surface EMG signal analysis has been adopted in physiological studies to investigate motor unit recruitment strategies and discharge properties (Merletti et al., 2008), myoelectric manifestations of fatigue (Botter et al., 2009; Farina et al., 2004a; Merletti et al., 1990), spinal reflexes (Türker, 2010), muscle architecture and posture (Merletti et al., 2010), and exercise-related muscle damage (Hedayatpour et al., 2009; Piitulainen et al., 2011). However, the technique has also been applied to the investigation of numerous pathological conditions, including neck (Falla and Farina, 2008) and low back pain (Jacobs et al., 2011), fibromyalgia (Casale and Rainoldi, 2011), carpal tunnel syndrome (Rainoldi et al., 2008), temporomandibular disorders (Castroflorio et al., 2008), neurological disorders such as motor neuron diseases, neuropathies, myopathies (Drost et al., 2006), involuntary muscle phenomena such as fasciculations (Kleine et al., 2012), cramps (Minetto et al., 2011), and tremor (Dideriksen et al., 2011). Surprisingly, no surface EMG studies have been performed in obese patients, even if obesity is frequently characterized by increased fatigability and reduced motor performance, especially in the highest degree of disorder that is known as severe obesity or morbid obesity.
The anti-fatigue activity of corn peptides and their effect on gut bacteria
2022, Journal of the Science of Food and AgricultureSerial whole-body cryotherapy in fibromyalgia is effective and alters cytokine profiles
2021, Advances in Rheumatology