Fibromiyalji Hastalarında Merkezi Duyarlılık ve Vücut Farkındalığının Belirleyicisi Olarak Hastalık Aktivitesinin Rolü: Kesitsel Bir Çalışma

Yıl 2025, Cilt: 9 Sayı: 1, 30 - 36, 21.04.2025

Yasemin Mirza , Adem Küçük

https://doi.org/10.46332/aemj.1533118

Öz

Amaç: Bu çalışmanın amacı fibromiyalji sendromu (FMS) hastalarında hastalık aktivitesinin santral sensitizasyon ve vücut farkındalığı üzerine etkisini belirlemektir.

Araçlar ve Yöntem: Bu kesitsel çalışmaya FMS'li 45 hasta (ortalama yaş: 45.9 (6.9) yıl, ortanca hastalık süresi: 3 (2-6) yıl) katıldı. Hastalık aktivitesi, Fibromiyalji Etki Anketi (FEA) kullanılarak değerlendirildi ve daha yüksek puan yüksek hastalık aktivitesi olarak kabul edildi. Santral sensitizasyonu değerlendirmek için Santral Sensitizasyon Ölçeği (SSÖ) uygulandı. Vücut farkındalığı seviyeleri Vücut Farkındalığı Anketi (VFA) ile değerlendirildi. Ağrı şiddetini belirlemek için Görsel Analog Skala (GAS) kullanıldı. Hastalık aktivitesini hangi bağımsız değişkenin açıklayabileceğini araştırmak için basit doğrusal regresyon analizleri kullanıldı.

Bulgular: Ortalama FEA ve VFA puanları sırasıyla 53.4 ve 90 dı. Ortanca GAS ve SSÖ puanları sırasıyla 8 ve 52 idi. Tüm hastaların %82.2'sinde santral sensitizasyon pozitifti. FEA, GAS skoruyla orta düzeyde ilişkiliydi (r=0.445, R2=0.198, p=0.002) ve SSÖ ile yüksek düzeyde ilişkiliydi (r=0.539, R2=0.291, p<0.001). FEA ve VFA arasında ise anlamlı bir korelasyon saptanmadı (p=0.791). Basit doğrusal regresyon analizinin sonuçları, GAS'ın hastalık aktivitesinin %19.8'ini açıkladığını gösterdi. FEA (r=0.445, p=0.002) ağrı şiddetini anlamlı şekilde tahmin etti. Ayrıca SSÖ hastalık aktivitesinin %29.1'ini açıklarken, FEA (r=0.539, p<0.001) santral sensitizasyonu anlamlı şekilde öngörüldü.

Sonuç: Yüksek hastalık aktivitesi FMS'li hastalarda santral sensitizasyon ve vücut farkındalığını olumsuz bir şekilde etkilemektedir. Klinisyenler yüksek hastalık aktivitesi olan hastaların yönetiminde rutin tedavilere ek olarak multimodal biyopsikososyal bakış açısını da göz önünde bulundurmalıdır.

Anahtar Kelimeler

beden farkındalığı , fibromiyalji sendromu , hastalık aktivitesi , santral sensitizasyon

The Role of Disease Activity as a Determinant of Central Sensitivity and Body Awareness in Fibromyalgia Patients: A Cross-Sectional Study

Öz

Purpose: The present study aimed to identify the influence of disease activity on central sensitization (CS) and body awareness in fibromyalgia syndrome (FMS) patients.

Materials and Methods: Forty-five patients with FMS (mean age: 45.9 (6.9) years, median disease duration: 3 (2-6) years) were participated this cross-sectional study. Disease activity was assessed using the Fibromyalgia Impact Questionnaire (FIQ) and higher score was considered high disease activity. The Central Sensitization Inventory (CSI) was performed for central sensitivity. Body awareness levels were evaluated with the Body Awareness Questionnaire (BAQ). Visual Analogue Scale (VAS) was used to identify pain severity. Simple linear regression analyses were used to determine which independent variables could explain disease activity.

Results: The mean FIQ and BAQ were 53.4 and 90 points, respectively. The median VAS and CSI were 8 cm and 52 point, respectively. The CS is positive in 82.2% of all patients. FIQ was moderately correlated with the VAS score (r=0.445, R2=0.198, p=0.002) and is highly correlated with CSI (r=0.539, R2=0.291, p<0.001). There was no significant correlation between FIQ and BAQ (p=0.791). The results of the simple linear regression analysis presented that VAS explained 19.8% of the the disease activity. FIQ (r=0.445, p=0.002) significantly predicted pain severity. Additionally, The CSI explained 29.1% of the disease activity and FIQ (r=0.539, p<0.001) significantly predicted CS.

Conclusion: High disease activity negatively impacts CS and body awareness in FMS patients. Clinicians should consider a multimodal biopsychosocial perspective in addition to routine treatments in the management of patients with high disease activity.

Anahtar Kelimeler

body awareness , central sensitization , fibromyalgia syndrome , disease activity

Etik Beyan

This study was conducted granted by the Necmettin Erbakan University Non-Invasive Clinical Research Ethics Committee (Decision No: 2024/4831). All patients were informed about the study and then their written consent was obtained. The study was performed in regarding the Declaration of Helsinki’s principles.

Kaynakça

• 1. Häuser W, Ablin J, Fitzcharles M, et al. Fibromyalgia. Nat Rev Dis Primers. 2015;1(15022):1-16.
• 2. Cabo A, Cerdá G, Trillo J. Fibromyalgia: Prevalence, epidemiologic profiles and economic costs. Med Clin. 2017;149(10):441-448.
• 3. Sarmer S, Ergin S, Yavuzer G. The validity and reliability of the Turkish version of the Fibromyalgia Impact Questionnaire. Rheumatol Int. 2000;20(1):9-12.
• 4. Russell IJ, Larson AA. Neurophysiopathogenesis of fibromyalgia syndrome: a unified hypothesis. Rheum Dis Clin North Am. 2009;35(2):421-435.
• 5. Nijs J, Meeus M, Van Oosterwijck J, et al. In the mind or in the brain? Scientific evidence for central sensitisation in chronic fatigue syndrome. Eur J Clin Invest. 2012;42(2):203-212.
• 6. Meeus M, Nijs J. Central sensitization: a biopsychosocial explanation for chronic widespread pain in patients with fibromyalgia and chronic fatigue syndrome. J Clin Rheumatol. 2007;26(4):465-473.
• 7. Williams DA, Gracely RH. Biology and therapy of fibromyalgia. Functional magnetic resonance imaging findings in fibromyalgia. Arthritis Res Ther. 2006; 8(224):1-8.
• 8. Cagnie B, Coppieters I, Denecker S, Six J, Danneels L, Meeus M. Central sensitization in fibromyalgia? A systematic review on structural and functional brain MRI. Semin Arthritis Rheum. 2014;44(1):68-75.
• 9. Baskan E, Yagci N, Cavlak U. Factors affecting body awareness in older adults with chronic musculoskeletal pain. Arch Med Sci. 2021;17(4):934-939.
• 10. Apaydın H, Apaydın ZB. The role of disease activity as a determinant of body awareness and central sensitization in patients with axial spondyloarthritis: a cross-sectional study. J Health Sci Med. 2023;6(5): 1022-1028.
• 11. Bravo C, Skjaerven LH, Sein-Echaluce LG, Catalan-Matamoros D. Effectiveness of movement and body awareness therapies in patients with fibromyalgia: a systematic review and meta-analysis. Eur J Phys Rehabil Med. 2019;55(5):646-657.
• 12. Skjaerven LH, Mattsson M, Catalan-Matamoros D, Parker A, Gard G, Gyllensten AL. Consensus on core phenomena and statements describing Basic Body Awareness Therapy within the movement awareness domain in physiotherapy. Physiother Theory Pract. 2019;35(1):80-93.
• 13. Durlik C, Cardini F, Tsakiris M. Being watched: The effect of social self-focus on interoceptive and exteroceptive somatosensory perception. Conscious Cogn. 2014;25(2014):42-50.
• 14. Gyllensten AL, Hui-Chan CW, Tsang WW. Stability limits, single-leg jump, and body awareness in older Tai Chi practitioners. Arch Phys Med Rehabil. 2010;91(2):215-220.
• 15. Erden A, Altuğ F, Cavlak U. Investigation of the relationship between body awareness, pain, emotional status, and quality of life among healthy people. J Kartal TR. 2013;24(3):145-150.
• 16. Akkaya N, Akkaya S, Atalay NS, Balci CS, Sahin F. Relationship between the body image and level of pain, functional status, severity of depression, and quality of life in patients with fibromyalgia syndrome. Clin Rheumatol. 2012;31(6):983-988.
• 17. Tahran Ö, Ersöz Hüseyinsinoğlu B, Yolcu G, Karadağ Saygı E. Internet-based basic body awareness therapy in fibromyalgia syndrome: A report of three cases. Modern Mod Rheumatol Case Rep. 2023;7(2): 464-469.
• 18. Courtois I, Cools F, Calsius J. Effectiveness of body awareness interventions in fibromyalgia and chronic fatigue syndrome: a systematic review and meta-analysis. J Bodyw Mov Ther. 2015;19(1):35-56.
• 19. Gunel M, Yağli NV, Kerem Günel M, et al. Effect of body awareness therapy on fibromyalgia syndrome in women: a randomized controlled trial. J Exercise Ther Rehabil. 2014;1(2):43-48.
• 20. Wolfe F, Clauw DJ, Fitzcharles MA, et al. The American College of Rheumatology preliminary diagnostic criteria for fibromyalgia and measurement of symptom severity. Arthritis Care Res (Hoboken) 2010;62(5):600-610.
• 21. Begum MR, Hossain MA. Validity and reliability of visual analogue scale (VAS) for pain measurement JMCRR 2019;2(11):394-402.
• 22. Keleş ED, Birtane M, Ekuklu G, et al. Validity and reliability of the Turkish version of the central sensitization inventory. Arch Rheumatol. 2021;36(4):518-526.
• 23. Karaca S, Bayar B. Turkish version of body awareness questionnaire: validity and reliability study. Turk J Physiother Rehabil. 2021;32(1):44-50.
• 24. Mukaka MM. A guide to appropriate use of correlation coefficient in medical research. Malawi Med J. 2012;24(3):69-71.
• 25. Kalkışım ŞN, Erden A, Kanber Uzun Ö, Ertemoğlu Öksüz C, Zihni NB, Çan MA. Relationship between body awareness level and musculoskeletal pain complaints, physical activity level and emotional status in healthy people. Acta Neurol Belg. 2023;123(5):1789-1796.
• 26. Kieselbach K, Fauler I, Abberger B. Patients With Chronic Pain: The Aspect Of Negative Body Image. Psychother Psychosom Med Psychol. 2024;74(9-10): 369-375.
• 27. Van Overmeire R, Vesentini L, Vanclooster S, Muysewinkel E, Bilsen J. Body Image, Medication Use, and Mental Health among Women with Fibromyalgia in Flanders, Belgium. Int J Environ Res Public Health. 2022;19(1418):1-8.
• 28. Casas-Barragán A, Molina F, Tapia-Haro RM, García-Ríos MC, Correa-Rodríguez M, Aguilar-Ferrándiz ME. Association of core body temperature and peripheral blood flow of the hands with pain intensity, pressure pain hypersensitivity, central sensitization, and fibromyalgia symptoms. Ther Adv Chronic Dis. 2021;12:1-17.
• 29. Lima D, Pacheco-Barrios K, Slawka E, et al. The role of symptoms severity, heart rate, and central sensitization for predicting sleep quality in patients with fibromyalgia. Pain Med. 2023;24(10):1153-1160.
• 30. Valera‐Calero JA, Úbeda‐D'Ocasar E, Arias‐Buría JL, Fernández‐de‐las‐Peñas C, Gallego‐Sendarrubias GM, Cigarán‐Méndez M. Convergent validity of the central sensitization inventory in women with fibromyalgia: Association with clinical, psychological and psychophysical outcomes. European Journal of Pain. 2022;26(10):2141-2151.
• 31. Guler MA, Celik OF, Ayhan FF. The important role of central sensitization in chronic musculoskeletal pain seen in different rheumatic diseases. Clin Rheumatol. 2020;39(1):269-274.
• 32. Garcia-Hernandez A, de la Coba P, Reyes Del Paso G. Central sensitisation pain and autonomic deficiencies in fibromyalgia. Clin Exp Rheumatol. 2022;40(6): 1202-1209.
• 33. Cigarán-Méndez M, Úbeda-D’Ocasar E, Arias-Buría J, et al. Pain extent is associated with Central Sensitization Inventory but not widespread pressure pain sensitivity or psychological variables in women with fibromyalgia. Scand J Rheumatol. 2023;52(3):268-275.
• 34. Rehm S, Sachau J, Hellriegel J, et al. Pain matters for central sensitization: sensory and psychological parameters in patients with fibromyalgia syndrome. Pain Rep. 2021;6(1):901.
• 35. Salaffi F, Farah S, Mariani C, Sarzi‐Puttini P, Di Carlo M. Validity of the Central Sensitization Inventory compared with traditional measures of disease severity in fibromyalgia. Pain Pract. 2022;22(8):702-710.