Alterations in sleep quality, depression, anxiety and somatic symptoms in patients with fibromyalgia syndrome with treatment

Objective: Fibromyalgia is a syndrome characterized by widespread musculoskeletal pain accompanied by fatigue; sleep disturbance, cognitive changes, mood disturbance and other somatic symptoms. Disordered sleep is such a prominent symptom in fibromyalgia that the American College of Rheumatology included symptoms such as waking unrefreshed, fatigue, tiredness, and insomnia in the 2010 diagnostic criteria for fibromyalgia. Long term outcome for the majority of patients with fibromyalgia, is sufficiently disappointing so that most patients can be considered to have resistant disease. In the treatment which symptoms to what extent is healed remains controversial. The aim of this study is to investigate the changes in symptoms among responsive and nonresponsive groups after the treatment.

Methods: 34 patients diagnosed as having fibromyalgia (FM) in Erenkoy Physical Therapy and Rehabilitation Hospital outpatient clinic were included in this study and 27 patients with FM completed the evaluation with Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), Fibromyalgia Impact Questionnaire (FIQ), Visual Analog Scale (VAS), Patient Health Questionnaire Somatic, Anxiety, and Depressive Symptom Scales (PHQ-SADS) and Polysomnography (PSG) before medical treatment. In the sixth week of the treatment, the evaluation was repeated. Treatment response defined as 14% decrease on FIQ. The responsive group was compared with the nonresponsive group; and the values obtained before and after the treatment were compared for each group. In drug treatment, drug choice, the duration of treatment and the dose has been şexible.

Results: In the nonresponsive group only PSQI scores improved significantly (z:-2,077, p:0.038).Other parameters (ESS, FIQ, VAS, PHQ-SADS, PSG) are not significant. In the responsive group all the parameters (PSQI, PHQ15, GAD 7, PHQ 9, FIQ, VAS; respectively z:-2.522, p:0.012; z:-3.309, p:0.001; z:-2,042, p:0.041; z:-2,563, p:0.010; z:-3,621, p<0.001; z:-3.181, p:0.001) improved significantly, except sleepiness and PSG data. In both groups, subjective sleep quality improved but objective sleep measurements and sleepiness did not get better. In the responsive group; pain, depression, anxiety and somatic symptoms were significantly improved.

Conclusion: In the treatment response of fibromyalgia, the improvement of pain, depression, anxiety and somatic symptoms are more significant than subjective sleep quality. Despite the treatment, sleepiness and objective sleep measurements may not improve in both responsive and nonresponsive groups. These findings supports difficulty in treatment of fibromyalgia and this difficulty may be due to unimproved sleep.