Effects of a multidisciplinary rehabilitation program for men with fibromyalgia: controlled randomized study
DOI:
https://doi.org/10.11606/issn.2317-0190.v14i4a102862Keywords:
Fibromyalgia, Pain, Quality of Life, Patient Care Team, Rehabilitation, MenAbstract
Fibromyalgia (FM) is a chronic widespread syndrome associated to sleep disturbances, fatigue and a myriad of other symptoms. Ten percent of patients are males. Gender differences related to pain perception may be explained by influences of genetics, metabolism, cognition, behavior, and emotions. Men with FM have less objective complaints, except for sleep disturbances and widespread pain. There is little evidence on the presentation, outcomes, treatment approach and prognosis of fibromyalgia in men. Objectives: To assess the effectiveness of a multidisciplinary rehabilitation program for male adults of working age with FM and study FM characteristics in men. Methods: Twenty-five men with FM were enrolled. Ten men with diagnosed FM were randomly assigned to one of two groups. The Treatment group consisted of a 2-month multidisciplinary rehabilitation program that included classes and therapy, administered by a multidisciplinary team consisting of a physiatrist, a social worker, a psychologist, a physical therapist, an occupational therapist, a nurse, a nutritionist and a physical educator. The Control group received standard treatment focused on outpatient management and advice to practice physical exercises inside the community. Both groups received standard medical care and medication prescriptions. Outcome measures included the Visual Analog Scale, SF36, and FIQ; additionally, a standard protocol inquiring about sleep/ depression/ memory disturbances and work status was filled out by a blinded examiner. Outcomes were measured at the beginning and at the end of the intervention, as well as at 4-month follow-up. Statistical analysis included non-parametric and descriptive tests. Results: There was a statistically significant improvement in the Treatment group observed at the Pain domain of FIQ and Pain/ Vitality/ Mental Health domains of SF 36. No improvement was sustained during the follow-up (6 months after treatment). Age averages were 50.6 (controls) and 44.2 (treatment), and a high prevalence of sick leaves, depression and sleep disturbances were observed, with no changes in absolute numbers during the 3 measurements, as well as in the number of FM tender points. Conclusions: Men with FM are likely to benefit from a multidisciplinary rehabilitation only for a short span of time. The measurements’ decrease to baseline values suggests the loss of improvement 6 months after the intervention, which is in agreement with previous researches. Studies with larger samples and longer follow-up periods are necessary to verify the effectiveness of the program. FM and its specific characteristics in men are not well understood and should be analyzed in further studies, particularly aiming at clinical specificities, evolution and social aspects, as such elements are the cornerstone to design and implement the ideal rehabilitation program for men with FM. Comparative studies aiming at men and women with fibromyalgia are recommended.
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