Year: 2014
Type: dissertation
Abstract: espanolRESUMEN Introduccion: la fibromialgia es un sindrome de sensibilidad central caracterizado por la presencia de dolor generalizado, fatiga, rigidez, trastornos del sueno y problemas cognitivos; estos sintomas se acompanan frecuentemente de ansiedad y depresion, alteracion del funcionamiento y disfuncion sexual. La funcion sexual es un aspecto importante de la salud humana y de la calidad de vida del individuo. La mayoria de los pacientes con fibromialgia consideran que la capacidad sexual es un aspecto importante de sus vidas. Varias enfermedades que cursan con dolor cronico, incluyendo la fibromialgia, se han asociado a la presencia de disfuncion sexual. Sin embargo, la literatura sobre disfuncion sexual en pacientes con fibromialgia era limitada y estaba restringida a pacientes del sexo femenino. El objetivo de nuestro estudio fue evaluar la funcion sexual en mujeres y hombres con fibromialgia en comparacion con la de controles sanos. Pacientes y Metodos: para este estudio utilizamos datos basales de varios estudios realizados en pacientes de ambos sexos con fibromialgia en los que se habia incluido una evaluacion de la funcion sexual. Los criterios de inclusion de los estudios de donde se obtuvieron los datos basales de los pacientes eran muy similares en todos ellos: hombres y mujeres de 18 o mas anos, que cumplieran los criterios diagnosticos de fibromialgia del American College of Rheumatology de 1990 y que no hubieran respondido de forma satisfactoria al tratamiento previo para la fibromialgia, considerando como respuesta no satisfactoria presentar una puntuacion superior a 4 en el item de severidad del dolor del Cuestionario para la Evaluacion del Impacto de la Fibromialgia (FIQ). Como grupo control se selecciono un grupo de sujetos sanos emparejados con el de pacientes por edad y sexo. Los criterios de exclusion para los controles sanos incluyeron la existencia de enfermedad medica o psiquiatrica relevante y la utilizacion de farmacos que tengan un impacto negativo en la funcion sexual (por ejemplo, antihistaminicos H2 y antidepresivos). La severidad de la enfermedad se evaluo con la FIQ. La funcion sexual se evaluo con el Cuestionario de Cambios en la Funcion Sexual (CSFQ), una herramienta validada en pacientes con depresion tanto en su version original en ingles como en su adaptacion espanola. Se calculo la proporcion de pacientes que presentan disfuncion sexual (esto es, con una puntuacion total en el CSFQ igual o menor de 41 en mujeres y de 47 en hombres). Se compararon las puntuaciones del CSFQ entre pacientes y controles y se calculo el tamano del efecto para la diferencia de medias. Resultados: nuestra muestra incluyo 293 pacientes con fibromialgia (276 mujeres y 17 hombres) y 86 controles sanos (72 mujeres y 14 hombres). La frecuencia de disfuncion sexual fue significativamente mas elevada en pacientes con fibromialgia que en controles, tanto en mujeres (86,9% vs. 23,6%; riesgo relativo [RR] 3,7, IC 95%, 2,4 a 5,6) como en hombres (76,5% vs. 6,7%; RR 11,5, IC 95%, 1,7 a 77,6). En mujeres, las pacientes con fibromialgia presentaron un puntuacion total del CSFQ significativamente mas baja que las controles (diferencia de medias -14,4, IC 95%, -16,7 a -12,1, p EnglishABSTRACT Introduction: Fibromyalgia is a central sensitivity syndrome characterized by the presence of widespread pain, fatigue, stiffness, sleep disturbances and cognitive problems; frequently accompanied by anxiety and depressive symptoms, impaired functioning and sexual dysfunction. Sexual functioning is an important aspect of the human health and individuals? quality of life. Most patients with fibromyalgia believe that sexual ability is an important aspect of their lives. Sexual dysfunction has been associated with several chronic pain conditions, including fibromyalgia. However, the literature on sexual functioning in patients with fibromyalgia was limited and restricted to female patients. The aim of our study was to evaluate sexual functioning in female and male patients with fibromyalgia compared to healthy controls. Patients and Methods: We used baseline data from several studies performed in adult patients with fibromyalgia of both sexes in which sexual functioning was included in the clinical evaluation. Selection criteria were very similar across the studies: male or female patients who were 18 years or older, met the American College of Rheumatology criteria for the diagnosis of fibromyalgia and had not satisfactorily responded to their previous fibromyalgia treatment (i.e., they had a score > 4 on the pain severity item of the Fibromyalgia Impact Questionnaire) were included in the studies. As a control group, we selected an age- and sex-matched group of healthy subjects. The exclusion criteria for healthy controls included evidence of relevant medical or psychiatric illness and the use of drugs that have a negative impact on sexual functioning (e.g., H2 blockers and antidepressants). Disease severity was evaluated using the Fibromyalgia Impact Questionnaire (FIQ). Sexual functioning was evaluated using the Changes in Sexual Functioning Questionnaire (CSFQ), an assessment tool validated in patients with depression in the original English version and in the Spanish version. We calculated the proportion of patients exhibiting sexual dysfunction (i.e., a CSFQ total score equal to or lower than 41 in females, and 47 in males). CSFQ scores for patients and controls were compared, and the effect sizes for the difference of means were calculated. Results: Our sample comprised 293 patients with fibromyalgia (276 females and 17 males) and 86 healthy controls (72 females and 14 males). The frequency of sexual dysfunction was significantly higher in patients with fibromyalgia than in controls for both females (86.9% vs. 23.6%; relative risk [RR] 3.7, 95% CI, 2.4 to 5.6) and males (76.5% vs. 6.7%; RR 11.5, 95% CI, 1.7 to 77.6). In females, patients with FMS exhibited a significantly lower total score on the CSFQ compared to controls (difference in the means -14.4, 95% CI, -16.7 to-12.1, p Conclusions: Despite the several limitations of the design, our results show that sexual dysfunction is common in patients with fibromyalgia. The disease seems to deeply affect all dimensions of sexual functioning in both females and males. Age, psychological symptoms, especially depression, and the use of antidepressants appear to be the main determinants of the presence of sexual dysfunction in these patients.
Author: Fernando Rico‐Villademoros
Language: Spanish
Subfield: Psychiatry and Mental health
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W167106589