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Lung Function, Respiratory Muscle Strength, and Thoracoabdominal Mobility in Women with Fibromyalgia Syndrome

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Lung Function, Respiratory Muscle Strength, and Thoracoabdominal Mobility in Women with Fibromyalgia Syndrome Lung Function, Respiratory Muscle Strength, and Thoracoabdominal Mobility in Women With Fibromyalgia Syndrome Meire Forti MSc, Antonio R Zamune´r PhD, Carolina P Andrade, and Ester Silva PhD BACKGROUND: Fibromyalgia syndrome (FMS) is associated with a variety of symptoms, such as fatigue and dyspnea, which may be related to changes in the respiratory system. The objective of this work was to evaluate pulmonary function, respiratory muscle strength, and thoracoabdominal mobility in women with FMS and its association with clinical manifestations. METHODS: The study included 23 women with FMS and 23 healthy women (control group). Pulmonary function, respiratory muscle strength, and thoracoabdominal mobility were assessed in all participants. Clinical manifestations such as number of active tender points, pain, fatigue, well-being, and general pressure pain threshold and pressure pain threshold in regions involved in respiratory function were also assessed. For data analysis, the Mann-Whitney test and Spearman correlation coefficient were used. RESULTS: The FMS group showed lower values of maximum voluntary and cirtometry at the axillary ,(003. ؍ maximal inspiratory pressure (P ,(030. ؍ ventilation (P and xiphoid levels (P < .001 and P < .001, respectively) as well as higher cirtometry at the compared with the control group. However, there was no significant (005. ؍ abdominal level (P difference between groups for maximum expiratory pressure. In predicted percentage, maximal ,0.41 ؍ inspiratory pressure showed significant positive correlation with axillary cirtometry (r ,؊0.44؍ and negative correlation with the number of active tender points (r (049. ؍ P CONCLUSIONS: Subjects with FMS had lower .(049. ؍ ؊0.41, P؍ and fatigue (r (031. ؍ P respiratory muscle endurance, inspiratory muscle strength, and thoracic mobility than healthy sub- jects. In addition, inspiratory muscle strength was associated with the number of active tender points, fatigue, and axillary mobility. Key words: fibromyalgia; respiratory muscle strength; lung function; respiratory function tests; respiratory mechanics; respiratory muscles. [Respir Care 2016;61(10):1384–1390. © 2016 Daedalus Enterprises] Introduction fuse chronic pain of non-inflammatory origin and hyper- sensitivity in specific anatomical sites, called tender points.2 Fibromyalgia syndrome (FMS) is a rheumatic condition Although pain in FMS is widespread, the most affected of increasing prevalence worldwide,1 characterized by dif- regions are related to respiratory mechanics, such as the upper trapezius muscle, the suboccipital muscles, the an- terior cervical region, and the second rib.3 The literature reports that diseases that promote pain and stiffness of The authors are affiliated with the Department of Physical Therapy, Federal University of Sa˜o Carlos, Sa˜o Carlos, Sa˜o Paulo, Brazil. thorax and spine muscles can decrease the functional ca- pacity of muscles involved in breathing, facilitating the This study was supported by Sa˜o Paulo Research Foundation (FAPESP) development of respiratory disorders.4 Grants 2013/16008-0 and 2011/22122-5 and by National Council for Thus, the presence of pain in regions related to respi- Scientific and Technological Development (CNPq) Grants 483032/2012-3 and 307187/2013-6. The authors have disclosed no conflicts of interest. ratory mechanics and the presence of symptoms, such as dyspnea and fatigue, have drawn attention to the respira- Correspondence: Meire Forti MSc, Department of Physical Therapy, tory evaluation in women with FMS.5-10 However, the Federal University of Sa˜o Carlos, Rodovia Washington Luís, Km 235, 13565-905, Sa˜o Carlos, SP, Brazil. E-mail: [email protected]. results are still incipient, and some of them are contradic- tory. Kesiktas et al10 reported an obstructive respiratory DOI: 10.4187/respcare.04401 pattern in women with FMS, due to the lower values of 1384 RESPIRATORY CARE • OCTOBER 2016 VOL 61 NO 10 CLINICAL MANIFESTATIONS OF FIBROMYALGIA SYNDROME 7-9 FEV1 and FEV1/FVC. On the other hand, other studies have found no abnormalities in the lung function of women QUICK LOOK with FMS. Current knowledge Regarding respiratory muscle strength and thoracic mo- Fibromyalgia syndrome (FMS) is a rheumatic condi- bility, Ozgocmen et al7 found reduced values in subjects with FMS compared with healthy subjects. However, Sa- tion characterized by widespread chronic pain. Never- theless, the most affected regions are related to respi- hin et al8 observed impairment only in respiratory muscle strength, with no change in thoracic mobility. The causes ratory mechanics. Respiratory muscle strength is of these changes are still unknown, but some hypotheses reduced in subjects with FMS compared with healthy subjects, although the causes of these changes are still have been proposed. Ozgocmen et al7 suggested that re- spiratory muscle weakness in subjects with FMS can be unknown. Results regarding pulmonary function and explained by the low thoracic mobility and that painful thoracic mobility are controversial. reflex inhibition, caused by the fear of pain, might be one What this paper contributes to our knowledge of the major factors explaining this relationship. Con- versely, some studies8,10 have proposed that the low respi- Subjects with FMS had lower respiratory muscle en- ratory muscle strength and thoracic mobility are due to durance, inspiratory muscle strength, and thoracic mo- respiratory muscle dysfunction that stems from low levels bility than healthy subjects. Inspiratory muscle strength of physical activity in this population. However, despite was associated with the number of active tender points, the hypotheses raised by previous studies, whether the fatigue, and axillary mobility. respiratory dysfunction is related to clinical manifestations, such as number of tender points, fatigue, and pain, still remains to be clarified. In addition, to our knowledge, no studies have assessed pressure pain threshold in specific Exclusion criteria were smoking, history of systemic regions involved in respiratory function or abdominal mo- diseases such as diabetes mellitus, hypertension or any bility in FMS. respiratory, cardiac or neurological disease, difficulties in Based on the above, it was hypothesized that subjects understanding the experimental procedures, obesity (body Ͼ 2 with FMS have lower respiratory muscle strength and lower mass index, BMI 40 kg/m ), regular practice of physical thoracoabdominal mobility, despite normal lung function. activity, according to the International Physical Activity In addition, these changes are expected to be associated Questionnaire (IPAQ)11, or use of drugs that could influ- with clinical symptoms, such as pain, fatigue, and low ence the variables studied (i.e. bronchodilators, analgesics, pressure pain threshold, in regions related to respiratory tranquilizers or antidepressants). All participants read and function. Thus, the present study aimed to evaluate lung signed an informed consent form approved by the Institu- function, respiratory muscle strength, and thoracoabdomi- tion Ethics Committee for Research on Human Subjects nal mobility as well as to evaluate the relationship between (protocol 112.508). these variables and the clinical symptoms presented by women with FMS. Experimental Procedures Methods All measurements were carried out in the morning (8 AM to 12 PM) by the same evaluator. Room temperature was Study Design and Participants maintained at 22°C, and relative air humidity was main- tained at 40–60%. A cross-sectional case-control study was carried out be- All participants attended the laboratory 3 times, sepa- tween December 2013 and August 2014 at the Federal rated by an interval of at least one week. The first visit University of Sa˜o Carlos. One hundred twenty potential consisted of anamnesis and clinical and physical exami- volunteers with clinical diagnosis of primary FMS (the nations. In the second visit, participants underwent exer- FMS group), according to criteria from the American Col- cise testing, supervised by a cardiologist. The hemody- lege of Rheumatology,2 were screened, and 23 eligible namic variables evaluated during this test showed behavior subjects participated in the study. Twenty-three healthy as expected, and no evidence of electrocardiographic women matched to the FMS group for age, body mass changes was found. On the same day, participants were index, and level of physical activity11 composed the healthy acquainted with the research protocol and were instructed control group. Participants were recruited through an- to abstain from stimulants (eg, coffee, tea, soft drinks) and nouncements made in the university physical therapy and alcoholic beverages for 24 h before examination and to rheumatologic and orthopedic clinics, social media, and have a light meal at least 2 h before the test. To avoid any personal invitation. residual fatigue, subjects were asked to refrain from stren- RESPIRATORY CARE • OCTOBER 2016 VOL 61 NO 10 1385 CLINICAL MANIFESTATIONS OF FIBROMYALGIA SYNDROME uous physical activity at least 2 days before the tests. The Table 1. Age, Body Mass Index, and Cardiorespiratory Baseline third visit was devoted to clinical manifestations, lung Characteristics and Clinical Manifestations of the function, respiratory muscle strength, and thoracoabdomi- Fibromyalgia Syndrome Group and Control Group nal mobility assessments. Upon arrival at the laboratory, Characteristics/Clinical FMS Control participants were asked about their health status and
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