IIntroduction: Fibromyalgia (FM) is a chronic pain syndrome characterized by musculoskeletal pain, coupled with fatigue, stiffness, disordered sleep, perceived cognitive dysfunction, and mood disturbances. FM affects around 1.78% of worldwide population, and around 2.4% of Spanish population. Additionally, a high percentage of FM patients (84% in Spain) presents comorbid pathologies. FM impact on everyday life of patients who suffer it is usually severe and affects at multiple levels. One of the main problems in research and clinical practice related to FM is the lack of biomarkers for diagnose. The main aims of this thesis is to define the immune profile of people with FM, and to study the its role on the physiopathology and maintenance of FM symptomatology. Additionally, there are no curative treatments for FM. However, evidence-based guidelines on the treatment of FM agree on the recommendations of multidisciplinary and multicomponent interventions directed towards the specific symptomatology of each individual patient. Within psychological interventions, Mindfulness Based Interventions (MBIs), and specifically Mindfulness Based Stress Reduction (MBSR) are arising as promising interventions to accomplish a better quality of life, and a lesser impairment in functionality associated to FM. Objectives: This thesis is presented in two sections, the first is focused on determining the immunological differences between FM and CS through two studies. The first is a case-control study compares the immunological profiles of patients with FM vs a group of healthy women, controlling by cofounding variables; the second one is a meta-analysis, which seeks to contrast the results obtained in the first study considering the published data so far. In the second block of the thesis, the focus is on the mindfulness effects in clinical severity and the immune system of patients with FM. Conclusions FM patients present a characteristic immune-inflammatory profile, different from persons without the syndrome. These differences are maintained even after controlling by cofounding variables. This immune profile presents an anomalous upregulation of the IRS/CIRS phenotypes. Lower levels of IL-10 seem to be significantly related with the FM diagnose, while lower levels of IL-6, IL-10 and CXCL-8 contribute to the prediction of the chronic pain levels of these patients. MBSR is an effective intervention to reduce clinical symptomatology, severity, functional impairment, depressive symptomatology and perceived stress in patients with FM. Additionally, MBSR intervention had a significant effect on IL-10, since its levels decreased in the treatment as usual group, but not after MBSR, suggesting a potential effect of the intervention on the immune regulation in patients with FM. MBSR efficacy on reducing perceived pain was buffered when FM patients presented higher basal levels of CXCL-8. At the same time, there was a similar association between higher levels of IL-6/IL-10 and CXCL-8/IL-10 and less improvement in psychological inflexibility after MBSR. The results of this thesis provide new information regarding the immune profile of people suffering from FM, and the potential of MBSR as an adjuvant intervention.
Caracterització del perfil immunoinflamatori i efectes del Mindfulness en pacients amb fibromiàlgia
Andrés Rodriguez, L. (Author). 22 Jul 2020
Student thesis: Doctoral thesis
Student thesis: Doctoral thesis