Background: Somatosensory temporal discrimination (STD) is the detection of two separate stimuli applied to the body over a short period of time (1). It is thought that STD provides information about the central processing of sensory stimuli. It has recently been reported that STD is impaired in fibromyalgia syndrome (FMS), which is considered to be the prototype of central sensitization syndromes (2).
Objectives: To evaluate the effect of dynamic exercise program on STD in patients with FMS.
Methods: The study included 48 female FMS patients diagnosed according to the ACR 2010 classification criteria who applied to outpatient clinics of Physical Medicine and Rehabilitation Department. Patients with inflammatory rheumatic disease, peripheral and central neurological disease, history of malignancy and cardiac problems, and those who started a new medical therapy or exercise program related to FMS in the last 3 months were excluded. Before the study, local ethics committee approval was obtained. The study was designed as a prospective, randomized, single blind and controlled study. The patients were divided into two groups. Those included in the supervised exercise group (SEG) were given an exercise program that consisted of submaximal aerobic exercise (treadmill) and low-medium resistant isotonic exercises under the supervision of a physiotherapist, 1-hour per day, 3 days in a week for 4-weeks. Those included in the home exercise group (HEG) were given a home exercise program that consisted of low-to-medium resistance isotonic exercises and aerobic exercises 1-hour per day, 3 days in a week for 4-weeks. All patients were evaluated at baseline and after 4 weeks of treatment. Visual analogue scale (VAS) for pain, hospital anxiety and depression scales (anxiety: HADA, depression: HADD), fibromyalgia effect questionnaire (FIQ), symptom severity scale (SSS) were used for clinical assessment. Additionally somatosensory temporal discrimination threshold (STDT) was measured by a blinded investigator. In order to achieve a difference of 25ms in STDTs between two groups, we calculated 20 FMS patients per group (power: 80%, alpha: 0.05 two sided) (2). However, 24 patients were included in the study because of the 20% chance of discontinuation. For the demographic, basal clinical and neurophysiological comparisons between the two groups, the independent sample-T test was used for the normally distributed data, and the Mann Whitney U test was used for the non-normally distributed data. In order to assess the effect of treatment on outcome measures, 2-way repeated measures of variance analysis (Treatment group x time) was used. Intention to treat analysis was performed.
Results: There were statistically significant changes in the VAS, HADA, HADD, FIQ and SSS scores and STDTs in both groups after treatment programs (p <0.001). In the 2-way repeated measures of variance analysis, the treatment group x time interactions for VAS, HADA, HADD, FIQ and SSS scores were found to be significant in favor of the supervised exercise group (p <0.05). However, no statistically significant interaction (treatment group x time) was found for STDT (p: 0.18).
Conclusion: We demonstrated that STD improves with exercise in patients with fibromyalgia for the first time. However, this change was similar in both groups. Additionally, we showed that dynamic exercise program ameliorates pain, psychological status, function and other symptoms related to fibromyalgia syndrome.
References:  Lacruz F, Artieda J, Pastor M A, Obeso J A. The anatomical basis of somaesthetic temporal discrimination in humans. J Neurol Neurosurg Psychiatry. 1991;54:1077-1081
 Gunendi Z, Polat M, Vuralli D, Cengiz B. Somatosensory temporal discrimination is impaired in fibromyalgia. J Clin Neurosci. 2019; 60:44-48
Disclosure of Interests: None declared
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