Impacto de um programa de educação em saúde sobre aspectos neuroimunocomportamentais de pacientes com diagnostico de fibromialgia

Abstract

Fibromyalgia (FM) is a clinical condition characterized by the presence of chronic and widespread pain, which is often accompanied by other symptoms such as sleep disturbances, fatigue, anxiety and depression. The pathophysiology of FM has not yet been fully elucidated and no really effective treatment is available. Besides pharmacological treatment, a series of non-pharmacological interventions has been tested with encouraging results. Among them, the health education programs (HEP), however, to date, do not know if the benefits provided by the HEP are limited to subjective perception of patients or are supported by biochemical and physiological changes. The aim of this study was to evaluate the impact of the Inter-relational School of Fibromyalgia (ISF), a model of HEP specific to patients with FM, on some markers of immune activity (IL-2, IL-4, IL-6, IL-10, TNF, IFN and IL-17A), neuroendocrine activity (cortisol and 6-sulfatoxymelatonin) and behavioral (anxiety and quality of life). To this end, 58 women with FM and 39 healthy controls were recruited. Before assessing the impact of the ISF on biomarkers, a comparative analysis of the biomarkers concentrations between patients and healthy controls was performed. Then the group of patients was divided into two groups: treated patients (TP) and untreated patients (UP). The TP group underwent 11 weeks of intervention by ISF while the UP group was waiting to be attended and served as control. After the end of the intervention in the TP group, all variables were again analyzed in both groups of patients in order to determine the influence of treatment on them. The statistical analysis was performed using the GraphPad Prism v.5 and PASW v.18, the significance level of all tests was set to =0.05 ( p0.05 ). The results showed that patients with FM showed significant increase: in plasma levels of IL-2, IL-4, TNF, IFN, IL- 17A and significant reduction: in the ratio anti-inflammatory cytokines / proinflammatory cytokines, in salivary cortisol levels at 8 am and 5 pm and in urinary levels of 6-sulphatoxymelatonin, besides they present unsatisfactory levels of quality of life. The results also demonstrated that the ISF was significantly effective on: the quality of life, plasma levels of IL-4 and IL-10, ratio anti-inflammatory cytokines / pro-inflammatory cytokines and salivary cortisol levels at 8 am in treated FM patients. This study demonstrated that although the pathophysiology of FM is the result of a complex interaction between immune, neuroendocrine and behavioral mechanisms, patients with FM may be benefit clinically by participating in health education programs such as the ISF and that this clinical benefit is not limited to the subjective perception of patients, but can be supported by biochemical and physiological changes.