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Publications

  • Zettel-Watson, L., *Suen, M., *Wehbe, L., Rutledge, D.N., & Cherry, B.J. (2015) Aging well: Processing speed, inhibition and working memory related to balance and aerobic endurance. Geriatrics & Gerontology International. doi: 10.1111/ggi.12682

    PURPOSE: The present study explored whether certain physical performance measures could be linked to specific cognitive domains in healthy older adults. It was concluded that better dynamic balance and aerobic endurance predicted enhanced processing speed, inhibition and working memory in older adults, with these last two domains considered components of executive function.


  • Rosenfeld, V., Rutledge, D. N., & Stern, J. (2015). Polysomnography with quantitative EEG in patients with and without fibromyalgia. Journal of Clinical Neurophysiology, 32, 164–170. doi: 10.1097/WNP.0000000000000134

    PURPOSE: The purpose of this study was to determine whether fibromyalgia patients differ in quantitative EEG and polysomnographic (PSG) measures (used to study sleep disorders) when compared with a control population with sleep disorders like periodic leg disorder and poor sleep efficiency. It was determined that there is a difference between poor sleep disorder patients and patients with fibromyalgia alone, because conditions like sleep apnea are common in fibromyalgia, but periodic leg movement disorder and poor sleep efficiency are not common in patients with fibromyalgia.


  • Jones, C. J., Rakovski, C., Rutledge, D. N., & *Gutierrrez, A. (2015). Fitness performance of women with fibromyalgia compared to criterion standards: A pilot study. Journal of Aging and Physical Activity, 23(1), 103-111 doi: 10.1123/japa.2013-0159.

    PURPOSE: The purpose of this study was to compare the fitness of women with fibromyalgia syndrome (FMS) aged 50+ with performance standards associated with functional independence in late life. Data included most recent symptoms, activity levels, and fitness assessments. Physical activity was positively associated with fitness performance, while pain and depression symptoms were negatively associated. High proportions of women with FMS do not meet fitness standards recommended for maintaining physical independence in late life, indicating a risk for disability. Regular fitness assessments and targeted exercise interventions are warranted.


  • *Follick, B. T., Cherry, B., Rutledge, D. N., Zettel-Watson, L., & Jones, C. J. (2015, published online). Heterogeneity in fibromyalgia based upon cognitive and physical performance and psychological symptomology. Journal of the American Association of Nurse Practitioners. doi: 10.1002/2327-6924.12270

    PURPOSE: This study sought to investigate the existence of subgroups within a fibromyalgia (FM) sample based on physical and cognitive performance measures, as well as self-report psychological measures. FM can lead to declines in cognitive functioning and difficulty with psychological health. Study results support the existence of subgroups among the FM population based on levels of cognitive and physical performance and psychological symptoms.


  • Jones, C. J., Rakovski, C., Rutledge, D. N., & Gutierrez, A. (2014). A comparison of women with fibromyalgia syndrome to criterion fitness standards: A pilot study [Epub ahead of print]. Journal of Physical Activity and Aging. doi: 10.1016/j.apmr.2011.08.006.

    PURPOSE: To compare fitness of women with fibromyalgia syndrome (FMS) aged 50+ with performance standards associated with functional independence in late life.METHODS: Data came from a longitudinal study tracking physical/cognitive function of 93 women with FMS and included the most recent symptoms, activity levels, and fitness assessments.RESULTS: Most women performed below criterion-referenced fitness standards for all measures. Nearly 90% percent of those < 70 years scored below the standard for lower body strength. Only ~20% of respondents < 70 years old met the criteria for aerobic endurance. A third of those aged over 70 met the standard in agility/dynamic balance. Physical activity was positively associated with fitness performance, while pain and depression symptoms were negatively associated.DISCUSSION: High proportions of women with FMS do not meet fitness standards recommended for maintaining physical independence in late life, indicating a risk for disability. Regular fitness assessments and targeted exercise interventions are warranted.


  • Rutledge, D. N., Cantero, P. J., & *Ruiz, J. E. (2013). Chronic pain management strategies used by low income overweight Latinos. Chronic Illness.  9(2), 133-144. doi: 10.1177/1742395312464719

    OBJECTIVE: The objective of this study is to examine the strategies used to manage chronic pain from the perspective of the individual in group interviews. METHODS: Sixteen low-income overweight Latino adults participated in two group interviews facilitated by a trained moderator who inquired about the type of chronic pain suffered by participants, followed by more specific questions about pain management. Interviews were audio-recorded, transcribed verbatim (Spanish), back-translated into English, and analyzed using thematic analysis. RESULTS: Participants' pain varied in type, location, and intensity. Participants discussed pain-related changes in activities and social life, and difficulties with health care providers, and as a result, we discovered five major themes: pain-related life alterations, enduring the pain, trying different strategies, emotional suffering, and encounters with health care system/providers. DISCUSSION: Findings indicated that there are opportunities for providers to improve care for low-income overweight Latinos with chronic pain by listening respectfully to how pain alters their daily lives and assisting them in feasible self-management strategies.


  • Rutledge, D. N., Martinez, A., Traska, T. K., &. Rose, D. J. (2013). Fall experiences of persons with fibromyalgia over 6 months. Journal of Advanced Nursing, 69(2), 435-48. doi: 10.1111/j.1365-2648.2012.06026.x

    AIMS: To describe circumstances and consequences of falls occurring among persons with fibromyalgia who had recent falls. BACKGROUND: Fibromyalgia is a common widespread pain condition that has been linked to increased fall-risk. No published research described experiences of falling in persons with fibromyalgia. Prior to development of fall-risk reduction interventions, it is essential to understand the context of falls and fall experiences in persons with fibromyalgia.DESIGN: Descriptive longitudinal study.METHODS: The study took place during 2009; data were collected via fall diaries and interviews in 18 US women ages 21-69 years.RESULTS: Over 6 months, 17 of 18 participants fell or had a near-fall. For the 15 women with 6-month fall-prevalence data, median number of falls was 2, with 3 near-falls. Most fall experiences contained intrinsic and extrinsic contributory factors. Participants reported engaging in various activities prior to falls/near-falls. A substantial minority (32-48%) experienced severe symptoms (pain, fatigue, stiffness) at the time. Most falls/near-falls occurred in homes during the day; one resulted in injury. Themes that were identified included the following: always being careful or generally cautious; fear of losing control of one's body, especially related to balance; desire to continue activities counterbalanced with frustration at not being able to because of fear of falling; perception of having become clumsy.CONCLUSIONS: Nurses caring for persons with fibromyalgia should assess for potential fall-risk factors and offer plans for individualized fall-prevention strategies.


  • Rutledge, D. N., Rakovski, C., & Zettel-Watson, L. (2012). Healthcare underutilization among overweight Mexican-Americans with chronic pain. Ethnicity and Inequalities in Health and Social Care, 5(4), 123-132.

    Aims/objectives: To determine healthcare utilization issues for low income Hispanic immigrants who have both excess weight and chronic pain. Community health workers conducted at-home interviews with 101 middle-aged and older Mexican Americans (aged 40 – 79 years, M = 52.1 ± 8.8) associated with a community agency in southern California to evaluate healthcare underutilization and reported reasons for not using medical or pharmaceutical care. Almost all participants (91%) reported having received at least some medical care in the year preceding the study interview. However, at some point during the prior year, 62% had not seen a doctor when it was needed and 45% had not taken a prescribed medication. While the primary reason for underutilization was financial, communication and trust reasons were also reported. Although cross-sectional and geographically restricted, this study lays the foundation for additional research on reasons for underutilization of recommended healthcare and lack of pain management in low income Hispanic immigrants who are overweight and have chronic pain. Implications for providers include the need for accurate pain assessment and better communication about medication to prevent non-adherence in this population. The current study highlights the existence of healthcare underutilization among overweight and obese Mexican Americans with chronic pain and identifies specific barriers to care, care-seeking, and pain management.


  • Cherry, B. J., Zettel-Watson, L., Shimizu, R., Roberson, I., Rutledge, D. N., & Jones, C. J. (2012). Cognitive performance in individuals with and without fibromyalgia. Journal of Gerontology, Series B: Psychological Sciences and Social Sciences, 69(2), 199-208. doi: 10.1093/geronb/gbs122

    OBJECTIVES: Persons with fibromyalgia (FM) report having cognitive dysfunction. Neuropsychological performance was compared across a variety of domains in 43 women with FM (Mage = 63 years) and in 44 women without FM (Mage = 65 years).METHOD: Measures included explicit memory (Consortium to Establish a Registry for Alzheimer's Disease [CERAD] immediate/delayed recall, delayed recognition), aspects of executive function including interference/inhibition (Stroop Color/Word test), working memory (Digit Span Forward/Backward), set-shifting/complex sequencing (Trails B), monitoring (verbal fluency: naming animals), processing speed (Trails A, Digit Symbol Substitution Coding), and problem solving (Everyday Problems Test).RESULTS: Women with FM performed more poorly than controls on executive function (Stroop Color/Word) and one processing speed measure (Digit Symbol Substitution Coding).DISCUSSION: Results partly support altered cognitive function in FM. Mixed findings across cognitive domains among individuals with or without FM is consistent with the literature and suggest that factors beyond those typically controlled for (e.g., heterogeneity in FM) may be influencing findings. Future research is warranted.


  • Rakovski, C., Zettel-Watson, L., & Rutledge, D. N. (2012). Association of employment and working conditions with physical and mental health symptoms for people with fibromyalgia. Disability & Rehabilitation, 34(15), 1277-1283. doi: 10.3109/09638288.2011.64165

    PURPOSE: This study examines physical and mental health symptoms among people with fibromyalgia (FM) by employment status and working conditions.METHOD: Secondary data analysis of the 2007 National Fibromyalgia Association Questionnaire study resulted in employment and symptom information for 1702 people of working age with FM. In this cross-sectional internet study, six factors of symptom clusters (physical, mental health, sleeping, concentration, musculoskeletal, support) were seen in the data. Linear regression models used employment, age, income, gender, and education to predict symptom clusters. Among those employed, working conditions were also associated with symptom severity.RESULTS: In the predominately female sample, 51% were working. Of these, 70% worked over 30 hours/week and half had flexible hours. Employment, higher income, and education were strongly associated with fewer symptoms. Working conditions, including level of physical and mental exertion required on the job as well as coworkers' understanding of FM, were related to symptoms, particularly physical and mental health symptoms. Many participants reported modifying their work environment (66%) or changing occupations (33%) due to FM.CONCLUSIONS: Work modifications could allow more people with FM to remain employed and alleviate symptoms. Persons with FM should be counseled to consider what elements of their work may lead to symptom exacerbation.


  • Cherry, B. J., Zettel-Watson, L., Chang, J., Shimizu, R., Rutledge, D. N., & Jones, C. J. (2012). Positive associations between physical and cognitive performance measures in fibromyalgia. Archives of Physical Medicine & Rehabilitation, 93, 63-71. doi:10.1016/j.apmr.2011.08.006

    OBJECTIVE: To investigate the associations between perceived physical function (self-report) and physical and cognitive performance (objective assessments) in persons with fibromyalgia (FM).DESIGN: Correlational study.SETTING: Exercise testing laboratory in Southern California.PARTICIPANTS: Community-residing ambulatory adults meeting the American College of Rheumatology 1990 criteria for FM (N=68; mean age, 59.5y).INTERVENTIONS: Not applicable.MAIN OUTCOME MEASURES: Composite Physical Function scale, Senior Fitness Test (3 items), Fullerton Advanced Balance scale, 30-foot walk, Trail Making Test parts A and B, Digit Symbol Substitution Test, a composite score of these 3 cognitive measures, attention/executive function composite, processing speed composite, problem solving, inhibition, and episodic memory composite.RESULTS: Hierarchical regression analyses showed that after controlling for age and FM symptoms, better physical performance (based on assessments, not self-report) was associated with higher cognitive function in attention/executive function, processing speed, problem solving, and inhibition.CONCLUSIONS: Researchers should continue to investigate the relationship between physical and cognitive function in both clinical and nonclinical populations, as well as explore changes across time. Because physical activity has been associated with neural improvements, further research may identify whether particular mechanisms, such as neurogenesis, synaptogenesis, or changes in inflammatory marker levels, are involved


  • Traska, T. K., Rutledge, D. N., Weiss, J., Mouttapa, M., & Aquino, J. (2011) Strategies used for managing symptoms for persons with fibromyalgia. Journal of Clinical Nursing, 21, 626-635. doi: 10.1111/j.1365-2702.2010.03501.x.

    AIMS/OBJECTIVES: The goal of this study was to describe how persons with fibromyalgia (FM) manage their lives given the multiple symptoms they experience, in particular how they use non-pharmacologic strategies, or how they incorporate these strategies along with pharmacologic agents. BACKGROUND. Persons with FM, a widespread chronic pain condition, often suffer from considerable fatigue, sleep disturbances, and morning stiffness. Medical management does not lead to a cure, and sufferers must self-manage in order to maintain a good quality of life. DESIGN/METHODS. Data for this qualitative descriptive study were obtained in a single group interview with eight women with FM. Women’s mean age was 61 years (range 54 to 81). Participants were invited to participate in a 1 ½-hour group interview focused on symptom management. In the interview, open-ended questions allowed them to speak freely about managing multiple FM symptoms. Content analysis by the first and second authors led to identification of themes, which were validated by the co-authors who attended the interviews. RESULTS. Participants reported many strategies to cope with FM symptoms and manage their lives. Main strategies included: pacing/planning, distraction techniques, coping with touch sensitivity, putting on the mask, and medications. In addition, social support from others with FM and from family members was reported to be very important. CONCLUSIONS. Study findings demonstrate that women with FM can develop strategies that enable them to cope with a life encumbered with chronic pain and fatigue. Moreover, this study confirmed effective FM management strategies reported in other studies. Further research is needed on risks/benefits of these and other self-management strategies used by women with FM. RELEVANCE TO CLINICAL PRACTICE. Our findings suggest that nurses should discuss the self-management strategies found with persons who have FM in the context of individual patient experiences.


  • Zettel-Watson, L., Rakovski, C., Levine, B., Rutledge, D. N., & Jones, C. J. (2011)  Impact of employment and caregiving roles on the well-being of people with fibromyalgia. Journal of Musculoskeletal Pain, 19(1), 8-17. doi:10.3109/10582452.2010.538824

    Objective: Examine associations between social roles and health status, quality of life, physical functioning, and depression in individuals 50+ years with/without Fibromyalgia Syndrome [FMS]. METHODS: Cross-sectional study. RESULTS: FMS participants had significantly worse health status, quality of life, and physical functioning, as well as more depression symptoms, than those without FMS.  While positively linked with depression, number of roles was not significantly associated with health status, quality of life, or physical functioning for those without FMS.  For individuals with FMS, increased roles were associated with all outcomes. CONCLUSION: Fulfilling multiple roles may enhance overall well-being of individuals with FMS.


  • Rutledge, D. N., Cherry, B., Rose, D., Rakovski, C., & Jones, C. J. (2010). Do fall predictors in elders predict fall status in persons 50+ with fibromyalgia?An exploratory study. Research in Nursing & Health, 33, 192-206. doi: 10.1002/nur.20376.

    We explored potential predictors of fall status in 70 community-dwelling persons >50 years of age with fibromyalgia (FM). Over 40% of the sample reported one or more falls in the year prior to the study.  A logistic regression model using 10 variables known to predict falls in middle aged and older persons predicted 45% of the variance in fall status.  Three variables offered significant independent contributions to the overall model predicting fall status: perception of postural instability, balance performance, and executive function processing speed.  The results support prior work in both nonclinical and clinical populations of middle aged and older adults indicating that falls are associated with multiple risk factors.  Prospective designs with larger samples are needed to (a) validate and extend these findings, and (b) identify risk factors related to fall status that are unique to persons with FM.


  • Jones, C. J., Rutledge, D. N., & Aquino, J. (2010). Predictors of physical performance and functional ability in persons 50+ with and without fibromyalgia. Journal of Physical Activity and Aging, 18, 353-368. PMID: 20651419

    The purposes of this study were to determine whether persons with and without FM aged 50 years and above showed differences in physical performance and perceived functional ability, and to determine whether age, gender, depression, and physical activity level altered the impact of FM status on these factors. Dependent variables included perceived function and 6 six performance measures (multidimensional balance, aerobic endurance, overall functional mobility, lower body strength, and gait velocity – normal, fast). Independent (predictor) variables were FM status, age, gender, depression, and physical activity level. Results indicated significant differences between adults with and without FM on all physical performance measures and perceived function. Linear regression models showed the contribution of significant predictors was in expected directions. All regression models were significant, accounting for 16-65% of variance in the dependent variables.


  • Cherry, B. J., Weiss, J., Barakat, B. K., Rutledge, D. N.,&  Jones, C. J. (2009). Physical performance as a predictor of attention and processing speed in fibromyalgia. Archives of Physical Medicine & Rehabilitation, 90, 2066-2073. doi: 10.1016/j.apmr.2009.07.011

    OBJECTIVE: To explore the associations between physical (both self-report and objective measures) and cognitive function for persons with fibromyalgia (FM). DESIGN: Correlational study. SETTING: An exercise testing laboratory in southern California. PARTICIPANTS: Community-residing and functionally independent (not wheelchair-bound) adults meeting the American College of Rheumatology 1990 criteria for FM (N=51) with a mean age of 54 years and no history of stroke. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Composite Physical Function Scale, Fibromyalgia Impact Questionnaire, adapted Trail Making Test parts A (TMT-A) and B (TMT-B), Digit Symbol Substitution Test, a composite index of TMT-A, TMT-B, and Digit Symbol Substitution Test combined, and physical performance assessments. RESULTS: Hierarchical regression analyses indicated that better objective physical performance predicted increased cognitive function for TMT-A and the composite cognitive score after controlling for age and symptom burden. That is, as the physical performance level decreased, cognitive performance levels decreased. CONCLUSIONS: Findings suggest that research is needed to determine whether patterns of physical activity participation, through their effects on physical fitness and performance, can enhance cognitive performance in persons with FM. Physiologic changes in specific brain regions in FM (eg, hippocampus, neural pain regions) suggest that further research is also warranted in determining specific relationships between biomarkers and cognitive performance in persons with FM.


  • Rutledge, D.N., Mouttapa, M., & Wood, P.B. (2009). Symptom clusters in fibromyalgia: Potential utility in patient assessment and treatment evaluation. Nursing Research, 58, 359-367. doi: 10.1097/NNR.0b013e3181b499d2.

    BACKGROUND: Recent evidence points to the likelihood of heterogeneity in the presentation and, perhaps, etiology of fibromyalgia (FM). A clearer understanding of the symptomatology and consideration of potential FM subtypes could add insights regarding this condition. OBJECTIVE: The aim of this study was to determine whether clusters could be identified among 20 symptoms that participants in a prior online study identified and to elucidate the underlying structure of resultant clusters. METHODS: Factor analysis was used on data from a study sponsored by the National Fibromyalgia Association in which 2,569 persons with FM responded to an online survey during a 3-day period in 2005. RESULTS: In this well-educated, primarily Caucasian sample, morning stiffness, fatigue, and not feeling rested in the morning were the symptoms with the highest severity scores. A series of exploratory factor analyses and subsequent confirmatory factor analysis with Cronbach's alpha testing led to a five-factor model with the following domains containing 17 symptoms: Somatic, Distress, Fibromyalgia Core, Dyscognition, and Sleep Problems. DISCUSSION: The findings support the heterogeneity of the FM experience and the presence of symptom clusters within the greater spectrum of symptoms comprising the FM syndrome. These observations suggest the possibility of tailoring interventions based upon individual patient symptomatology. Further work is needed to develop symptom inventories that can be used in clinical trials as outcome metrics and by healthcare providers to describe clinical burden and effect of treatments.


  • Jones, C. J., Rutledge, D. N., Jones, K. D., Matallana, L., & Rooks, D. (2008). Self-assessed physical function levels of women with fibromyalgia. Women’s Health Issues, 18, 406-412. doi: 10.1016/j.whi.2008.04.005.

    OBJECTIVE: We sought to determine the self-reported physical function level of women with fibromyalgia (FM). METHODS: We performed a secondary analysis using data from an Internet-based survey posted on the National Fibromyalgia Association website. Data used for this study included women (n = 1,735) aged 31-78 years who reported being diagnosed with FM. RESULTS: More than 25% of women reported having difficulty taking care of personal needs and bathing, and >60% reported difficulty doing light household tasks, going up/down 1 flight of stairs, walking (1/2) mile, and lifting or carrying 10 lbs. More than 90% of women reported having difficulty doing heavy household tasks, lifting or carrying 25 lbs, and doing strenuous activities. Women with lower functional ability reported higher levels of fatigue, pain, spasticity, depression, restless legs, balance problems, dizziness, fear of falling, and bladder problems. CONCLUSIONS: The average woman in this sample reported having less functional ability related to activities of daily living and instrumental activities of daily living than the average community-dwelling woman in her 80s. Several symptoms/conditions were found to be associated with functional limitation in women with FM. Targeting these-singly or in clusters-may potentially be important in terms of future interventions.


  • Rutledge, D.N., & Jones, C.J. (2007). Effects of topical essential oil on exercise volume during a 12-week exercise program for women with fibromyalgia: A feasibility study. Journal of Alternative and Complementary Medicine, 13, 1099-1106. doi: 10.1089/acm.2007.0551.

    OBJECTIVES: We determined--in women with fibromyalgia (FM)--effects of essential oils used with a 12-week exercise program on exercise volume, pain, physical performance, and physical function. DESIGN: This was a randomized clinical trial comparing 024 essential oil with sham oil combined with exercise. Settings: Settings included community sites in southern California. SUBJECTS: The study included 20 women randomized to 024 oil, 23 to sham oil. INTERVENTIONS: Women were trained in oil application before exercise, at bedtime on exercise days; the 12-week program included weekly group sessions with trained leaders guided by a prerecorded regimen (allowing choice of program level) plus 2 days of home exercise with the recorded regimen. OUTCOME MEASURES: Primary: Exercise volume (number of days exercised multiplied by exercise level--intensity and duration). Secondary: Pain (Brief Pain Inventory), measures of physical performance (30-second chair stands, 6-minute walk, multidimensional balance), and self-reported physical function (Composite Physical Function scale). RESULTS: The average participant was 54 years old, had some college education, was married, Caucasian, and minimally/mildly depressed. There was no significant difference in exercise volume between women using 024 as compared with those using sham oil after 12 weeks (depression as covariate). There were no significant group nor pre- to postexercise changes in pain intensity or interference. There were greater positive changes in 30-second chair stands, 6-minute walk distance, and multidimensional balance scores in the 024 group than in the sham group, but these were not significant. The counterirritant 024 oil was not different from the sham oil in its effect on exercise volume (frequency, exercise level--intensity and duration) for women with FM. It is unknown whether 024 actually decreases local pain when used with exercise. CONCLUSIONS: Increases in physical function found, while not significant, may be attributable to the exercise regimen or to the interaction of the oils and exercise regimen.


  • Rutledge, D. N., Jones, C. J., & Jones, K. (2007) Predicting physical function in persons with fibromyalgia. Journal of Nursing Scholarship, 39, 319-324. PMID:18021131

    PURPOSE: The purpose of this study was to investigate predictors of high physical function in people with fibromyalgia (FM). DESIGN: Cross-sectional descriptive, correlational study of 2,580 persons with FM who responded to an online survey during fall 2005. METHODS: The survey indicated self-reported physical activity levels, functional abilities, symptoms, health care costs, employment status, work productivity, self management strategies. It had adequate validity and reliability. A significant binary logistic regression model of predictors of physical function (individual factors, symptoms, self management strategies) was validated using backwards logistic regression. FINDINGS: Significant explanatory variables of high physical function were: men, greater education, younger age, lower intensity fatigue, spasticity, and balance problems, not using prescription pain medications, using aerobic or strength training exercise, and not using relaxation methods. CONCLUSIONS: People with FM suffer from multiple symptoms and use many modalities to control symptoms to remain functional. Given knowledge of predictors of physical function in FM, health care providers might be able to develop strategies to promote better functioning. Prospective trials are needed to track the natural course of study variables, measuring their effect on function, and to test effects of interventions to maximize function.


  • Bennett, R. M., Jones, C. J., Turk, D. C., Russell, I. J., & Matallana, L. (2007). An internet based survey of 2,596 fibromyalgia people with fibromyalgia. BMC Musculoskeletal Disorders, 8, 27. doi:10.1186/1471-2474-8-27.

    BACKGROUND: This study explored the feasibility of using an Internet survey of people with fibromyalgia (FM), with a view to providing information on demographics, sources of information, symptoms, functionality, perceived aggravating factors, perceived triggering events, health care utilization, management strategies, and medication use. METHODS: A survey questionnaire was developed by the National Fibromyalgia Association (NFA) in conjunction with a task force of "experts in the field". The questionnaire underwent several rounds of testing to improve its face validity, content validity, clarity and readability before it was mounted on the internet. The questionnaire consisted of 121 items and is available online at the website of the National Fibromyalgia Association. RESULTS: The questionnaire was completed by 2,569 people. Most were from the United States, with at least one respondent from each of the 50 states. Respondents were predominantly middle-aged Caucasian females, most of whom had FM symptoms for > or = 4 years. The most common problems were morning stiffness, fatigue, nonrestorative sleep, pain, concentration, and memory. Aggravating factors included: emotional distress, weather changes, insomnia, and strenuous activity. Respondents rated the most effective management modalities as rest, heat, pain medications, antidepressants, and hypnotics. The most commonly used medications were: acetaminophen, ibuprofen, naproxen, cyclobenzaprine, amitriptyline, and aspirin. The medications perceived to be the most effective were: hydrocodone preparations, aprazolam, oxycodone preparations, zolpidem, cyclobenzaprine, and clonazepam. CONCLUSION: This survey provides a snap-shot of FM at the end of 2005, as reported by a self-selected population of people. This descriptive data has a heuristic function, in that it identifies several issues for further research, such as the prescribing habits of FM health care providers, the role of emotional precipitants, the impact of obesity, the significance of low back pain and the nature of FM related stiffness.

 

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