The Anxiety and Pain of Fibromyalgia Patients during the COVID-19 Pandemic

BackgroundEarly research on the impact of the COVID-19 pandemic found persistent related anxiety in the general population. We hypothesised that this anxiety will be associated with increased pain in chronic pain patients diagnosed with fibromyalgia (FM).MethodsTo study this, we carried out a 10-day online survey with 58 female participants, diagnosed with FM and no other pain condition. We identified which aspects of the COVID-19 pandemic evoked anxiety. We then asked participants to provide daily ratings of both anxiety and pain on 101-point visual analogue scales (VAS). Key participant characteristics were included as mediators in a mixed-effects analysis, where the primary outcome was pain VAS.ResultsWe found that participants were most often anxious about “impact on relationships”, “a family member contracting COVID-19”, and “financial hardships”, but on average rated “financial hardship”, “access to medication”, and “home loss/eviction” as evoking the strongest anxiety. Mixed-effects modelling showed that an increase in pain was significantly associated with an increase in anxiety, when taking into account individual variance and daily caffeine intake. Age and intake of some mild analgesics were also linked to stronger pain.ConclusionOur results extend the initial findings from the literature about the effects of COVID-19 pandemic on chronic pain sufferers. We found that not only is pandemic anxiety in FM patients present, but it is associated with amplified self-assessed chronic pain.SignificanceThe long-term support of fibromyalgia patients is challenging for healthcare professionals due to the nature of the condition. The new normal introduced by the pandemic particularly hinders pain management, which is the leading request from this patient group. Our study demonstrates that mental health decline during the COVID-19 pandemic is directly related to the worsening of pain in fibromyalgia. Core stressors that evoke the strongest anxiety were identified thus providing guidance for where to focus patient support.

Ibuprofen alters human testicular physiology to produce a state of compensated hypogonadism

Concern has been raised over increased male reproductive disorders in the Western world, and the disruption of male endocrinology has been suggested to play a central role. Several studies have shown that mild analgesics exposure during fetal life is associated with antiandrogenic effects and congenital malformations, but the effects on the adult man remain largely unknown. Through a clinical trial with young men exposed to ibuprofen, we show that the analgesic resulted in the clinical condition named “compensated hypogonadism," a condition prevalent among elderly men and associated with reproductive and physical disorders. In the men, luteinizing hormone (LH) and ibuprofen plasma levels were positively correlated, and the testosterone/LH ratio decreased. Using adult testis explants exposed or not exposed to ibuprofen, we demonstrate that the endocrine capabilities from testicular Leydig and Sertoli cells, including testosterone production, were suppressed through transcriptional repression. This effect was also observed in a human steroidogenic cell line. Our data demonstrate that ibuprofen alters the endocrine system via selective transcriptional repression in the human testes, thereby inducing compensated hypogonadism.

Interaction of Pharmaceuticals with Environmental Chemicals

This chapter describes research on several commonly used analgesics that have been described as endocrine-disrupting chemicals, leading to concerns about possible interactions between therapeutic drugs and chemicals in the environment. Mild analgesics such as acetaminophen are widely used by pregnant women worldwide. In vitro, in vivo, and epidemiologic studies report that prenatal exposure to acetaminophen and other mild analgesics can cause hormonal disturbances resulting in gonadal development and male genital abnormalities, particularly cryptorchidism. These results suggest the potential for interaction between mild analgesics and environmental chemicals such as phthalates because they appear to disrupt similar hormonal signaling systems and cause common reproductive changes. Given the increased prevalence of prenatal exposure to phthalates and analgesics, these potential adverse effects should be taken into account when considering the risks and benefits of mild analgesic use during pregnancy.