Limb Laterality Discrimination, Evoked Sensations and Somatosensory Behavior in Fibromyalgia Syndrome: A Cross-Sectional Study

Round 1

Reviewer 1 Report

Excellent study, on an understudied aspect of fibromyalgia, which may have an effect on the patient's overall functioning. The various sections are well written and clear. Despite the specificity of the topic, the article can be easy to understand even for non-experts. The definition of the object of study, the body schema, is clear, accurate, and repeatable. The methodology is correct and clearly explained.  There are some typos to be fixed (points before references, missing points at the end of sentences, missing spaces etc). See lines 78; 152; 159, 330, 374, 387, 393.  Check carefully. After these minor revisions, the article is in my opinion acceptable in its present form.

Author Response

Response to reviewers

Reviewer 1

Thank you for your time and comments.

Comments and Suggestions for Authors

Excellent study, on an understudied aspect of fibromyalgia, which may have an effect on the patient's overall functioning. The various sections are well written and clear. Despite the specificity of the topic, the article can be easy to understand even for non-experts. The definition of the object of study, the body schema, is clear, accurate, and repeatable. The methodology is correct and clearly explained.  There are some typos to be fixed (points before references, missing points at the end of sentences, missing spaces etc). See lines 78; 152; 159, 330, 374, 387, 393.  Check carefully. After these minor revisions, the article is in my opinion acceptable in its present form.

Regarding that,there are some typos to be fixed (points before references, missing points at the end of sentences, missing spaces etc). See lines 78; 152; 159, 330, 374, 387, 393.  Check carefully.

RESPONSE: Thank you for this comment.  We have corrected the points, points at the end of sentences and spaces.

Author Response File: Author Response.docx

Reviewer 2 Report

Dear Authors,

The aim of the manuscript was to evaluate somatosensory perception in patients with fibromyalgia syndrome (FMS). This is important for understanding the origin of sensory disturbances and chronic pain in FMS. The manuscript is well written, has high scientific soundness. However, some changes need to be made to improve its readability.

The proposed research objectives represent the methods that have been used to investigate somatosensory perception (lines 96-100: The main objective of this study was to compare upper and lower limb laterality discrimination, the evoked sensations, pressure pain threshold and conditioned pain modulation between patients with FMS and healthy subjects. The secondary aim was to analyze the relationships between laterality discrimination with respect to somatosensory variables). So, it is necessary to formulate the main aim of the study.

The "Introduction" section should be reorganized in accordance with the purpose of the study and the methodological approaches that were used in the study. The "Discussion" section also needs editing and representing the results in context of evaluation of somatosensory disturbances in FMS.

Figure 1 (Flow diagram?) should be provided with a title.. "Study Design" or "Subject Groups" are presented.

Figures 2 and 3 repeat the content of table 2, as well figure 4 repeats the content of table 3. Therefore, Authors should consider using figures to represent their results.

The abstract should indicate the subjects (groups, sex, age, etc.).

My overall comment, the manuscript is not ready for publication in its current form and needs to be edited.

Author Response

Reviewer 2

Dear Authors,

The aim of the manuscript was to evaluate somatosensory perception in patients with fibromyalgia syndrome (FMS). This is important for understanding the origin of sensory disturbances and chronic pain in FMS. The manuscript is well written, has high scientific soundness. However, some changes need to be made to improve its readability.

The proposed research objectives represent the methods that have been used to investigate somatosensory perception (lines 96-100: The main objective of this study was to compare upper and lower limb laterality discrimination, the evoked sensations, pressure pain threshold and conditioned pain modulation between patients with FMS and healthy subjects. The secondary aim was to analyze the relationships between laterality discrimination with respect to somatosensory variables). So, it is necessary to formulate the main aim of the study.

RESPONSE:

We have formulated the main objective as follows:

“The main objective of this study was to assess the status of body schema using limb laterality discrimination tasks and pain measurement variables of patients with FMS compared to healthy subjects.”

 

The "Introduction" section should be reorganized in accordance with the purpose of the study and the methodological approaches that were used in the study. The "Discussion" section also needs editing and representing the results in context of evaluation of somatosensory disturbances in FMS.

RESPONSE:

We have reorganized the introduction as follows:

From line 48 to line 70 we briefly describe the symptoms of FMS and the potential pain mechanisms that are altered in FMS patients.

In the following paragraph, from lines 72 to 90, we talk about the body schema and how the laterality discrimination task serves to assess it. We also mention that in populations with chronic pain it can be altered (which is the main motivation of this work).

Finally, from lines 91 to 95 we have reorganized the information where we talked about the other measurement variables in patients with FMS and that we used in this study, which were pressure pain threshold and conditioned pain modulation.

In the discussion, in lines from 110 to 112 we have added that our results of somatosensory variables are in line with the results obtained in other investigations that measured PPT and CPM in patients with FMS.

 

 

Figure 1 (Flow diagram?) should be provided with a title. "Study Design" or "Subject Groups" are presented.

RESPONSE;

In figure 1 we have replaced the term “flow diagram” with the term “flowchart”. We have added a description to the title of figure 1: “The following flowchart shows how the participants are distributed in the FMS study groups and in the control group of healthy individuals. The cases that were discarded because they did not meet the selection criteria or abandoned the investigation are shown.”

Figures 2 and 3 repeat the content of table 2, as well figure 4 repeats the content of table 3. Therefore, Authors should consider using figures to represent their results.

RESPONSE: We can remove the tables, but we will lose precision in the data, since the means and standard deviations will not be known, if you consider that it is better to leave the figures, we will leave it as indicated.

The abstract should indicate the subjects (groups, sex, age, etc.).

RESPONSE: We have added the description of groups, sex and age in abstract. As following sentence: “Thirty patients women with FMS (women, with a mean age of 52.43±11.82 years)  women controls  and thirty healthy women (with a mean age of 47.93±5.92 years) matched subjects were recruited”.

 

 

 

Author Response File: Author Response.docx

Round 2

Reviewer 2 Report

Dear, Authors,

The manuscript has been improved. However, some editing is still required.

In the abstract, the purpose of the study should be presented in the same way as in the main text.

Figures 2, 3, 4 are recommended to be removed, as they completely repeat the tables and are not informative. Comparison (significance of differences) is not presented either.

I would advise to carefully edit the maintext, as many typos (missing dots at the end of sentences) still exist.

Author Response

Reviewer 2

Dear Authors,

The manuscript has been improved. However, some editing is still required.

In the abstract, the purpose of the study should be presented in the same way as in the main text.

RESPONSE:

We have formulated the main objective in the abstract like in main text

“The main objective of this study was to assess the status of body schema using limb laterality discrimination tasks and pain measurement variables of patients with FMS compared to healthy subjects.”. The secondary aim was to analyze the relationships between laterality discrimination with respect to somatosensory variables”.

 

Figures 2, 3, 4 are recommended to be removed, as they completely repeat the tables and are not informative. Comparison (significance of differences) is not presented either.

 

RESPONSE: We can remove the Figures, as it´s have been suggested

 

I would advise to carefully edit the maintext, as many typos (missing dots at the end of sentences) still exist.

RESPONSE; typos have been corrected

Author Response File: Author Response.docx