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Cetingok S, Seker O, Cetingok H. The relationship between fibromyalgia and depression, anxiety, anxiety sensitivity, fear avoidance beliefs, and quality of life in female patients. Medicine (Baltimore) 2022; 101:e30868. [PMID: 36181089 PMCID: PMC9524976 DOI: 10.1097/md.0000000000030868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
The study aims to determine whether there is a relationship between fibromyalgia (FM) disease and depression, anxiety, anxiety sensitivity, fear-avoidance beliefs, and quality of life in female patients with a diagnosis of fibromyalgia. 37 female patients followed up with FM diagnosis in pain medicine clinic and a control group consisting of 37 healthy women were included in the study. Sociodemographic and Clinical Characteristics Data Form, Quality of Life Form, fear-avoidance beliefs questionnaire, Anxiety Sensitivity Index-3, Beck Anxiety Inventory, Beck Depression Inventory, and Visual Analogue Scale was applied to the participants. When the patients in the FM group were compared to the control group; Statistically lower scores in all Quality of Life Form subscales except emotional role difficulty and social functionality scores; statistically higher scores in both physical and work activity subscales in fear-avoidance beliefs questionnaire; statistically higher scores in cognitive symptoms subscale in Anxiety Sensitivity Index-3, Beck Anxiety Inventory, Beck Depression Inventory, and Visual Analogue Scale scores were found. In FM patients, it has been determined that anxiety, depression and perceived pain severity reduce social functionality and quality of life in areas such as mental health, physical function, and emotional role difficulties. It was determined that the functionality and quality of life of patients diagnosed with FM decreased in daily life. An important contribution of the study to the literature is that it shows that the behavior of avoiding activity due to pain-induced fear exacerbates the pain and even contributes to its chronicity. These results, which show the effects of anxiety, depression, anxiety sensitivity, and fear-avoidance behavior on the prognosis of the disease in FM patients, indicate that psychiatric evaluation and treatment in FM patients is an important factor that determines the functionality and quality of life.
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Affiliation(s)
- Sera Cetingok
- Faculty of Health Science, Gerontology, Istanbul University – Cerrahpasa, Istanbul, Turkey
| | - Oznur Seker
- Limit Educational Institutions, Istanbul, Turkey
| | - Halil Cetingok
- Division of Pain Medicine, Department of Anesthesiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
- *Correspondence: Halil Cetingok, Division of Pain Medicine, Department of Anesthesiology, Istanbul Faculty of Medicine, Istanbul University, Turgut ozal Millet Street, 34093 Fatih, Istanbul, Turkey (e-mail: )
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Kim SC, Landon JE, Lee YC. Patterns of health care utilization related to initiation of amitriptyline, duloxetine, gabapentin, or pregabalin in fibromyalgia. Arthritis Res Ther 2015; 17:18. [PMID: 25627453 PMCID: PMC4343277 DOI: 10.1186/s13075-015-0530-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Accepted: 01/19/2015] [Indexed: 11/21/2022] Open
Abstract
Introduction Several pharmacologic treatments are available for fibromyalgia, but little is known about the comparative effectiveness of these treatments on health care utilization. Methods Using US commercial insurance claims data (covering 2007 to 2009), we conducted a cohort study to examine the comparative effectiveness of amitriptyline, duloxetine, gabapentin, and pregabalin on health care utilization in patients with fibromyalgia. We measured patients’ medication adherence using the proportion of days covered (PDC) and estimated multivariable rate ratios (RRs) for outpatient visits, prescriptions, hospitalization, and emergency department (ED) visits in propensity score (PS)–matched cohorts. Results Cohorts of 8,269 amitriptyline, 9,941 duloxetine, and 18,613 gabapentin initiators were compared with their PS-matched pregabalin initiators. During the baseline 180-day period, patients had, on average, seven to nine physician visits, including six to eight specialist visits, and received eight prescription drugs. The mean PDC up to 180 days varied from 38.6% to 67.7%. The number of outpatient visits, prescriptions, and hospitalizations decreased slightly after initiating one of the study drugs, but the number of ED visits increased after treatment initiation. Compared to pregabalin, duloxetine was associated with decreased outpatient visits (RR, 0.94; 95% confidence interval (CI), 0.88 to 1.00), prescriptions (RR, 0.94; 95% CI, 0.90 to 0.98), hospitalizations (RR, 0.75; 95% CI, 0.68 to 0.83), and ED visits (RR, 0.85; 95% CI, 0.79 to 0.91). Little difference in health care utilization rates was noted among amitriptyline and gabapentin initiators compared to those who were started on pregabalin. Conclusions Fibromyalgia patients had high health care utilization before and after initiation of amitriptyline, duloxetine, gabapentin, or pregabalin. Medication adherence was suboptimal. Overall, fibromyalgia treatment had little impact on reducing health care utilization, but duloxetine initiators had less health care utilization than those started on pregabalin. Electronic supplementary material The online version of this article (doi:10.1186/s13075-015-0530-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Seoyoung C Kim
- Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital and Harvard Medical School, 1620 Tremont St, Suite 3030, Boston, MA, 02120, USA.
| | - Joan E Landon
- Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital and Harvard Medical School, 1620 Tremont St, Suite 3030, Boston, MA, 02120, USA.
| | - Yvonne C Lee
- Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital and Harvard Medical School, 1620 Tremont St, Suite 3030, Boston, MA, 02120, USA.
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Improving the primary care physicians' decision making for fibromyalgia in clinical practice: development and validation of the Fibromyalgia Detection (FibroDetect®) screening tool. Health Qual Life Outcomes 2014; 12:128. [PMID: 25341959 PMCID: PMC4221679 DOI: 10.1186/s12955-014-0128-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Accepted: 08/07/2014] [Indexed: 11/25/2022] Open
Abstract
Background Fibromyalgia diagnosis is a challenging and long process, especially among primary care physicians (PCPs), because of symptom heterogeneity, co-morbidities and clinical overlap with other disorders. The purpose was to develop and validate a screening tool in French (FR), German (DE) and English (UK) to help PCPs identify patients with fibromyalgia. Methods The FibroDetect questionnaire was simultaneously developed in FR, DE and UK based on information obtained from a literature review, focus groups conducted with clinicians, and face-to-face interviews with fibromyalgia patients (FR, DE and UK, n = 23). The resulting tool was comprehension-tested in patients with diagnosed or suspected fibromyalgia (n = 3 and n = 2 in each country, respectively). Acceptability and applicability were assessed and the tool modified accordingly, then assessed in clinical practice. A scoring method was created using an iterative process based on statistical and clinical considerations with American College of Rheumatology + (ACR+) patients and ACR– patients (n = 276), and validated with fibromyalgia and non-fibromyalgia patients (n = 312). Results The FibroDetect included 14 questions assessing patients’ pain and fatigue, personal history and attitudes, symptoms and impact on lives. Six questions were retained in the final scoring, demonstrating satisfactory discriminative power between ACR + and ACR- patients with area under the Receiver Operating Characteristic curve of 0.74. The predictive accuracy of the tool increased to 0.86 for fibromyalgia and non-fibromyalgia patient detection, with a sensitivity of 90% and a specificity of 67% for a cut-off of 6 on the score. Conclusions The FibroDetect is a self-administered tool that can be used as a screening classification surrogate to the ACR criteria in primary care settings to help PCPs detect potential fibromyalgia patients among a population complaining of chronic widespread pain.
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Kim SC, Landon JE, Solomon DH. Clinical characteristics and medication uses among fibromyalgia patients newly prescribed amitriptyline, duloxetine, gabapentin, or pregabalin. Arthritis Care Res (Hoboken) 2014; 65:1813-9. [PMID: 23861291 DOI: 10.1002/acr.22071] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2013] [Revised: 05/20/2013] [Accepted: 06/21/2013] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Fibromyalgia is a common chronic pain disorder with unclear etiology. No definitive treatment is available for fibromyalgia, and treatment with antidepressants or antiepileptics is often used for symptom management. METHODS Using US health care utilization data, a large population-based cohort study was conducted to describe clinical characteristics and medication use patterns in patients diagnosed with fibromyalgia who newly started amitriptyline, duloxetine, gabapentin, or pregabalin. RESULTS There were 13,404 amitriptyline starters, 18,420 duloxetine starters, 23,268 gabapentin starters, and 19,286 pregabalin starters. The mean age ranged from 48–51 years and 72–84% in each group were women. Back pain was the most frequent comorbidity in all 4 groups (range 48–64%) and hypertension, headache, depression, and sleep disorder were also common. The median daily dose at the start of followup was 25 mg for amitriptyline, 60 mg for duloxetine, 300 mg for gabapentin, and 75 mg for pregabalin, and >60% of patients remained on the same dose throughout the follow up period. Only one-fifth of patients continued the treatment started for ≥1 year. The mean number of different prescription drugs at baseline ranged from 8–10 across the groups. More than one-half of patients took opioids and one-third took benzodiazepines, sleep disorder drugs, and muscle relaxants. CONCLUSION Patients who started 1 of the 4 common drugs for fibromyalgia similarly had multiple comorbidities and other fibromyalgia-related medication use, but continued the treatment only for a short time. The dose of the 4 drugs was not increased in most patients during the followup period.
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Yoon SYR, Jain UR, Shapiro CM. Sleep and daytime function in adults with attention-deficit/hyperactivity disorder: subtype differences. Sleep Med 2013; 14:648-55. [PMID: 23643650 DOI: 10.1016/j.sleep.2013.03.003] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2012] [Revised: 03/06/2013] [Accepted: 03/18/2013] [Indexed: 01/23/2023]
Abstract
OBJECTIVES Although sleep disorders have been reported to affect more than half of adults with attention-deficit/hyperactivity disorder (ADHD), the association between sleep and ADHD is poorly understood. The aims of our study were to investigate sleep-related variables in adults with ADHD and to assess if any differences exist between ADHD of the predominantly inattentive (ADHD-I) and combined (ADHD-C) subtypes. METHODS We used the Epworth sleepiness scale (ESS), the Pittsburgh Sleep Quality Index (PSQI), and the fatigue severity scale (FSS) to collect data on daytime sleepiness, sleep quality, and fatigue in 126 subjects (45 ADHD-I and 81 ADHD-C subjects). RESULTS Approximately 85% of subjects reported excessive daytime sleepiness or poor sleep quality. The most common sleep concerns were initial insomnia, interrupted sleep, and feeling too hot. When examining ADHD subtype differences, ADHD-I subtypes reported poorer sleep quality and more fatigue than ADHD-C subtypes. Partial correlation analyses revealed that interrelationships between sleep quality, daytime sleepiness, and fatigue differ between ADHD subtypes; in ADHD-I subtypes fatigue was associated with sleep quality, while in the ADHD-C subtypes fatigue was associated with both sleep quality and daytime sleepiness. There also appears to be a subtype×gender interaction that affects the perception of fatigue, as subjective fatigue was markedly higher in ADHD-I women than in ADHD-C women. CONCLUSION Altogether our data indicate that the interplay of variables associated with daytime function and sleep varies between ADHD subtypes. This finding may have considerable relevance in the management and pathophysiologic understanding of ADHD, and thus lead to tailored treatments for ADHD subtypes.
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Hallberg LRM, Carlsson SG. Psychosocial Vulnerability and Maintaining Forces Related to Fibromyalgia. Scand J Caring Sci 2013. [DOI: 10.1111/j.1471-6712.1998.tb00482.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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High frequency of fibromyalgia in patients with psoriatic arthritis: a pilot study. ARTHRITIS 2013; 2013:762921. [PMID: 23476767 PMCID: PMC3586452 DOI: 10.1155/2013/762921] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/23/2012] [Revised: 12/06/2012] [Accepted: 01/16/2013] [Indexed: 11/17/2022]
Abstract
Background. Widespread pain from fibromyalgia syndrome (FMS) is observed in patients with psoriatic arthritis (PsA). We hypothesized that there is increased frequency of FMS in patients with PsA that contributes to fatigue and pain. Method. We prospectively enrolled patients with PsA based on the Classification criteria for Psoriatic Arthritis and healthy subjects were used as controls. The frequency of FMS was determined using London Fibromyalgia Epidemiologic Study Screening Questionnaire (LFESSQ) and Symptoms Intensity scale (SIs). Results. 34 PsA patients and 44 controls fulfilled the inclusion criteria. Median age of PsA patients was 52 years with 53.33% females. Median age of controls was 50.5 years with 59% females. FMS was present in 53.33% of PsA patients compared to 4.54% of the controls (P < 0.001), based on LFESSQ. 37.50% of PsA had FMS compared to 6.66% of controls (P < 0.001) based on SIs. There was a significant correlation between LFESSQ and SIs in the psoriatic group (P = 0.00243). 76.66% of PsA patients complained of fatigue compared to 40.90% of controls, but the mean fatigue score between the two groups was comparable (5.03 versus 5.18). Conclusion. FMS-associated pain and fatigue are significantly more frequent in patients with PsA compared to controls.
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Abstract
Fibromyalgia (FM) is a complex disorder that affects up to 5% of the general population worldwide, more frequently in women than in men. In addition to chronic widespread pain, patients with FM usually experience other characteristic symptoms, including fatigue, disturbed sleep, stiffness, reduced functioning, dyscognition, and depressed mood. Many patients also have comorbid conditions such as depression, irritable bowel syndrome, temporomandibular disorder, or migraine. Although the etiology of FM remains unclear, evidence suggests that biologic, genetic, and environmental factors are involved. The variability of symptoms and the frequency of comorbidities among patients with FM make this a difficult disorder to diagnose. Diagnosis may be further complicated by the stigmatization of this disorder among treatment providers, the health insurance industry, and the general population. Treating chronic pain disorders such as FM can be time consuming and costly, and other issues such as polypharmacy, treatment adherence, and access to treatment often need to be addressed. The aim of this article is to provide physicians with a general overview of FM, including a brief review of the pathophysiology that explains the biologic and genetic bases of this disorder. Also included is a synopsis of new diagnostic criteria and other useful diagnostic tools and a discussion of various treatment challenges and strategies.
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Wilkinson K, Shapiro C. Nonrestorative sleep: symptom or unique diagnostic entity? Sleep Med 2012; 13:561-9. [PMID: 22560828 DOI: 10.1016/j.sleep.2012.02.002] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2011] [Revised: 02/01/2012] [Accepted: 02/07/2012] [Indexed: 10/28/2022]
Abstract
Nonrestorative sleep (NRS) refers to the subjective experience of sleep as insufficiently refreshing, often despite the appearance of normal sleep according to traditionally assessed objective parameters. This has led researchers to pursue alternative physiological markers of nonrestorative or unrefreshing sleep, though much of this research remains controversial and inconclusive. This review summarizes the recent findings on NRS in the literature and discusses some of the issues inherent in current efforts to define and measure NRS. We offer a summary of recommended clinical approaches to NRS and discuss a new potential paradigm for the assessment of NRS-an approach modelled on current diagnosis of insomnia.
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Affiliation(s)
- Kate Wilkinson
- Department of Cell and Systems Biology, University of Toronto, 25 Harbord Street, Toronto, ON M5S 3G5, Canada.
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Gore M, Tai KS, Chandran A, Zlateva G, Leslie D. Clinical comorbidities, treatment patterns, and healthcare costs among patients with fibromyalgia newly prescribed pregabalin or duloxetine in usual care. J Med Econ 2012; 15:19-31. [PMID: 21970699 DOI: 10.3111/13696998.2011.629262] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To assess comorbidities, pain-related pharmacotherapy, and healthcare resource use among patients with fibromyalgia (FM) newly prescribed pregabalin or duloxetine (index event) in usual care settings. METHODS Using the LifeLink™ Health Plan Claims Database, patients with FM (International Classification of Diseases, Ninth Revision, Clinical Modification code 729.1X) were identified. Patients initiated on duloxetine were propensity score-matched with patients initiated on pregabalin (n = 826; mean age [standard deviation] of 48.3 [9.3] years for both groups). Prevalence of comorbidities, pain-related pharmacotherapy, and healthcare resource use/costs were examined during the 12-month pre-index and follow-up periods. RESULTS Both patient groups had multiple comorbidities and a substantial pain-related and adjuvant medication burden. In the pregabalin group, use of other anticonvulsants decreased significantly (31.6% vs 24.9%), whereas use of serotonin-norepinephrine reuptake inhibitors (SNRIs; 16.5% vs 22.5%) and topical agents (10.1% vs 13.2%) increased in the follow-up period (p < 0.01). In the duloxetine group, there were significant decreases in the use of other SNRIs (13.0% vs 5.7%), selective serotonin reuptake inhibitors (41.3% vs 21.7%), and tricyclic antidepressants (18.8% vs 13.2%), and an increase in the use of anticonvulsants (28.6% vs 40.1%; p < 0.0001). There were significant increases (p < 0.0001) in pharmacy and total healthcare costs in both cohorts, and a significant increase in outpatient costs (p = 0.0084) in the duloxetine cohort from pre-index to follow-up. There were no significant differences in median total healthcare costs between the pregabalin and duloxetine groups in both the pre-index ($10,159 vs $9,556) and follow-up ($11,390 vs $11,746) periods. LIMITATIONS Limitations of this study are typical of those associated with retrospective database analyses. CONCLUSIONS Patients with FM prescribed pregabalin or duloxetine were characterized by a significant comorbidity and pain/adjuvant medication burden. Although healthcare costs increased in both groups, there were no statistically significant differences in direct healthcare costs between the two groups.
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Affiliation(s)
- Mugdha Gore
- Avalon Health Solutions, Inc., Philadelphia, PA 19102, USA.
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Gore M, Tai KS, Chandran A, Zlateva G, Leslie D. Clinical characteristics, pharmacotherapy, and healthcare resource use among patients with fibromyalgia newly prescribed pregabalin or tricyclic antidepressants. J Med Econ 2012; 15:32-44. [PMID: 21970698 DOI: 10.3111/13696998.2011.629263] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To examine treatment patterns and costs among patients with fibromyalgia prescribed pregabalin or tricyclic antidepressants (TCAs). METHODS Using the LifeLink™ Health Plan Claims Database, patients with fibromyalgia (International Classification of Diseases, Ninth Revision, Clinical Modification code 729.1X) newly prescribed (index date) TCAs (n = 898) were identified and propensity score-matched (PSM) with patients newly prescribed pregabalin (n = 898). Pain-related pharmacotherapy, comorbidities, and healthcare resource use/costs were examined during the 12 months, pre-index, and follow-up periods. RESULTS Both patient groups reported multiple comorbidities and received pain medications in the pre-index and follow-up periods. Among patients prescribed pregabalin, use of non-selective non-steroidal anti-inflammatory drugs (43.3% vs 39.8%), other anticonvulsants (28.6% vs 23.3%), and tetracyclic/miscellaneous antidepressants (28.5% vs 25.8%) significantly decreased, and cyclooxygenase 2 (COX-2) inhibitors (7.7% vs 10.4%), TCAs (4.8% vs 7.9%), and topical agents (10.8% vs 15.1%) increased in the follow-up period (p < 0.05). Among patients prescribed TCAs, there were significant decreases in muscle relaxants (42.0% vs 38.4%) and sedative hypnotics (27.4% vs 23.9%), and increases in COX-2 inhibitors (5.8% vs 7.9%) and anticonvulsants (25.1% vs 33.7%; p < 0.05). There were increases (p < 0.0001) in pharmacy costs in both cohorts and total healthcare costs in the pregabalin cohort from pre-index to follow-up. Median total costs were higher (p < 0.05) in the pregabalin group vs TCAs in the pre-index ($9935 vs $8771) and follow-up ($10,689 vs $8379) periods. LIMITATIONS Despite attempts to address bias through PSM, the higher pre-index costs in the pregabalin cohort suggest a channeling of patients with more severe fibromyalgia to pregabalin. CONCLUSIONS Patients with fibromyalgia prescribed pregabalin or TCAs had multiple comorbidities and a sizeable pain medication burden, which increased in the follow-up period for both cohorts. Only 5% of pregabalin initiators had been treated with concomitant TCAs at baseline, suggesting that TCAs were inappropriate for these patients owing to their contraindications.
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Affiliation(s)
- Mugdha Gore
- Avalon Health Solutions, Inc., Philadelphia, PA 19102, USA.
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Kleinman NL, Sanchez RJ, Lynch WD, Cappelleri JC, Beren IA, Joshi AV. Health outcomes and costs among employees with fibromyalgia treated with pregabalin vs. standard of care. Pain Pract 2011; 11:540-51. [PMID: 21392253 DOI: 10.1111/j.1533-2500.2011.00453.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To compare comorbidities, drug use, benefit costs, absences, medication persistence/adherence between employees with fibromyalgia initiating treatment with pregabalin (PGB) vs. antidepressant Standard of Care ([SOC] amitriptyline, duloxetine, or venlafaxine). METHODS Retrospective study of 240 adults initiating PGB or SOC after 7/1/2007. Multivariate regression models on propensity-score-matched cohorts compared postindex costs, absences, and adherence between cohorts. RESULTS Pregabalin users had significantly more preindex muscle pain and dizziness and less depression than SOC (each P < 0.05). Use of some non-PBG/SOC drugs differed. No differences were found in total medical, drug, or absenteeism cost. PGB had more sick leave (9.8 vs. 6.8 days, P = 0.04), but other absence types were similar. All adherence metrics were nonsignificantly greater for PGB vs. SOC. CONCLUSION Despite several comorbidity and drug use differences, most employee benefit outcomes and adherence did not differ between the cohorts.
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Abstract
OBJECTIVES To calculate the fibromyalgia (FM) burden of illness (BOI) from the employer perspective and to compare annual prevalence, work output, absence, and health benefit costs of employees with FM versus osteoarthritis (OA). METHODS Retrospective regression model analysis comparing objective work output, total health benefit (health care, prescription drug, sick leave, disability, workers' compensation) costs, and absence days for FM, versus OA and NoFM cohorts, while controlling for differences in patient characteristics. RESULTS FM prevalence was 0.73%; OA 0.90%. Total health benefit costs for FM were $8452 versus $11,253 (P < 0.0001) for OA and $4013 (P < 0.0001) for NoFM, with BOI = $4439. Total absence days were 16.8 versus 19.8 (P < 0.0001) and 6.4 (P < 0.0001), respectively. FM had significantly lower annual work output than NoFM (19.5%, P = 0.003) but comparable with OA. CONCLUSION FM places a significant cost, absence, and productivity burden on employers.
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Providing Physical Activity for Older Women with Fibromyalgia Syndrome. ACTIVITIES ADAPTATION & AGING 2009. [DOI: 10.1300/j016v25n01_05] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Cappelleri JC, Bushmakin AG, McDermott AM, Sadosky AB, Petrie CD, Martin S. Psychometric properties of a single-item scale to assess sleep quality among individuals with fibromyalgia. Health Qual Life Outcomes 2009; 7:54. [PMID: 19534799 PMCID: PMC2706811 DOI: 10.1186/1477-7525-7-54] [Citation(s) in RCA: 104] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2008] [Accepted: 06/17/2009] [Indexed: 12/04/2022] Open
Abstract
Background Sleep disturbances are a common and bothersome symptom of fibromyalgia (FM). This study reports psychometric properties of a single-item scale to assess sleep quality among individuals with FM. Methods Analyses were based on data from two randomized, double-blind, placebo-controlled trials of pregabalin (studies 1056 and 1077). In a daily diary, patients reported the quality of their sleep on a numeric rating scale ranging from 0 ("best possible sleep") to 10 ("worst possible sleep"). Test re-test reliability of the Sleep Quality Scale was evaluated by computing intraclass correlation coefficients. Pearson correlation coefficients were computed between baseline Sleep Quality scores and baseline pain diary and Medical Outcomes Study (MOS) Sleep scores. Responsiveness to treatment was evaluated by standardized effect sizes computed as the difference between least squares mean changes in Sleep Quality scores in the pregabalin and placebo groups divided by the standard deviation of Sleep Quality scores across all patients at baseline. Results Studies 1056 and 1077 included 748 and 745 patients, respectively. Most patients were female (study 1056: 94.4%; study 1077: 94.5%) and white (study 1056: 90.2%; study 1077: 91.0%). Mean ages were 48.8 years (study 1056) and 50.1 years (study 1077). Test re-test reliability coefficients of the Sleep Quality Scale were 0.91 and 0.90 in the 1056 and 1077 studies, respectively. Pearson correlation coefficients between baseline Sleep Quality scores and baseline pain diary scores were 0.64 (p < 0.001) and 0.58 (p < 0.001) in the 1056 and 1077 studies, respectively. Correlations between the Sleep Quality Scale and the MOS Sleep subscales were statistically significant (p < 0.01), except for the MOS Snoring subscale. Across both studies, standardized effect sizes were generally moderate (0.46 to 0.52) for the 300 mg group and moderate (0.59) or moderate-to-large (0.70) for the 450 mg group. In study 1056, the effect size for the 600 mg group was moderate-to-large (0.73). In study 1077, the effect size for the 600 mg group was large (0.82). Conclusion These results provide evidence of the reproducibility, convergent validity, and responsiveness to treatment of the Sleep Quality Scale and provide a foundation for its further use and evaluation in FM patients.
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Affiliation(s)
- Joseph C Cappelleri
- Pfizer Inc., Global Research and Development, New London, Connecticut 06320, USA.
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The effects of pregabalin on sleep disturbance symptoms among individuals with fibromyalgia syndrome. Sleep Med 2009; 10:604-10. [DOI: 10.1016/j.sleep.2009.01.009] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2008] [Revised: 01/23/2009] [Accepted: 01/31/2009] [Indexed: 11/21/2022]
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Cappelleri JC, Bushmakin AG, McDermott AM, Dukes E, Sadosky A, Petrie CD, Martin S. Measurement properties of the Medical Outcomes Study Sleep Scale in patients with fibromyalgia. Sleep Med 2009; 10:766-70. [PMID: 19185539 DOI: 10.1016/j.sleep.2008.09.004] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2008] [Revised: 07/16/2008] [Accepted: 09/24/2008] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Sleep problems are a common symptom of fibromyalgia (FM). The objective of this study was to evaluate the Medical Outcomes Study (MOS) Sleep Scale as a measure of FM-related sleep problems. METHODS Analyses were based on data from the 1056 and 1077 studies, two randomized, double-blind, placebo-controlled trials of pregabalin for adults with FM. MOS Sleep Scale scores of study patients were compared with United States normative scores using a one-sample Z test. Subscale structure of the MOS was evaluated by confirmatory factor analyses, internal consistency was evaluated using Cronbach's alpha reliability coefficients. Estimated clinically important differences (CID) in MOS Sleep Disturbance subscale scores were evaluated using mixed-effects models of change in subscale scores as a function of the Patient Global Impression of Change (PGIC). RESULTS 1056 and 1077 included 748 and 745 patients, respectively. Most patients were female (1056: 94.4%, 1077: 94.5%) and white (1056: 90.2%, 1077: 91.0%). Mean ages were 48.8 years (1056) and 50.1 years (1077). Baseline MOS Sleep Scale scores were statistically (P<0.001) and substantially poorer than general population values. The MOS subscale structure was confirmed in both studies at each assessment except at baseline in the 1056 study. Cronbach's alpha coefficients were acceptable, at least 0.70, for all multi-item scales at baseline and end-of-study assessments in both studies, with the exception of the Sleep Adequacy subscale at baseline. The estimated CID for the MOS Sleep Disturbance subscale was 7.9. CONCLUSIONS The MOS Sleep Scale is an appropriate measure of FM-related sleep problems. These analyses provide the foundation for further use and evaluation of the MOS Sleep Scale in FM patients.
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Affiliation(s)
- Joseph C Cappelleri
- Pfizer Inc., Global Research and Development, 50 Pequot Avenue, New London, CT 06320, USA
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Berger A, Sadosky A, Dukes E, Martin S, Edelsberg J, Oster G. Characteristics and patterns of healthcare utilization of patients with fibromyalgia in general practitioner settings in Germany. Curr Med Res Opin 2008; 24:2489-99. [PMID: 18664319 DOI: 10.1185/03007990802316550] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To examine characteristics and patterns of healthcare utilization of patients with fibromyalgia (FM) under the care of general practitioners (GPs) in Germany. RESEARCH DESIGN AND METHODS Retrospective cohort study, using a large electronic database with information on GP encounters in Germany (IMS MediPlus). We identified all patients, aged > or =18 years, with any encounters for FM (ICD-10 diagnosis code M79.7) between February 1, 2004 and January 31, 2007. We also constituted a comparison group consisting of randomly selected patients with one or more GP encounters - but none for FM - during this period, who we matched to FM patients based on age and sex. Characteristics and healthcare utilization of patients in the FM and comparison groups were then examined over the 1-year period, February 1, 2006-January 31, 2007. MAIN OUTCOME MEASURES Prevalence of co-morbidities; use of pain-related pharmacotherapy; number of GP office visits; number of specialist referrals; and number of sick notes (physician-excused absences from work). RESULTS The study sample consisted of 4983 FM patients and an identical number in the comparison group. Mean age was 58 years; 87% were women. The prevalence of various co-morbidities was greater among FM patients, including painful neuropathies (33% vs. 18% for comparison group) and depression (20% vs. 5%) (both p<0.01); more FM patients also received pain-related pharmacotherapy (67% vs. 28%; p<0.01). Compared with patients in the comparison group, FM patients averaged approximately twice as many GP visits (11.4 [SD=10.1] vs. 5.8 [7.5]), referrals (4.5 [5.2] vs. 2.2 [3.6]), and sick notes (0.6 [1.8] vs. 0.3 [1.1]) (all p<0.01). LIMITATIONS Information in the study database is limited to GP encounters, and the sensitivity and specificity of our case-finding methods are unknown. CONCLUSIONS Patients with FM under the care of GPs in Germany have comparatively more co-morbidities and higher levels of healthcare utilization.
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Hoffman DL, Dukes EM. The health status burden of people with fibromyalgia: a review of studies that assessed health status with the SF-36 or the SF-12. Int J Clin Pract 2008; 62:115-26. [PMID: 18039330 PMCID: PMC2228371 DOI: 10.1111/j.1742-1241.2007.01638.x] [Citation(s) in RCA: 180] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE The current review describes how the health status profile of people with fibromyalgia (FM) compares to that of people in the general population and patients with other health conditions. METHODS A review of 37 studies of FM that measured health status with the 36-item Medical Outcomes Study Short-Form Health Survey (SF-36) or the 12-item Short-Form Health Survey (SF-12). RESULTS Studies performed worldwide showed that FM groups were significantly more impaired than people in the general population on all eight health status domains assessed. These domains include physical functioning, role functioning difficulties caused by physical problems, bodily pain, general health, vitality (energy vs. fatigue), social functioning, role functioning difficulties caused by emotional problems and mental health. FM groups had mental health summary scores that fell 1 standard deviation (SD) below the general population mean, and physical health summary scores that fell 2 SD below the general population mean. FM groups also had a poorer overall health status compared to those with other specific pain conditions. FM groups had similar or significantly lower (poorer) physical and mental health status scores compared to those with rheumatoid arthritis, osteoarthritis, osteoporosis, systemic lupus erythematosus, myofacial pain syndrome, primary Sjögren's syndrome and others. FM groups scored significantly lower than the pain condition groups mentioned above on domains of bodily pain and vitality. Health status impairments in pain and vitality are consistent with core features of FM. CONCLUSIONS People with FM had an overall health status burden that was greater in magnitude compared to people with other specific pain conditions that are widely accepted as impairing.
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Berger A, Dukes E, Martin S, Edelsberg J, Oster G. Characteristics and healthcare costs of patients with fibromyalgia syndrome. Int J Clin Pract 2007; 61:1498-508. [PMID: 17655684 PMCID: PMC2040193 DOI: 10.1111/j.1742-1241.2007.01480.x] [Citation(s) in RCA: 206] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
PURPOSE To examine the characteristics and healthcare costs of fibromyalgia syndrome (FMS) patients in clinical practice. MATERIALS AND METHODS Using a US health-insurance database, we identified all patients, aged > or = 18 years, with any healthcare encounters for FMS (ICD-9-CM diagnosis code 729.1) in each year of the 3-year period, 1 July 2002 to 30 June 2005. A comparison group was then constituted, consisting of randomly selected patients without any healthcare encounters for FMS during this 3-year period. Comparison group patients were matched to FMS patients based on age and sex. Characteristics and healthcare costs of FMS patients and comparison group patients were then examined over the 1-year period, 1 July 2004 to 30 June 2005 (the most recent year for which data were available at the time of the study). RESULTS The study sample consisted of 33,176 FMS patients and an identical number in the comparison group. Mean age was 46 years, and 75% were women. FMS patients were more likely to have various comorbidities, including painful neuropathies (23% vs. 3% for comparison group), anxiety (5% vs. 1%), and depression (12% vs. 3%) (all p < 0.001); they also were more likely to have used pain-related pharmacotherapy (65% vs. 34% for comparison group; p < 0.001). Mean (SD) total healthcare costs over 12 months were about three times higher among FMS patients [$9573 ($20,135) vs. $3291 ($13,643); p < 0.001]; median costs were fivefold higher ($4247 vs. $822; p < 0.001). CONCLUSIONS Patients with FMS have comparatively high levels of comorbidities and high levels of healthcare utilization and cost.
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Affiliation(s)
- A Berger
- Policy Analysis, Inc., Brookline, MA 02445, USA
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Abstract
In this article, the authors review current concepts in fibromyalgia. Findings regarding diagnosis, prevalence, comorbidities, and potential pathophysiologic links are discussed. Although fibromyalgia continues to be a complex disorder, there are specific criteria one must meet. Fibromyalgia questionnaires, along with commonalities of age, gender, menopause status, sleep disturbances, and mood symptoms, may aid in the diagnosis. Additionally, the close relationship between fibromyalgia and other chronic disorders should alert the physician to explore for comorbid illness. The relationship between fibromyalgia and irritable bowel syndrome, migraine headaches, and obesity are addressed. The roles of the hypothalamic-pituitary-axis, potential effects of neurotransmitters, and gender-specific hormones all substantiate this diagnosis and provide clues to causality, as well as venues for future treatment.
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Affiliation(s)
- Diane Thompson
- Department of Psychiatry, Queen's Medical Center, John A Burns School of Medicine, 1356 Lusitana Street, Fourth Floor, Honolulu, HI 96813, USA.
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Lindberg L, Iwarsson S. Subjective quality of life, health, I-ADL ability and adaptation strategies in fibromyalgia. Clin Rehabil 2002; 16:675-83. [PMID: 12392344 DOI: 10.1191/0269215502cr539oa] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES To describe subjective quality of life and health, self-perceived instrumental activities of daily living (I-ADL) ability and adaptation strategies, and to explore possible relationships between these variables in fibromyalgia patients. DESIGN Two instruments were used with fibromyalgia patients: the Fibrositis Impact Questionnaire and 'Living with fibromyalgia - adaptation to chronic disease and handicap', and correlative analyses were performed. SUBJECTS A sample of 34 patients undergoing rehabilitation (in a specific programme). RESULTS The majority of the patients used many adaptation strategies, demonstrating some significant relationships with perceived I-ADL ability and subjective quality of life and health. Different symptoms correlated highly significantly with self-perceived ability in I-ADL. CONCLUSION The significant relationships between adaptation strategies and I-ADL ability and health demonstrated deserve clinical awareness and further research efforts.
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Affiliation(s)
- Lorry Lindberg
- Division of Occupational Therapy, Tomelilla Health Care Centre, Sweden.
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Abstract
This study aims to describe, from the perspective of patients with fibromyalgia themselves, their experiences of having to live with chronic pain and how they manage their situation. The sample consists of 22 female patients (22-60 years). Open-ended in-depth interviews were analysed by a method directed by the tradition of Grounded Theory. Three descriptive categories were grounded in the data, labelled subjective pain language, diversified pain coping, and pain communication. These descriptive categories formed the higher-order, or core, concept preoccupied with pain. Having to live with chronic pain seems to include that the sufferer becomes self-centred and preoccupied with the pain: the pain is mostly present and affects every aspect of life, leading to a continuous awareness of and coping with the pain. Pain tends to interrupt normal life, demands attention and is difficult to disengage from. Although coping should not be evaluated in terms of good and bad, passivity, escape behaviours, and resignation/catastrophizing, which dominated in the present study sample, might affect social and psychological functioning negatively. Patients with fibromyalgia might benefit from psychological support in coping with their pain and from reinforcement of healthy behaviours.
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Affiliation(s)
- L R Hallberg
- Department of Psychology, Göteborg University, Göteborg, Sweden.
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Ng SY. Hair calcium and magnesium levels in patients with fibromyalgia: a case center study. J Manipulative Physiol Ther 1999; 22:586-93. [PMID: 10626702 DOI: 10.1016/s0161-4754(99)70019-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Fibromyalgia is not an uncommon condition. Because its cause has yet to be identified. treatment of the condition has been empirical; frequently, outcomes are unsatisfactory. Some patients with fibromyalgia were observed to have high hair calcium and magnesium levels compared with healthy subjects. Because of this and because supplementing calcium with magnesium to fibromyalgia subjects reduced the number of tender points detected by digital palpation, it is worth investigating if patients with fibromyalgia have significantly higher hair calcium and magnesium levels than their healthy counterparts. OBJECTIVES To determine the degree of difference between the hair calcium and magnesium levels in patients with fibromyalgia and in healthy subjects. METHODS The study was retrospective and of paired design. Twelve patients who had hair analysis performed and met the criteria of fibromyalgia defined by American College of Rheumatology (1990) were selected consecutively from clinical files. These patients were then matched by age and sex to 12 healthy subjects selected consecutively from the same patient files who had hair analysis performed for checkup purposes. Nonparametric Wilcoxon rank sum tests were used to determine if the hair calcium and magnesium levels in patients with fibromyalgia were significantly higher than that of the control subjects. RESULTS Wilcoxon rank sum tests showed that patients with fibromyalgia had significantly higher calcium and magnesium levels than the control subjects at alpha = .025 and .05, respectively. CONCLUSION In the presence of high hair calcium and magnesium levels, calcium and magnesium supplements may be indicated as an adjunctive treatment of fibromyalgia.
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Henriksson CM. Living with continuous muscular pain--patient perspectives. Part I: Encounters and consequences. Scand J Caring Sci 1995; 9:67-76. [PMID: 7617994 DOI: 10.1111/j.1471-6712.1995.tb00390.x] [Citation(s) in RCA: 69] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
The purpose of the present study was to focus on the patient perspectives of living with chronic muscular pain, and to identify factors that can explain and give further understanding of how the condition influences everyday life. Forty women with fibromyalgia, living in two different cultural, health care and social security settings, Sweden and the USA, were interviewed, using a semi-structured format. Three preliminary typologies are suggested for further studies: Encounters, Consequences, and Strategies. The study is presented in two articles: Part I: Encounters and consequences, Part II: Strategies for daily life. This first article shows that the contradiction between the patients' perception of illness and the lack of objective findings is stressful. The women feel rejected, misunderstood, and disbelieved, which prevents them from dealing with their situation constructively. Long investigation periods provoke anxiety, and confirmation of the diagnosis is a relief. Daily routines are disrupted, conflicts between life roles lead to additional stress and the women experience loss of ability to perform valued activities, lack of physical fitness and loss of future opportunities. Patients need early and adequate information and the consequences of the condition must be acknowledged and taken into consideration if secondary economic and psychosocial consequences are to be minimized.
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Moldofsky H. Sleep, neuroimmune and neuroendocrine functions in fibromyalgia and chronic fatigue syndrome. ADVANCES IN NEUROIMMUNOLOGY 1995; 5:39-56. [PMID: 7795892 DOI: 10.1016/0960-5428(94)00048-s] [Citation(s) in RCA: 65] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
The justification for disordered chronobiology for fibromyalgia and chronic fatigue syndrome (CFS) is based on the following evidence: The studies on disordered sleep physiology and the symptoms of fibromyalgia and CFS; the experimental studies that draw a link between interleukin-1 (IL-1), immune-neuroendocrine-thermal systems and the sleep-wake cycle; studies and preliminary data of the inter-relationships of sleep-wakefulness, IL-1, and aspects of peripheral immune and neuroendocrine functions in healthy men and in women during differing phases of the menstrual cycle; and the observations of alterations in the immune-neuroendocrine functions of patients with fibromyalgia and CFS (Moldofsky, 1993b, d). Time series analyses of measures of the circadian pattern of the sleep-wake behavioural system, immune, neuroendocrine and temperature functions in patients with fibromyalgia and CFS should determine whether alterations of aspects of the neuro-immune-endocrine systems that accompany disordered sleep physiology result in nonrestorative sleep, pain, fatigue, cognitive and mood symptoms in patients with fibromyalgia and CFS.
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Affiliation(s)
- H Moldofsky
- Centre for Sleep and Chronobiology, Toronto Hospital, Western Division, Canada
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Wolfe F, Aarflot T, Bruusgaard D, Henriksson KG, Littlejohn G, Moldofsky H, Raspe H, Vaerøy H. Fibromyalgia and disability. Report of the Moss International Working Group on medico-legal aspects of chronic widespread musculoskeletal pain complaints and fibromyalgia. Scand J Rheumatol 1995; 24:112-8. [PMID: 7747142 DOI: 10.3109/03009749509099295] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
The present article is the result of a working group conference held in Moss, Norway, in June 1993, financed by the Royal Norwegian Ministry of Health and Social Affairs. Its purpose was to review and focus upon problems and needs related to the medico-legal aspects of fibromyalgia and chronic widespread musculoskeletal complaints: thus to define directions for future work on issues which have generally not been addressed within the medical community. Our report describes specific problems in this area in regard to definition, evaluation and recommendation, and in currently available work and disability statistics. We have recommended international efforts to establish research programs through organizations such as the International Social Security Association and the World Health Organization. While our recommendations call for research into medico-legal interactions, causes and pathogenic mechanisms, prevention and treatment are also key and relevant concerns in the medico-legal setting.
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Affiliation(s)
- F Wolfe
- Dept. of Internal Medicine, University of Kansas School of Medicine,/Arthritis Research and Clinical Centers, Wichita, USA
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Wolfe F, Ross K, Anderson J, Russell IJ, Hebert L. The prevalence and characteristics of fibromyalgia in the general population. ARTHRITIS AND RHEUMATISM 1995; 38:19-28. [PMID: 7818567 DOI: 10.1002/art.1780380104] [Citation(s) in RCA: 1482] [Impact Index Per Article: 51.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVE To determine the prevalence and characteristics of fibromyalgia in the general population. METHODS A random sample of 3,006 persons in Wichita, KS, were characterized according to the presence of no pain, non-widespread pain, and widespread pain. A subsample of 391 persons, including 193 with widespread pain, were examined and interviewed in detail. RESULTS The prevalence of fibromyalgia was 2.0% (95% confidence interval [95% CI] 1.4, 2.7) for both sexes, 3.4% (95% CI 2.3, 4.6) for women, and 0.5% (95% CI 0.0, 1.0) for men. The prevalence of the syndrome increased with age, with highest values attained between 60 and 79 years (> 7.0% in women). Demographic, psychological, dolorimetry, and symptom factors were associated with fibromyalgia. CONCLUSION Fibromyalgia is common in the population, and occurs often in older persons. Characteristic features of fibromyalgia--pain threshold and symptoms--are similar in community and clinic populations, but overall severity, pain, and functional disability are more severe in the clinic population.
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Affiliation(s)
- F Wolfe
- University of Kansas School of Medicine-Wichita
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Affiliation(s)
- D L Goldenberg
- Department of Rheumatology, Newton-Wellesley Hospital, MA 02162
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Russell IJ, Orr MD, Littman B, Vipraio GA, Alboukrek D, Michalek JE, Lopez Y, MacKillip F. Elevated cerebrospinal fluid levels of substance P in patients with the fibromyalgia syndrome. ARTHRITIS AND RHEUMATISM 1994; 37:1593-601. [PMID: 7526868 DOI: 10.1002/art.1780371106] [Citation(s) in RCA: 460] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVE To measure, and seek clinical correlates with, levels of substance P (SP) in the cerebrospinal fluid (CSF) of fibromyalgia syndrome (FMS) patients. METHODS CSF from 32 FMS patients and 30 normal control subjects was tested for SP by radioimmunoassay. Clinical measures included tender point examination and standardized questionnaires. RESULTS CSF SP levels were 3-fold higher in FMS patients than in normal controls (P < 0.001), but they correlated only weakly with tenderness found on examination. CONCLUSION SP is significantly elevated in FMS CSF, but other abnormalities must exist in FMS to more fully explain the symptoms.
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Affiliation(s)
- I J Russell
- Department of Medicine, University of Texas Health Science Center, San Antonio 78284-7874
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Middleton GD, McFarlin JE, Lipsky PE. The prevalence and clinical impact of fibromyalgia in systemic lupus erythematosus. ARTHRITIS AND RHEUMATISM 1994; 37:1181-8. [PMID: 8053957 DOI: 10.1002/art.1780370812] [Citation(s) in RCA: 118] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVE To ascertain the prevalence of fibromyalgia syndrome (FMS) in systemic lupus erythematosus (SLE) and to evaluate its clinical impact and relationship to SLE disease activity. METHODS A cross-sectional analysis of 102 patients from a public hospital SLE clinic. Information was obtained on symptoms of FMS, disability, tender points, pain thresholds, and SLE disease activity. RESULTS Twenty-two SLE patients (22%) met the American College of Rheumatology criteria for FMS, and another 24 (23%) had clinical FMS but did not meet the classification criteria. The patients who met the criteria for FMS had a significantly increased frequency and severity of symptoms commonly associated with FMS, and were much more likely to be unable to perform daily activities. The FMS patients also were less likely to be employed, and more likely to be divorced and to be receiving welfare or medical disability benefits. However, patients with and those without FMS did not differ in measures of SLE activity. CONCLUSION FMS is very common in SLE patients, and accounts for many of the symptoms and much of the disability in these patients.
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