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Mortality in Fibromyalgia: A Study of 8,186 Patients Over Thirty-Five Years
Abstract
To determine if mortality is increased among patients diagnosed as having fibromyalgia.
We studied 8,186 fibromyalgia patients seen between 1974 and 2009 in 3 settings: all fibromyalgia patients in a clinical practice, patients participating in the US National Data Bank for Rheumatic Diseases (NDB), and patients invited to participate in the NDB who refused participation. Internal controls included 10,087 patients with osteoarthritis. Deaths were determined by multiple source communication, and all patients were also screened in the US National Death Index (NDI). We calculated standardized mortality ratios (SMRs) based on age- and sex-stratified US population data, after adjustment for NDI nonresponse.
There were 539 deaths, and the overall SMR was 0.90 (95% confidence interval [95% CI] 0.61-1.26). Among 1,665 clinic patients, the SMR was 0.92 (95% CI 0.81-1.05). Sensitivity analyses varying the rate of NDI nonidentification did not alter the nonassociation. Adjusted for age and sex, the hazard ratio for fibromyalgia compared with osteoarthritis was 1.05 (95% CI 0.94-1.17). The standardized mortality odds ratio (OR) compared with the US general population was increased for suicide (OR 3.31, 95% CI 2.15-5.11) and for accidental deaths (OR 1.45, 95% CI 1.02- 2.06), but not for malignancy.
Mortality does not appear to be increased in patients diagnosed with fibromyalgia, but the risk of death from suicide and accidents was increased.
... The percentage of subjects who had completed primary school ranged from 38.6 (29) to 61.5% (31), while the unemployment rate ranged from 5.6 (31) to 13.6% (26). Five and four studies were carried out in Spain (26,(29)(30)(31)33), and in the USA (24,27,28,34), respectively, whereas the remaining four studies were performed in Denmark (25), Canada (23), Taiwan (32) and Israel (20). Seven studies (23-25, 27, 28, 32, 34) were database-based, while three (26,30,31) and three (20,29,33) were cross-sectional and case-control studies, respectively. ...
... No longitudinal studies could be found. The diagnosis of fibromyalgia was mostly based on the 1999 ACR criteria, with the exception of two studies, one of which utilized the 2010 ACR criteria (27), and the second (34) which utilized machine learning techniques, and combined diagnostic criteria, clinical expertise and textual information from clinical charts and medical records. The diagnosis of suicidality was made by asking ad hoc questions in two studies (23,26), or utilizing structured, validated, and reliable psychometric tools in seven studies (20,25,26,(29)(30)(31)33). One study (24) did not report sufficient details about methodology adopted, while one study (34), as also previously mentioned for the diagnosis of fibromyalgia, deployed an ensemble of techniques, combining machine learning approaches, literature review and clinical expertise. ...
... The diagnosis of suicidality was made by asking ad hoc questions in two studies (23,26), or utilizing structured, validated, and reliable psychometric tools in seven studies (20,25,26,(29)(30)(31)33). One study (24) did not report sufficient details about methodology adopted, while one study (34), as also previously mentioned for the diagnosis of fibromyalgia, deployed an ensemble of techniques, combining machine learning approaches, literature review and clinical expertise. Three studies (27,28,32) evaluated suicide event (categorized in completed suicide, suicide attempt, and non-suicidal self-inflicted injury). ...
Background: Suicide is a leading cause of death worldwide, affecting ~800,000 people every year. Fibromyalgia is an extremely prevalent rheumatic disease with a predisposition for comorbid anxiety and depression, which are known risk factors for suicidal behavior. Suicidality and relevant risk factors for suicidal behavior have not been thoroughly studied in patients with fibromyalgia.
Objectives: To investigate the risk of suicidal ideation and attempts in patients with fibromyalgia.
Methods: A systematic review and meta-analysis was conducted and reported according to the “Preferred Reporting Items for Systematic reviews and Meta-analyses” (PRISMA) standards. Also, the gray literature was extensively searched.
Results: Thirteen studies were included in the present systematic review and meta-analysis, including 394,087 fibromyalgia patients. Sample size ranged from 44 to 199,739 subjects, mean age ranged from 45.8 to 54.5 years while the female percentage with fibromyalgia ranged from 17.1 to 100.0%. The overall suicide ideation prevalence was 29.57% (95%CI 1.84–72.07), with an OR 9.12 of (95%CI 1.42–58.77), ranging from 2.34 (95%CI 1.49–3.66) to 26.89 (95%CI 5.72–126.42). Pooled suicide attempt prevalence was 5.69% [95%CI 1.26–31.34], with an OR of 3.12 [95%CI 1.37–7.12]. Suicide risk was higher with respect to the general population with an OR of 36.77 (95%CI 15.55–96.94), as well as suicide events with an HR of 1.38 (95%CI 1.17–1.71). Determinants of suicidality were found to be: employment status, disease severity, obesity and drug dependence, chronic pain and co-morbidities, in particular depression, anxiety, poor sleep, and global mental health. However, in some cases, after adjusting for psychiatric conditions, the threshold of statistical significance was not achieved.
Conclusion: Fibromyalgia patients are particularly prone to suicide, in terms of ideation, attempt, risk and events, warranting a pre-emptive screening of their mental health status. Given the few studies available, the high amount of heterogeneity, the evidence of publications bias and the lack of statistical significance when adjusting for underlying psychiatric co-morbidities, further high-quality studies should be conducted.
Clinical Trial Registration: ClinicalTrial.gov , identifier 10.17605/OSF.IO/Y4BUE.
... As can be seen in Table 1, a range of suicidality variables was assessed. Two studies solely assessed SI (34,40), three solely investigated completed suicide (28,32,41), and one study examined solely suicide risk (32), which was defined as thoughts of suicide, depression, and hopelessness, among other variables (45). The remaining portion of the reviewed studies examined a multitude of suicidal thoughts and behaviors. ...
... Notably, no longitudinal studies could be found. Most studies included patients solely with FM; interestingly, one study examined patients with both diagnosed and "possible" FM, in which FM diagnostic criteria were not fully met (41), and another study examined patients with migraine and comorbid FM (38). Studies utilized a variety of control groups, varying from matched reference controls (13), to patients with low-back pain (LBP) (36) and osteoarthritis (OA) (30), to healthy controls (32,35). ...
... However, pain scores did not differ between the groups (33). Finally, it was found that the standardized odds ratio for completed suicide among FM patients and osteoarthritis patients as compared to the US general population was 3.31 (41). ...
Fibromyalgia (FM), a poorly understood rheumatic condition, is characterized by chronic pain and psychiatric comorbidities, most notably depression and anxiety. Additional symptoms include sleep difficulties, fatigue, and various cognitive impairments. Furthermore, FM is surrounded by social stigma, due to the unclear nature and etiology of this condition. While there is widespread evidence for the emotional and psychological suffering of those with FM, the scope of suicidality, as well as the underlying factors that are associated with suicidal ideation and behavior among this population, are not well understood. The present review, which is the first of its kind, aims to summarize existing data on the prevalence of suicide-related outcomes among FM patients, highlight factors associated with suicidal ideation and behavior in FM, and identify gaps in the literature to better inform research and clinical care. Studies were extracted from the literature that measured suicidal ideation, attempted suicide, and/or completed suicide among FM patients. Results indicated that both suicidal ideation and suicidal behavior were prevalent among individuals suffering from FM. Psychiatric comorbidity, sleep difficulties, and inpatient hospitalization were associated with both suicidal ideation and suicidal behavior. Functional impairment was associated with suicidal ideation in FM. Factors associated with higher levels of suicidal behavior in FM included female gender, unemployment and lower income, medical comorbidity, and drug dependence. While an understanding of currently recognized risk factors is important for improving FM research and clinical care, some clear methodological and conceptual limitations of the reviewed studies were identified. Future work should focus on longitudinal studies, as well as on gaining a better biological and psychological understanding of the underpinnings of FM and suicidality.
... Moreover, FM assessments were made using the following: (1) three studies used the ACR 1990 criteria (Dreyer et al., 2010;Triñanes et al., 2015), (2) one study analyzed the data for diagnostic classification using the FM diagnosis criteria modified from the ACR 2010 diagnostic criteria, the fibromyalgianess scale, the Widespread Pain Index and widespread pain definition from the ACR 1990 criteria (Wolfe et al., (Calandre et al., 2011), (4) one study used the ICD-9-CM criteria (Ilgen et al., 2013), one study used a validated phenotype from the Phenotype KnowledgeBase to confirm diagnosis (McKernan et al., 2018) and (6) one study used database and/or patient chart review (i.e., CCHS; Ratcliffe et al., 2008). Data on SC was evaluated in three studies using the following criteria: review of the Veterans National Patient Care Database and Disease Control Prevention's National Death Index, US National Death Index (NDI), and hospital medical records and mortality register (Dreyer et al., 2010;Ilgen et al., 2013;Wolfe et al., 2011). ...
... Three articles assessed SC using a retrospective cohort study design (Dreyer et al., 2010;Wolfe et al., 2011;Ilgen et al., 2013). All three found an increased risk of suicide within FM patients. ...
... Risk factors for suicide include persistent mental illness and polysomatic symptoms. Wolfe et al., 2011 Selection: *** Comparability: * Outcome: ** To assess whether primary FM is associated with SC compared to general population and osteoarthritis controls. ...
Objective
Fibromyalgia (FM) is a condition associated with chronic pain in muscles and soft tissues. Extant literature has demonstrated an association between FM, mood symptoms and suicidal behaviour. This systematic review aims to synthesize available literature assessing the prevalence of suicidality in FM populations and qualitatively review the included articles.
Methods
PsycINFO, Google Scholar and PubMed databases were systematically searched for studies published from database inception to 15 February 2020. Studies were included that assessed FM as a primary or co-primary disease condition, as well as an assessment of suicidal behaviour (suicidal ideations (SI), suicide attempts (SA) and death by suicide (SC)). The quality of the studies was assessed using the Newcastle-Ottawa Scale.
Results
699 unique articles were reviewed for eligibility. Data were derived from nine studies (cross-sectional: k = 5; retrospective cohort: k = 4) that assessed suicidal behaviour in FM participants (SI: k = 5, SC: k = 3, SA: k = 3). Four studies assessing SI found elevated rates of SI among FM participants. Three studies found elevated risk for SC and three studies found increased SA in FM participants relative to the general population. In two studies, this association was no longer significant after adjusting for depression and other psychiatric comorbidities.
Conclusion
Preliminary findings suggest that FM is associated with significantly higher risks for SI, SA and SC compared to the general population. There may be unique risk factors underlying suicidal behaviour in FM patients and the interaction between FM and other known risk factors (i.e., mental illness) require further investigation.
... The global prevalence of FM is 2.7%, and it is more frequent among women [12]. Several studies have indicated a higher prevalence of suicidal behaviors in patients with FM, including SI [13][14][15], suicide attempts [16], and death by suicide [17,18]. Although those suffering from FM may experience life weariness, this should not necessarily be understood as a desire to die [10]. ...
... Calandre et al. [16] applied a survey to 180 FM patients and found that 16.7% of them reported one or more previous suicide attempts, a percentage very higher than the expected worldwide lifetime prevalence of 2.7% [1,2]. In addition, two large population-based studies, one performed in Denmark and the other one in the US, found that mortality by suicide was increased among FM patients compared not only to the general population [17,18]. Several studies reported an increase in suicidal behaviors related either to chronic pain [5], as well as depression [2] and sleep disorders [4]. ...
... These patients should be referred to mental health services to be adequately evaluated and, if necessary treated. Such prevention measures could be useful to decrease the excess of mortality by suicide associated with fibromyalgia [17,18]. The evaluation of FM patients should consider the neurocognitive, psychological, physical and functional dimensions [51]. ...
Perceived burdensomeness and thwarted belongingness are key factors in the development of suicidal behaviors that have been frequently observed among patients with fibromyalgia. The aim of the present study was to compare these two factors in patients with fibromyalgia with and without suicidal ideation and healthy subjects. Secondary objectives were to evaluate the relationship between these two factors and the secondary variables included in the study, such as depression, sleep quality or the degree of marital adjustment. Perceived burdensomeness and thwarted belongingness were assessed with the Interpersonal Needs Questionnaire, depression and suicidal ideation with the Patients Health Questionnaire-9, suicidal risk with the Plutchik Suicide Risk scale, sleep with the Insomnia Severity Index, and marital adjustment with the Locke-Wallace Marital Adjustment scale. Questionnaire scores were compared with the Kruskal-Wallis test. 49 healthy subjects, 38 patients with fibromyalgia without suicidal ideation and 15 patients with fibromyalgia and suicidal ideations were included. Perceived burdensomeness scores were significantly higher in patients with suicidal ideation than in patients without suicidal ideation and controls; thwarted belongingness scores were significantly higher in patients with suicidal ideation than in controls. Marital adjustment was also significantly poor in patients with suicidal ideation than in patients without suicidal ideation and controls. Among patients with fibromyalgia, perceived burdensomeness seems to be strongly related with suicidal ideation, whereas thwarted belongingness seems to play a less relevant role at this respect. Poor marital adjustment could be related with depression.
... 34 records (30 full-published articles and 4 studies published in an abstract form) that included specific data related to the frequency and/or potential determinants of suicidal behaviors in rheumatic diseases were included in the present review. 14 studies assessed suicidality in SLE [20][21][22][23][24][25][26][27][28][29][30][31][32][33], 11 studies in fibromyalgia [34][35][36][37][38][39][40][41][42][43][44], and 12 in inflammatory joint disorders [7,9,11,35,36,40,[45][46][47][48][49][50]. As shown in Table 1, the majority of these studies were of cross-sectional design [7, 22, 24, 26-30, 32, 34, 35, 39, 41-43, 45-48, 50], half of them had a comparator group [7, 9, 11, 33-38, 40, 41, 44, 46, 47, 49], and only seven studies were representative of the general population [7,11,35,[44][45][46][47]. ...
... The prevalence of suicide attempts in fibromyalgia reached 16.7% in the cross-sectional study conducted by Calandre et al. [39]; 66.7% of these patients reported one suicide attempt and 16.7% reported two or three suicide attempts. Suicide mortality in patients with fibromyalgia was shown to be elevated as compared to the general population [37,38,40]. In the cohort study conducted by Dreyer et al. [37] in a total of 1353 patients, 48 deaths were registered during the observation period of 5295 person-years at risk of death. ...
... No increase in overall mortality was found in relation with the general population, but there was an increased risk of death due to suicide [standardized mortality ratios: 10.5, 95% CI 4.5-20.7]. In another cohort study conducted by Wolfe et al. [38], a higher mortality risk for deaths due to suicide (OR 3.31, 95% CI 2.15-5.11) and accidental deaths (OR 1.45, 95% CI 1.02-2.06) ...
Chronic rheumatic disorders are characterized by inflammation and chronic pain, and both anxiety and depression have been frequently observed in these patients. Depression and chronic pain are recognized as risk factors for the development of suicidal behaviors. Accordingly, the objective of the present review is to provide a comprehensive review of suicidal behaviors associated with rheumatic diseases. Medline and EMBASE were searched for English language publications using key words related with rheumatic diseases, suicide, suicide attempts, and suicidal ideation. 34 records (30 full-length published papers and 4 studies published in abstract form) that included data related to the frequency and/or potential determinants of suicidal behaviors in rheumatic diseases were included in the review. It was found that both suicidal ideation and completed suicide seem to be more frequent in patients experiencing systemic lupus erythematosus, fibromyalgia and arthritis. Major determinants were comorbid depression in fibromyalgia and arthritis, and neuropsychiatric disease in systemic lupus erythematosus. Based on these findings, suicide risk should be assessed in patients suffering from systemic lupus erythematosus, fibromyalgia and/or arthritis.
... A study from a multidisciplinary pain clinic in Denmark reported in their patients a six-fold higher mortality rate than in the general population (Vaegter et al., 2019). Population studies and studies on specific chronic pain patients, such as ours and those of others (Dreyer et al., 2010;Krause et al., 2017;Vaegter et al., 2019;Wolfe et al., 2011) probably represent different ends of the spectrum of patients with long-lasting pain, which could explain why some previous studies did not show any relationship between pain and mortality (Andorsen et al., 2016;Åsberg et al., 2016). In our study of tertiary MPM patients, the overall SMR was not as high as in Denmark, but we showed a strong association of HRQoL and its psychosocial problems with overall mortality. ...
... Chronic pain is an independent risk factor of suicidality (Campbell et al., 2015;Ilgen et al., 2013;Owen-Smith et al., 2019;Racine, 2018), but pain-related risk factors for suicide are not as well-established. Patients with painful fibromyalgia are at increased risk of death by suicide, although this patient group does not seem to have an increase in overall mortality (Dreyer et al., 2010;Wolfe et al., 2011). In the present study, both suicides and intoxications with unknown intentionality occurred in the youngest age groups, as in the general population (Statistics Finland, 2020). ...
Background:
Severe chronic pain that interferes with daily activities is associated with an increased risk of mortality. We assessed the overall mortality of tertiary chronic pain patients in comparison with the general population, with a special aim to analyse the association of health-related quality of life (HRQoL) and its dimensions with the risk of death.
Methods:
In this prospective observational follow-up study, patients with non-cancer chronic pain attended an outpatient multidisciplinary pain management (MPM) episode in a tertiary pain clinic in 2004-2012 and were followed until May 2019. Mortality between the patients and the general population was compared with standardized mortality ratios (SMR) in different age groups. Causes of death and comorbidities were compared among the deceased. Association of mortality and HRQoL and its dimensions, measured with the 15D instrument, was studied with Cox proportional hazards model.
Results:
During a mean of 10.4-year follow-up of 1498 patients, 296 died. The SMR in the youngest age group (18-49 years) was significantly higher than that of the general population: 2.6 for males and 2.9 for females. Even elderly females (60-69 years) had elevated mortality (SMR 2.3). Low baseline HRQoL at the time of MPM, as well as poor ratings in the psychosocial dimensions of HRQoL, was associated with an increased risk of death.
Conclusions:
Our results support the role of HRQoL measurement by a validated instrument such as the 15D in capturing both the physical and the psychological symptom burden, and consequently, an elevated risk of death, in patients with chronic pain.
Significance:
Severe chronic pain is associated with elevated mortality. In patients in chronic pain under 50 years old, the mortality was 2.5-3 times higher than in the general population. Psychological distress appears to contribute to the increased mortality. Regular follow-up by health-related quality of life (HRQoL) measurement could be useful in identifying patients in chronic pain who are in need of intensive symptom management and to prevent early death.
... L'évolution entre les critères de 1990 et les critères suivants marque un changement dans la conception que l'on se fait de la fibromyalgie, d'abord comme une problématique où le diagnostic se concentre essentiellement sur la douleur (avec la palpation des points douloureux) puis comme une problématique à différentes facettes où l'ensemble des signes et des autres symptômes associés doivent être pris en compte (tout en laissant la douleur chronique au centre du tableau). (Calandre et al., 2011 ;Dreyer et al., 2010) comme aux USA (Wolfe, Hassett et al., 2011) ; dans une enquête espagnole, 16,7% des patients fibromyalgiques rapportaient des antécédents de passage à l'acte suicidaire contre 4,4% de la population générale (Calandre et al., 2011). Dans cette étude, le risque suicidaire était corrélé à la sévérité de la fibromyalgie. ...
... Dans cette étude, le risque suicidaire était corrélé à la sévérité de la fibromyalgie. Dans la population américaine, la mort par suicide est fortement augmentée dans les populations de patients fibromyalgiques comparées à la population générale avec un Odd ratio de 3,31 (Wolfe, Hassett et al., 2011). L'indice standardisé de mortalité par suicide pour la fibromyalgie dans la population danoise était de 10,5 (Dreyer et al., 2010). ...
Ce travail de thèse interroge le rôle des pensées répétitives négatives (PRN) dans le développement et le maintien de la douleur et des émotions négatives dans la fibromyalgie. Nous pensons que l’étude des pensées répétitives négatives pourrait nous permettre de mieux comprendre la comorbidité psychiatrique de la fibromyalgie. Pour cela nous nous sommes appuyés sur un modèle de pensées répétitives dans la douleur chronique.Afin de tester une partie de ce modèle dans la fibromyalgie nous avons mené trois études. Dans notre première étude, nous avons souhaité répliquer, dans le champ de la fibromyalgie, les résultats obtenus pour d’autres populations cliniques non douloureuses qui ont démontré les liens entre pensées répétitives négatives et différentes psychopathologies. Dans une deuxième étude, nous avons interrogé le lien indirect entre PRN et douleur par des processus attentionnels. Enfin, dans notre troisième étude, nous nous sommes plus particulièrement intéressés à l’hypothèse d’un lien direct, causal, entre pensées répétitives et douleur.Nous avons montré que de hauts niveaux de pensées répétitives négatives font le lien entre incapacité liée à la douleur et anxiété et dépression dans la fibromyalgie. Nous avons également mis en évidence un lien entre tendance élevée aux pensées répétitives négatives et mécanismes attentionnels dans la fibromyalgie. Nous avons enfin montré que les pensées répétitives négatives entretiennent les douleurs en prolongeant leur durée.Les résultats de l’ensemble de ces travaux soutiennent l’intérêt de considérer les pensées répétitives comme un processus transdiagnostique participant au maintien de la Fibromyalgie et de ses comorbidités psychiatriques. Nous discutons de ces résultats d’un point de vue théorique et clinique.
... Chronic widespread pain (CWP) occurs in10-12% of the general population [1], and fibromyalgia in 2-4% [2]. There have been two studies of all-cause mortality in persons with fibromyalgia (FM) [3,4] and five studies of chronic WSP (CWP) [5][6][7][8][9][10][11]. Both FM studies found no association of FM with mortality, while a meta-analysis of CWP studies reported an all-cause mortality risk ratio (MRR) of 1.22, 95%CI 0.93-1.60. ...
... It is of some interest that we found evidence of cause-specific mortality for suicide and accidents in FM 2016 positive patients. While this was found for clinical FM patients in our previous study [3], the current study supports this finding in FM positive RA and NIRMD patients as well. Mortality from suicide has been found by others [52]. ...
Purpose:
Studies of the relation of fibromyalgia (FM) and widespread pain (WSP) to mortality have differed as to the presence or absence of an association and the extent of cause-specific mortality. However, no studies have investigated which definitions of FM and WSP associate with mortality, nor of FM mortality in other diseases. We investigated these issues and the meaning of mortality in patients with FM.
Methods:
We used Cox regression to study 35,248 rheumatic disease patients with up to 16 years of mortality follow-up in all patients and separately in those with diagnoses of rheumatoid arthritis (RA) (N = 26,458), non-inflammatory rheumatic disorders (NIRMD) (N = 5,167) and clinically diagnosed FM (N = 3,659). We applied 2016 FM criteria and other FM and WSP criteria to models adjusted for age and sex as well as to models that included a full range of covariates, including comorbid disease and functional status. We estimated the degree of explained of variance (R2) as a measure of predictive ability.
Results:
We found positive associations between al`l definitions of FM and WSP and all-cause mortality, with relative risks (RR)s ranging from 1.19 (95%CI 1.15-1.24) for American College of Rheumatology (ACR) 1990 WSP to 1.38 (1.31-1.46) in age and sex adjusted revised 2016 criteria (FM 2016). However, in full covariate models the FM 2016 RR reduced further to 1.15 (1.09-1.22). The association with mortality was noted with RA (1.52 (1.43-1.61)), NIRMD (1.43 (1.24-1.66)) and clinical FM (1.41 (1.14-1.75) - where 37% of FM diagnosed patients did not satisfy FM 2016 criteria. In the all-patient analyses, the age and sex explained variation (R2) was 0.255, increasing to 0.264 (4.4%) when FM 2016 criteria were added, and to 0.378 in a full covariate model. Death causes related to FM 2016 status included accidents, 1.45 (1.11-1.91); diabetes 1.78 (1.16-2,71); suicide, 3.01 (1.55-5.84) and hypertensive related disorders, 3.01 (1.55-5.84). Cancer deaths were less common 0.77 (0.68-0.88).
Conclusions:
FM is weakly associated with mortality within all criteria definitions of FM and WSP examined (3.4% of explained variance), and across all diseases (RA, NIRMD, clinical FM) equally. Clinical and criteria-defined FM had different mortality outcomes. We found no evidence for a positive association of cancer and FM or WSP.
... FM, hipotiroidi, depresyon, sistemik lupus eritamatozis ve malignite gibi birçok hastalığı taklit edebilmektedir [3]. FM, hastanın klinik özelliklerine göre diğer olası tanılar dışlanarak teşhis edilir [9]. FM'de eşlik eden başka bir komorbid hastalık olmadığı sürece, genel olarak laboratuvar testleri normaldir [10]. ...
... Amerika ve Türkiye'de yapılan çalışmalarda, FM ile beraber özellikle depresyon ve anksiyete gibi psikiyatrik hastalıkların birlikteliğinin sık olduğunu bildirmişlerdir [18][19][20][21]. Bizim çalışmamızda da, anksiyete (%15,5) ve depresyon (%5, 9) başta olmak üzere %22,8 oranında psikiyatrik hastalık birlikteliği mevcuttu. Bunun yanında, FM hastalarında uyku bozuklukları başta olmak üzere birçok komorbid semptomlar görülebilmektedir. ...
... Similar findings occurred in a later study of 8,186 fibromyalgia patients, of whom 81% reported widespread pain at baseline [131]. There was no difference in the SMR of this patient population compared to the general US population (stratified by age and sex), although fibromyalgia patients had both a higher rate of suicide (4.4% compared to 1.4% of the general population, SMR 3.31 [95% CI, 2.15 to 5.11]) and a higher rate of accidental death (7.1% versus 5.0% in the general population, SMR 1.45 [95% CI, 1.02 to 2.06]) [131]. ...
... Similar findings occurred in a later study of 8,186 fibromyalgia patients, of whom 81% reported widespread pain at baseline [131]. There was no difference in the SMR of this patient population compared to the general US population (stratified by age and sex), although fibromyalgia patients had both a higher rate of suicide (4.4% compared to 1.4% of the general population, SMR 3.31 [95% CI, 2.15 to 5.11]) and a higher rate of accidental death (7.1% versus 5.0% in the general population, SMR 1.45 [95% CI, 1.02 to 2.06]) [131]. It is possible that some of the accidental deaths may have been unrecognized suicides. ...
... In women, the frequency is 4-9 times more than men. 6 FMS is diagnosed by excluding other possible diagnosis based on the patient's clinical features. There is no specific laboratory test or diagnostic method for FMS. ...
... The current study was planned to examine comorbid diseases of patients diagnosed with fibromyalgia and to determine the rates of comorbid diseases. [4][5][6][7] ...
Objective: To examine the prevalence of comorbid conditions in patients diagnosed with fibromyalgia.
Methods: The retrospective cross-sectional study was conducted at Eskisehir Osmangazi University, Eskisehir, Turkey, and comprised data of fibromyalgia patients aged 18 years or more admitted between January 1, 2012 and August 15, 2016. Hospital's database was investigated using the International Classification of Diseases, 10th Revision codes to identify fibromyalgia cases and predetermined comorbid conditions. SPSS 21 was used for data analysis.
Results: Of 509 patients, 51(10%) were males and 458(90%) were females with an overall mean age of 50.24±12.32 years. Of the total, 345(67.8%) patients had at least one comorbid disease, while 164(32.2%) had no comorbid disease. The most prevalent condition was cardiovascular diseases in 187(36.7%) patients followed by endocrine diseases in 157(30.8%).
Conclusion: Fibromyalgia is a disease that is seen to be increasing in frequency in recent years. It is useful to evaluate fibromyalgia patients with their comorbid conditions on their follow-up
... However, pain may also carry an increased risk of mortality, although the risk is unclear and the evidence contradictory (4,5). Some of the risk may be attributed to underlying disease such as cancer, which is considered to cause the pain (3), but the important question of whether the experience or nature of chronic pain confers a risk of premature death is unresolved (4)(5)(6)(7)(8)(9)(10)(11)(12)(13). ...
... (9), and people with fibromyalgia who satisfied the more stringent American College of Rheumatology (ACR) 2010 criteria had an increased risk of mortality when compared to those satisfying the less stringent 1990 criteria only (hazard ratio [HR] 1.62 [95% CI 1.19-2.21]) (11,16). The aim of this study was to investigate the effect of pain phenotype on the association between pain and mortality in older adults, using 2 different population cohorts, and to test the hypothesis that the association with mortality increases with increasing pain extent and impact on daily life. ...
Objective:
Moderate to severe chronic pain affects 1 in 5 adults. Pain may increase the risk of mortality, but the relationship is unclear. This study investigated whether mortality risk was influenced by pain phenotype, characterized by pain extent or pain impact on daily life.
Methods:
The study population was drawn from 2 large population cohorts of adults ages ≥50 years, the English Longitudinal Study of Ageing (n = 6,324) and the North Staffordshire Osteoarthritis Project (n = 10,985). Survival analyses (Cox's proportional hazard models) estimated the risk of mortality in participants reporting any pain and then separately according to the extent of pain (total number of pain sites, widespread pain according to the American College of Rheumatology [ACR] criteria, and widespread pain according to Manchester criteria) and pain impact on daily life (pain interference and often troubled with pain). Models were cumulatively adjusted for age, sex, education, and wealth/adequacy of income.
Results:
After adjustments, the report of any pain (mortality rate ratio [MRR] 1.06 [95% confidence interval (95% CI) 0.95-1.19]) or having widespread pain (ACR 1.07 [95% CI 0.92-1.23] or Manchester 1.16 [95% CI 0.99-1.36]) was not associated with an increased risk of mortality. Participants who were often troubled with pain (MRR 1.29 [95% CI 1.12-1.49]) and those who reported quite a bit of pain interference (MRR 1.38 [95% CI 1.20-1.59]) and extreme pain interference (MRR 1.88 [1.54-2.29]) had an increased risk of all-cause mortality.
Conclusion:
Pain that interferes with daily life, rather than pain per se, was associated with an increased risk of mortality. Future studies should investigate the mechanisms through which pain increases mortality risk.
... Current knowledge on the relationship between MSCs and hard end-points is sparse and has rendered conflicting results. Some studies have indicated an increased mortality among individuals with chronic MSCs [10][11][12][13][14], with the main causes of death being cardiovascular disease and cancer, whereas other studies have shown no association between MSCs and mortality [15][16][17][18][19]. Both prospective and cross-sectional studies have suggested that several negative health determinants, such as smoking, mental health complaints, low educational level, and physical inactivity, are associated with MSCs [20][21][22][23]3]. ...
... Our study highly suggests that presence of MSCs are not independent predictors of mortality. These findings are supported by other authors [13][14][15][16][17], including a Norwegian cohort study published in 2016 by Åsberg et al [19]. We previously demonstrated that the prevalence of severe MSCs increased up to the age of 50-59 years, and decreased thereafter [3]. ...
Background
The long-term consequences of chronic pain and/or stiffness from the musculoskeletal system (musculoskeletal complaints: MSCs) have not been well explored. The aims of this study were to investigate whether MSCs reported at baseline influence all-cause and cause-specific mortality during 21 years follow-up of a general Northern Norwegian adult population.
Methods
A total of 26,977 men and women aged 25–97 years who participated in the 1994–1995 survey of the Tromsø study (response rate 77%) were included in the present prospective cohort study. Baseline data were collected from the 1994–1995 survey and information on death and emigration was taken from the National Register of Norway. Cox regression analyses were performed to examine if MSCs predicted risk of mortality.
Results
5693 (21.1%) participants died during follow-up. Mean time between entry into the survey and death or emigration was 18.6 years (standard deviation 4.87) for all-cause mortality. There was an increased risk of death among those with MSCs at baseline in the crude Cox regression model. However, the multivariable model revealed no significant association between MSCs at baseline and all-cause mortality by sex (women: hazard ratio [HR] = 0.93, 95% confidence interval [CI]: 0.85–1.01; men: HR = 0.93, 95%CI: 0.85–1.01). Furthermore, no significant associations were found between widespread MSCs at baseline and all-cause mortality in multivariable models (women: HR = 0.90, 95%CI: 0.80–1.01; men HR = 0.87, 95%CI: 0.76–1.00). Analyses on cause-specific mortality did not reveal any significant results.
Conclusion
MSCs are not independently associated with increased risk of death from cardiovascular disease, cancer, or death from all causes.
... Studies comprising thousands of patients derived from specialty clinics, general surveys, and pharmaceutical trials observe fibromyalgia to be a disorder nearly exclusively of middle-aged Caucasian women. Studies, derived mainly from Western Europe and the United States describe fibromyalgia patients typically being between 45-55 years old, over 90% Caucasian, and over 90% female [11][12][13][14][15]. However, population-based epidemiological studies using research criteria observe fibromyalgia to be a more equitable illness, with a modest female predominance of 2-3:1 and no important differences related to age or ethnicity [16][17][18]. ...
... These levels are higher than seen in undiagnosed persons with comparable levels of PSD and they approach what is seen in persons meeting NHIS criteria. As diagnostic labeling can in itself encourage disablement [29] and indiscriminate prescription of pain and psychotropic medications can lead to injury and death [15,30], the widespread use of the fibromyalgia diagnosis as an explanation of mild-to-moderate polysymptomatic distress has likely led to substantial harm and societal costs [31]. The data of this study make clear that the use of the fibromyalgia diagnosis has been expanded beyond the initial intent of the fibromyalgia diagnosis. ...
Objectives:
Although fibromyalgia criteria have been in effect for decades, little is known about how the fibromyalgia diagnosis is applied and understood by clinicians and patients. We used the National Health Interview Survey (NHIS) to determine the prevalence of self-reported clinician diagnosed fibromyalgia and then compared demographics, symptoms, disability and medical utilization measures of persons with a clinical diagnosis of fibromyalgia that did not meet diagnostic criteria (false-positive or prior [F/P] fibromyalgia) to persons with and without criteria-positive fibromyalgia.
Methods:
The National Health Interview Survey (NHIS) collected information about both clinical diagnosis and symptoms of fibromyalgia that was appropriately weighted to represent 225,726,257 US adults. Surrogate NHIS diagnostic criteria for fibromyalgia were developed based on the level of polysymptomatic distress (PSD) as characterized in the 2011 modified American College of Rheumatology criteria (ACR) for fibromyalgia. Persons with F/P fibromyalgia were compared with persons who do not have fibromyalgia and those meeting surrogate NHIS fibromyalgia criteria.
Results:
Of the 1.78% of persons reporting a clinical diagnosis, 73.5% did not meet NHIS fibromyalgia criteria. The prevalence of F/P fibromyalgia is 1.3%. F/P fibromyalgia is associated with a mild degree of polysymptomatic distress (NHIS PSD score 6.2) and characterized by frequent but not widespread pain and insomnia. Measures of work disability and medical utilization in F/P fibromyalgia were equal to that seen with NHIS criteria positive fibromyalgia and were 6-7x greater in F/P fibromyalgia than in non-fibromyalgia persons. F/P fibromyalgia was best predicted by being female (Odds Ratio [OR] 8.81), married (OR 3.27), and white (OR 1.96). In contrast, being a white, married woman was only modestly predictive of NHIS (criteria positive) fibromyalgia (OR 2.1).
Conclusions:
The majority of clinically diagnosed fibromyalgia cases in the US do not reach levels of severity necessary and sufficient for diagnosis. The clinical diagnosis of fibromyalgia is disproportionally dependent on demographic and social factors rather than the symptoms themselves. Diagnostic criteria for fibromyalgia appear to be used as a vague guide by clinicians and patients, and allow for substantial diagnostic expansion of fibromyalgia.
... This is probably due to the owing to their intimate, regular contact with patients and working longer hours than average, frontline nurses treating patients with COVID-19 were potentially at the highest risk of infection (27). In this study, most of the cases of FM were aged between 30 and 39 years, and these findings corroborate with previous studies that reported FM among middle-aged people (30,31). In current study, most of the respondents have Vitamin D deficiency, and our findings are in accordance to the study by Bhatty et al. (32) where vitamin D deficiency is frequently seen in patients diagnosed as FM. ...
Background: In the face of the contemporary COVID-19 pandemic, health service providers have emerged as the most at-risk individuals who are likely to contract the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).
Aim: To measure the prevalence of fibromyalgia (FM) during COVID outbreak among health workers in Saudi Arabia using FiRST and LFESSQ tool.
Methods: The study employed a cross-sectional methodology to explore the prevalence of Fibromyalgia among health workers at different health care settings in Saudi Arabia. The assessment of the prevalence of fibromyalgia among health worker was determined by using the Fibromyalgia Rapid Screening Tool (FiRST) and London Fibromyalgia Epidemiological Study Screening Questionnaire (LFESSQ) questionnaires. Descriptive statistics were used to summarize the data.
Results: The sample size included 992 participants. The prevalence of fibromyalgia using FiRST and LFESSQ was 12.6 and 19.8%, respectively. In this study, the prevalence of fibromyalgia was higher in females when compared to males. Most of the respondents have Vitamin D deficiency. The relationship of fibromyalgia was significantly associated with the participants who worked during an outbreak, who covered COVID-19 inpatient, covered in-hospital on call and in area quarantine.
Conclusion: The study's findings demonstrate that the prevalence of Fibromyalgia among health service providers during the current COVID-19 pandemic is considerably higher and that there are potential interventions that may be employed to mitigate the prevalence of the infection during the COVID-19 crisis.
... But the psychological factors are also prognostic, be it the depression, anxiety, stress, or realm of catastrophizing (25). There is no over-risk of mortality in fibromyalgia (43). As for the progression in the mid-term, there is little to no change at 1 or 2 years (44). ...
The concept of fibromyalgia has progressed to achieve a certain consensus regarding the definition of the condition. We summarize what is known in 2020, be it in terms of diagnosis, with the criteria that have changed over the years, or at the level of the psychological profile, via the notions of “catastrophizing” and “coping” and post-traumatic syndrome. The importance of fatigue and sleep disorders is underlined, with the chronological sequence of post-traumatic syndrome, chronic fatigue, and then amplification of the pain and the onset of multiple associated symptoms. The etiopathogenic debate has been enriched thanks to neuro-imaging data to discover the start of the central neurological signature. The many associated symptoms are reanalyzed in the context of so-called sister conditions which form sometimes more or less separate entities, such as chronic fatigue syndrome or restless legs syndrome for example. What these conditions have in common is hypersensitivity, not just to pain, but also to all exteroceptive stimuli, from deep sensitivity in the neuro-vegetative system, the sense organs and certain functions of the central nervous system, to the psychological aspects and sleep control. In summary, it is possible to define fibromyalgia as a cognitive disorder of cortical integration of chronic pain, with amplification of painful and sensory nociception, decrease in the threshold for the perception of pain, and persistence of a stimulus that maintains the process in chronicity. Fibromyalgia is part of a group of chronic hypersensitivity syndromes of central origin, with a very wide range of means of expression.
... Therefore, suicidal ideation appears to be highly prevalent among severely affected adult fibromyalgia patients and more associated with mental, rather than physical manifestations [1]. Addressing suicidality is of the utmost importance due to the increased mortality by suicide reported in adults with fibromyalgia syndrome [6,7]. ...
Background
To characterize suicidality among youth with juvenile fibromyalgia syndrome (JFMS) receiving treatment from pediatric rheumatologists at a tertiary care center in order to determine the prevalence of suicidality in JFMS and to explore risk factors for persistent suicidal ideation.
Methods
We performed a cross-sectional cohort study of children 12–17 years old with JFMS seen in a specialty pediatric rheumatology pain clinic from 7/2017–9/2019. All subjects completed patient-reported outcomes measures, complemented by retrospective chart review. Subjects who endorsed item 8 on the Children’s Depression Inventory, 2nd Edition (CDI-2) were categorized as endorsing suicidal ideation. We assessed for differences between the suicidal and non-suicidal patients using Wilcoxon-rank sum test. Logistic regression modeling was performed to identify psychosocial factors associated with suicidality.
Results
Of the 31 subjects, more than one-quarter endorsed suicidality. Nearly 90% of teens with suicidal ideation were established in outpatient counseling. In bivariate analyses, suicidality was associated with lower resilience and greater depression and anxiety (all p < 0.05). Pain intensity trended towards a statistically significant positive association (OR: 1.16 [0.99–1.37]; p = 0.06). Lower resilience was independently associated with suicidality (OR: 0.90 [95% CI: 0.82–0.98]; p < 0.02).
Conclusions
Suicidality was prevalent among youth with JFMS and persistent despite concurrent receipt of mental health services. Higher patient-level resilience was independently associated with a reduced odds of suicidality. Future work should examine the role of resilience training on reducing psychological distress and mitigating the risk of suicidality in JFMS.
... Public Health 2021, 18,209 2 of 14 is perceived as ineffective and unsatisfactory [13,14]. There is no evidence of an increase in overall mortality among FM patients, nor a reduction in life expectancy [15], although an increase in suicides and accidental deaths compared to the general population is found [16]. ...
Several studies have emphasized the heterogeneity of fibromyalgia patients. Furthermore, fibromyalgia patients are considered a high-risk suicide group. The ideation-to-action framework proposes a set of transdiagnostic psychological factors involved in the development of suicidal ideation. The present study aims to explore the existence of different subgroups according to their vulnerability to suicidal ideation through these transdiagnostic psychological variables and a set of variables typically associated with fibromyalgia. In this cross-sectional study, 151 fibromyalgia patients were assessed through the Revised Fibromyalgia Impact Questionnaire, Beck Depression Inventory-II, Plutchik Suicide Risk Scale, Interpersonal Needs Questionnaire, Defeat Scale, Entrapment Scale, Psychache Scale, and Beck Hopelessness Scale. A K-means cluster analysis identified two clusters, one (45.70%) according to a low vulnerability, and a second (54.30%) with a high vulnerability to suicidal ideation. These clusters showed statistically significant differences in suicidal ideation and suicide risk. However, no differences were observed in most socio-demographic variables. In conclusion, fibromyalgia patients who present a clinical condition characterized by a moderate-high degree of physical dysfunction, overall disease impact and intensity of fibromyalgia-associated symptoms, along with a high degree of perceived burdensomeness, thwarted belongingness, defeat, entrapment, psychological pain and hopelessness, form a homogeneous group at high risk for suicidal ideation.
... The prevalence of lifetime suicide attempts in participants with self-reported fibromyalgia is striking, with one out of eight participants with self-reported fibromyalgia reporting a history of suicide attempts. This risk has been identified in other, independent samples (Dreyer et al., 2010;Wolfe, Hassett, et al., 2011b). Especially, a Taiwanese study highlighted that the presence of comorbidities associated with fibromyalgia greatly increased the risk of suicide events (Lan et al., 2016). ...
Background
Fibromyalgia has been associated with various physical and mental disorders. However, these comorbidities need to be quantified in a population‐based study.
Method
We compared participants with and without self‐reported fibromyalgia to assess (1) The prevalence of self‐reported fibromyalgia and its sociodemographic characteristics in a US representative sample, (2) The associations between self‐reported fibromyalgia and lifetime and past 12‐months mental and physical disorders, and (3) The quality of life associated with self‐reported fibromyalgia.
This cross‐sectional study used a large national sample (n=36,309) of the US population, the NESARC‐III. Face to face interviews were conducted, collecting socio‐demographic characteristics, DSM‐5 structured diagnosis, and self‐reported medical conditions (including fibromyalgia).
Results
The past 12 months prevalence of self‐reported fibromyalgia was estimated at 2.05%. Participants with self‐reported fibromyalgia were significantly at higher risk to report a lifetime history of mental disorder (adjusted odds ratio (aOR) = 2.32). Self‐reported fibromyalgia was also positively associated with 24 of the 27 physical conditions assessed in this study.
Participants with self‐reported fibromyalgia were more likely to report a past 12‐months history of suicide attempts (aOR = 5.81), substance use disorders (aOR = 1.40), mood disorders (aOR = 2.67), anxiety disorders (aOR = 2.75) and eating disorders (aOR = 2.45).
Participants with self‐reported fibromyalgia had lower levels of both mental and physical quality of life than those without fibromyalgia.
Conclusions
Participants with self‐reported fibromyalgia have a higher prevalence of comorbid mental and physical disorders, and lower mean levels of mental and physical quality of life than their counterparts without fibromyalgia.
... The global mean prevalence of FM in the general population is 2.7%, with a female-to-male ratio of 3:1, and the diagnosis is most often made in middle age (Sosa et al., 2017). Compared to the general population, patients with FM have higher odds of premature death due to suicide or accident (Wolfe, Hassett, Walitt, & Michaud, 2011), outcomes attributable to a higher lifetime prevalence of depression, anxiety and other psychiatric disorders (Dreyer, Kendall, Danneskiold, Bartels, & Bliddal, 2010). In line with this, research has shown that people with FM generally have a greater overall health status burden than patients with other pain conditions that are accepted as being burdensome (Hoffman & Dukes, 2008). ...
Background: Patients suffering from the Fibromyalgia (FM) have impaired cognitive function, reduced physical activity and more marked depressive symptoms. While physical activity and exercise therapy are not typically part of the standard treatment for this syndrome, there is mounting evidence that regular participation in activities involving physical exertion has a positive impact on psychological functioning in people with FM. This study compares the impact of two different interventions, aerobic exercise training and Zumba dancing, on working memory, motor function and depressive symptoms among female patients with FM. The design also included a control condition.
Method: A total of sixty middle-aged female patients with FM (mean age: 35.76 years) and undergoing standard care took part in the study. Participants were randomly assigned to one of the following three conditions: aerobic exercise training, Zumba dancing, or control. At baseline and 12 weeks later after the end of the intervention, participants’ working memory, motor function and depressive symptom severity were assessed.
Results: Working memory, motor function and depressive symptoms improved over time, but only in the aerobic exercise training and Zumba dancing conditions than in the control condition. Post-hoc analyses showed that improvements were greatest among participants assigned to Zumba dancing, followed by participants who engaged in aerobic exercise training; the scores of the control group remained virtually unchanged.
Conclusion: Aerobic exercise training and Zumba dancing can be recommended as add-ons to standard care to improve working memory and to reduce severity of depressive symptoms among female patients with FM. Although motor function improved in both intervention groups, the effects did not reach clinical relevance.
... which are unique to FM. Fibromyalgia symptoms are observed on a spectrum, often referred to as fibromyalgianess (48)(49)(50); as such, FM/non-FM dichotomies such as the one considered here essentially mask both within-group diversity in overall fibromyalgianess and the overlap between groups in terms of distribution of specific symptoms (e.g., fatigue). The association between cognitive functioning and both fibromyalgianess and specific symptom burden profiles warrants examination in larger and more diverse samples. ...
Objective:
Perceived cognitive dysfunction in fibromyalgia (FM), "fibrofog," is common. Prior laboratory-based studies have limited our understanding of cognitive function in FM in daily life. The aim of this study is to explore levels of subjective and objective cognitive functioning and the association between subjective and objective aspects of cognition in persons with and without FM in the lived environment.
Methods:
Participants (n=50 adults with FM; n= 50 adults without FM matched on age, sex, and education) completed baseline measures of subjective and objective (NIH Toolbox) cognitive functioning. Then, they completed ecological momentary assessments of cognitive clarity and speed and tests of processing speed and working memory, via a smart phone app, 5X/day for 8 days.
Results:
On baseline objective measures, the FM group demonstrated poorer cognitive functioning across three NIH Toolbox tests. There were no strong correlations between subjective and objective cognitive functioning in both the FM and control group. In the lived environment, the FM group demonstrated poorer subjective cognition and objective working memory; groups did not differ on processing speed. Momentary ratings of subjective cognitive dysfunction were significantly related to changes in objective processing speed but not working memory, with no group differences.
Conclusion:
Findings indicate worse lab-based and ambulatory subjective and objective cognitive function for those with FM compared to those without FM. Similar associations between measures of subjective and objective cognitive functioning for the groups suggest that people with FM are not overstating cognitive difficulties. Future research examining contributors to ambulatory fibrofog is warranted.
... Patients with CWP experience excess mortality, which can be mostly explained by low levels of physical activity, high body mass index, poorquality diet and smoking [7]. Two retrospective population-based studies conducted in Denmark and the USA did not find an increased mortality but increased suicide rates compared to controls [8,9]. However, most patients in clinical settings report a reduced health-related quality of life and of daily functioning [10]. ...
Psychological factors such as adverse childhood experiences, traumatic life events, interpersonal conflicts and psychological distress play an important role in the predisposition, onset and severity of chronic widespread pain (CWP) and fibromyalgia syndrome (FMS). Therefore, psychological therapies might have the potential to reduce disability as well as symptom and economic burden in patients with CWP and FMS. Recent interdisciplinary guidelines have suggested different strengths of recommendation for psychological therapies for FMS. The aims of this narrative review are to summarise: • Mechanisms of actions. • Evidence on efficacy, tolerability and safety. • Knowledge gaps and needs for future research of psychological therapies for CWP and FMS for non-mental health professionals.
... A total of seventy-three women diagnosed with FMS according to the criteria of the American College of Rheumatology (ACR) of 1990 and seventy-three healthy controls matched on weight, aged 30 and 70 years, were enrolled in this case-control study. We decided to perform this study only on women because FMS is most prevalent among middle-aged women, encompassing 75-90% of those diagnosed [32,33]. The higher frequency of FMS among women has been attributed to the fact that women tend to report more tender points than men [34] and feel pain more intensely at these sites [35]. ...
The link between fibromyalgia syndrome (FMS) and obesity has not been thoroughly investigated. The purpose of this study was to examine the relationships among body mass index (BMI) and body composition parameters, including fat mass, fat mass percentage, and visceral fat, as well as FMS features, such as tender point count (TPC), pain, disease activity, fatigue, sleep quality, and anxiety, in a population of FMS women and healthy controls. A total of seventy-three women with FMS and seventy-three healthy controls, matched on weight, were included in this cross-sectional study. We used a body composition analyzer to measure fat mass, fat mass percentage, and visceral fat. Tender point count (TPC) was measured by algometry pressure. The disease severity was measured with the Fibromyalgia Impact Questionnaire (FIQ-R) and self-reported global pain was evaluated with the visual analog scale (VAS). To measure the quality of sleep, fatigue, and anxiety we used the Pittsburgh Sleep Quality Questionnaire (PSQI), the Spanish version of the multidimensional fatigue inventory (MFI), and the Beck Anxiety Inventory (BAI), respectively. Of the women in this study, 38.4% and 31.5% were overweight and obese, respectively. Significant differences in FIQ-R.1 (16.82 ± 6.86 vs. 20.66 ± 4.71, p = 0.030), FIQ-R.3 (35.20 ± 89.02 vs. 40.33 ± 5.60, p = 0.033), and FIQ-R total score (63.87 ± 19.12 vs. 75.94 ± 12.25, p = 0.017) among normal-weight and overweight FMS were observed. Linear analysis regression revealed significant associations between FIQ-R.2 (β(95% CI)= 0.336, (0.027, 0.645), p = 0.034), FIQ-R.3 (β(95% CI)= 0.235, (0.017, 0.453), p = 0.035), and FIQ-R total score (β(95% CI)= 0.110, (0.010, 0.209), p = 0.032) and BMI in FMS women after adjusting for age and menopause status. Associations between sleep latency and fat mass percentage in FMS women (β(95% CI)= 1.910, (0.078, 3.742), p = 0.041) and sleep quality and visceral fat in healthy women (β(95% CI)= 2.614, (2.192, 3.036), p = 0.008) adjusted for covariates were also reported. The higher BMI values are associated with poor FIQ-R scores and overweight and obese women with FMS have higher symptom severity. The promotion of an optimal BMI might contribute to ameliorate some of the FMS symptoms.
... 101 Suicidal behaviors in FMS include suicidal ideation, 102,103 suicide attempts, 104 and death by suicide. 105,106 The risk of suicide in FMS is increased due to the presence of a constellation of factors that are usually related to suicide, such as being female, 107 psychological distress, poor sleep quality, 108,109 enhanced fatigue, 110 psychiatric comorbidities (especially depression, bipolar disorders, and borderline personality), 101,108,111 and physical comorbidities (like headache and gastric diseases). 101 Suicidal ideation is more common than suicide attempts 112 and the latter occurs ten times more frequently than suicide. ...
Fibromyalgia syndrome (FMS) is a chronic disorder characterized by widespread and persistent musculoskeletal pain and other frequent symptoms such as fatigue, insomnia, morning stiffness, cognitive impairment, depression, and anxiety. FMS is also accompanied by different comorbidities like irritable bowel syndrome and chronic fatigue syndrome. Although some factors like negative events, stressful environments, or physical/emotional traumas may act as predisposing conditions, the etiology of FMS remains unknown. There is evidence of a high prevalence of psychiatric comorbidities in FMS (especially depression, anxiety, borderline personality, obsessive-compulsive personality, and post-traumatic stress disorder), which are associated with a worse clinical profile. There is also evidence of high levels of negative affect, neuroticism, perfectionism, stress, anger, and alexithymia in FMS patients. High harm avoidance together with high self-transcendence, low cooperativeness, and low self-directedness have been reported as temperament and character features in FMS patients, respectively. Additionally, FMS patients tend to have a negative self-image and body image perception, as well as low self-esteem and perceived self-efficacy. FMS reduces functioning in physical, psychological, and social spheres, and also has a negative impact on cognitive performance, personal relationships (including sexuality and parenting), work, and activities of daily life. In some cases, FMS patients show suicidal ideation, suicide attempts, and consummated suicide. FMS patients perceive the illness as a stigmatized and invisible disorder, and this negative perception hinders their ability to adapt to the disease. Psychological interventions may constitute a beneficial complement to pharmacological treatments in order to improve clinical symptoms and reduce the impact of FMS on health-related quality of life.
... 175 Initial reports suggested that FM and CWP were associated with increased mortality, including from cancer and cardiovascular disease. 130,171 Although there has been variability across studies conducted, 56,190 the largest study that has examined this (UK Biobank) 120 combined into a meta-analysis has confirmed that patients with CWP do have an important excess risk of death. As expected, suicidal ideation and risk of suicide were associated primarily with depression and global mental health and were much greater in patients with FM than in patients with low back pain and controls. ...
Fibromyalgia (FM) is a common chronic pain disorder that presents diagnostic challenges for clinicians. Several classification, diagnostic and screening criteria have been developed over the years, but there continues to be a need to develop criteria that reflect the current understanding of FM and are practical for use by clinicians and researchers. The Analgesic, Anesthetic, and Addiction Clinical Trial Translations Innovations Opportunities and Networks (ACTTION) public-private partnership with the U.S. Food and Drug Administration (FDA) and the American Pain Society (APS) initiated the ACTTION-APS Pain Taxonomy (AAPT) to develop a diagnostic system that would be clinically useful and consistent across chronic pain disorders. The AAPT established an international FM working group consisting of clinicians and researchers with expertise in FM to generate core diagnostic criteria for FM and apply the multidimensional diagnostic framework adopted by AAPT to FM. The process for developing the AAPT criteria and dimensions included literature reviews and synthesis, consensus discussions, and analyses of data from large population-based studies conducted in the United Kingdom. The FM working group established a revised diagnosis of FM and identified risk factors, course, prognosis, and pathophysiology of FM. Future studies will assess the criteria for feasibility, reliability, and validity. Revisions of the dimensions will also be required as research advances our understanding of FM. Perspective: The ACTTION-APS FM taxonomy provides an evidence-based diagnostic system for FM. The taxonomy includes diagnostic criteria, common features, comorbidities, consequences, and putative mechanisms. This approach might improve the recognition of FM in clinical practice.
... The relationship between MSC and mortality is still unclear. Several previous studies suggesting an increased mortality among those with MSC [12][13][14][15][16][17], whereas other studies have not confirmed this [18][19][20][21][22][23]. A review of existing literature from 2014 did not find a clear relationship between MSC and mortality, whereas an extended review from 2017 reported a statistically significant association between all-cause mortality and chronic widespread pain [15]. ...
Background
Musculoskeletal complaints (MSC) are common in the general population, causing a major disease burden to the individual and society. The association between MSC and mortality is still unclear. To our knowledge, no study has hitherto evaluated the association between MSC onset within the last month (incident MSC) on the one hand, and all-cause and cause-specific mortality on the other.
Methods
This prospective population-based cohort study was done using data from the second Nord-Trøndelag Health Study (HUNT2) linked with data from a comprehensive national registry of cause of death. A total of 25,931 participants at risk for incident MSC were included. Hazard ratios (HR) of mortality were estimated for participants with incident MSC using Cox regression based on a mean of 14.1 years of follow-up.
Results
Participants who reported incident MSC did not have an excess mortality compared to those with no MSC in the analyses of all-cause mortality (HR 0.99, 95% CI 0.89–1.10) and cause specific mortality. This was true also after adjustment for several potential confounding factors. No clear association between the number of MSC body sites and mortality was found.
Conclusion
Incident MSC were not associated with an increased mortality, neither for all-cause mortality, nor cause-specific mortality.
... 6,7 It is most prevalent among middle-aged women, encompassing 75%-90% of those diagnosed. [8][9][10] A diagnosis of fibromyalgia has classically been reliant on an evaluation of ''tender points,'' or areas of tenderness around joints, assessed by palpation or algometer. 11,12 Women tend to report more tender points than men, 13 and have been reported to feel pain more intensely at these sites. ...
Background:
Fibromyalgia is a poorly understood, chronically disabling pain syndrome. While research has focused on its clinical presentation and treatment, less is known about fibromyalgia's clinical epidemiology in real-world healthcare systems. Gender differences have been difficult to study because relatively few males are diagnosed with fibromyalgia.
Methods:
Veterans Health Administration (VHA) patients diagnosed with fibromyalgia nationwide in FY 2012 were compared to Veterans with other pain diagnoses on sociodemographic characteristics, medical and psychiatric diagnoses, health service use, and opioid and psychotropic prescription fills. Additional analyses compared characteristics of men and women diagnosed with fibromyalgia. Risk ratios and Cohen's d were used for bivariate comparisons, followed by logistic regression analyses to identify independent factors associated with a diagnosis of fibromyalgia in the VHA.
Results:
Altogether, 77,087 of 2,216,621 Veterans with pain diagnoses (3.48%) were diagnosed with fibromyalgia. They were more likely to be female, younger than patients with other pain conditions, more likely to have multiple psychiatric comorbidities and other types of pain, and used more medical outpatient services. Women diagnosed with fibromyalgia were younger and more likely to have headaches, connective tissue diseases (CTD), and psychiatric comorbidities, while men had more comorbid medical conditions.
Conclusions:
In this large, predominantly older male sample of Veterans with pain diagnoses, those with fibromyalgia were far more likely to be women. Gender comparisons showed women with fibromyalgia were more likely to be diagnosed with psychiatric disorders and CTD, while males were more likely to be diagnosed with medical conditions. Fibromyalgia shows a striking, gender-dependent picture of multimorbidity, which should be considered in treatment.
... Some studies estimate the prevalence of suicidal behaviors in patients with fibromyalgia to range between 27% and 41% for passive and 6% and 14% for active suicidal ideation (Calandre et al., 2015;Jimenez-Rodriguez et al., 2014;Trinanes et al., 2014), while the prevalence of attempted suicide is reported at 17% (Calandre et al., 2011). Furthermore, compared to the general population, fibromyalgia was also found to be associated with an increased frequency (3 to 10 times higher) of completed suicide (Dreyer et al., 2010;Wolfe et al., 2011). In patients with migraines, a study (Liu et al., 2015) indicated that the prevalence of suicidal ideation and attempts was 27% and 7% respectively, while those with comorbid fibromyalgia were even likelier to endorse suicidal behaviors than their counterparts. ...
Death by suicide is one of the leading causes of mortality worldwide. Because individuals with chronic pain are at least twice as likely to report suicidal behaviors or to complete suicide, it is of utmost importance to target which risk factors contribute the most to increasing suicidality. This comprehensive review aims to provide an update on research advancements relating to the identification of potential risk factors for suicidality in individuals with chronic pain. Supporting the results of prior reviews, we found robust evidence that chronic pain itself, regardless of type, was an important independent risk factor for suicidality. The only sociodemographic factor found to be associated with suicidality in individuals with chronic pain was being unemployed/disabled. Depressive symptoms, anger problems, harmful habits (e.g. smoking, alcohol misuse, illicit drugs), childhood or adulthood adversities, and family history of depression/suicide were all also identified as general risk factors. Regarding pain-related factors, sleep problems, poorer perceived mental health, concurrent chronic pain conditions, and more frequent episodes of intermittent pain, were all found to be predictors of suicidality. Unexpectedly, pain characteristics (e.g. type, duration, and intensity/severity) and physical status (e.g. pain interference or disability) were not related to suicide risk. We also identified promising new psychosocial factors (e.g. mental defeat, pain catastrophizing, hopelessness, perceived burdensomeness and thwarted belongingness) associated with suicidality outcomes. A large number of these factors are amenable to change through targeted intervention, highlighting the importance of comprehensively assessing chronic pain patients at risk for suicide, while also incorporating a suicide prevention component into chronic pain management programs.
... 24 Increased risk of suicide has been found in chronic fatigue syndrome 25,26 and fibromyalgia. [27][28][29][30] To our knowledge, no studies of suicide and its relationship to sleep disturbances exist for POTS. Our hypothesis was that increased sleep disturbance in people with POTS would increase the risk of suicidal ideation and suicidal behavior. ...
Objective: We investigated the prevalence of suicidal ideation in relationship with symptoms of sleep disruption in people with postural orthostatic tachycardia syndrome (POTS).
Methods: Online surveys (including the Pittsburgh Sleep Quality Index and the Suicide Behaviors Questionnaire – Revised) were completed by 705 POTS patients and 170 non-POTS controls.
Results: Poor sleep quality was reported in 98.4% of POTS patients with a calculated subjective sleep efficiency of 65.4%. The POTS group’s sleep efficiency was significantly lower (t[873]= –11.32; p<0.001) and sleep disturbances because of pain were significantly higher (t[873]=15.36; p<0.001) than controls. Chi-square testing showed a larger proportion of individuals at high-risk for suicide among POTS patients than controls (χ2 [1, n=875]=55.6; p<0.001). Multiple linear regression analysis showed that sleep scores (β=0.23, p<0.001), age (β=–0.03, p<0.001), and illness with POTS (β=0.68, p=0.05) were significantly associated with suicide ideation scores (F[4, 870]=38.34, p<0.001). This model explained 15% of variance (R2=0.15) in suicidal ideation scores.
Conclusion: Patients with POTS may suffer from increased sleep disturbance and suicidal ideation compared with the general population. Treatment to improve sleep efficiency and sleep quality is an important step toward better quality of life for POTS patients.
... Finally, the study compared the time trends for non-AIDS-related diseases between the HIV and non-HIV groups, using the standardized mortality odds ratios (SMOR) 6 . This statistic is used to compare mortality between two groups when the data for the denominator are not available to calculate the mortality rate 4,7,8 . To use the SMOR, the mortality data should be analyzed as if they were data from a case-control study. ...
The aim of this study was to analyze trends in the listing of non-AIDS-related causes of death on the death certificates of adults with HIV/AIDS in Brazil. The study analyzed mortality data for persons 15 to 69 years of age from 1999 to 2010. Standardized mortality odds ratios were used to compare mortality from non-AIDS-related causes in the group with HIV/AIDS listed on the death certificate and in the group without HIV/ AIDS. From 1999 to 2010, there were 6,120,670 deaths among adults in Brazil. Deaths in the HIV group represented 2.2% of the total. Non- AIDS-related causes, and more specifically cardiovascular diseases, diseases of the genitourinary system, and non-AIDS-related malignant neoplasms increased at higher rates in the group with HIV/AIDS listed on the death certificate. The results point to a greater increase in mortality from non-AIDS-related diseases among persons with HIV/AIDS. This finding suggests that long contact with HIV and antiretroviral therapy play an important role in the occurrence of these diseases.
... Ayni şekilde, FMS hastalari siklikla panik bozukluk ve anksiyete gibi çeşitli psikiyatrik eş tanilar almaktadir (Epstein ve arkadaşlari, 1999;Schaefer ve arkadaşlari, 2011). Ayrica, araştirmalar tutarli olarak bu hasta grubunda fibromiyalji geliştikten sonra hastaliğin yükü ve yüksek depresyon yayginliği sebebiyle artan tasarlanmiş intihar oranina işaret etmektedir (Calandre ve arkadaşlari, 2010;Dreyer, Kendall, Danneskiold-Samsoe, Bartels ve Bliddal, 2010;Wolfe, Hassett, Walitt ve Michaud, 2011). ...
... [11] A positive association between chronic pain and suicidal behavior and death is suggested. [12,13] Generalized pain, depressive symptoms, and nonrestorative sleep, all of which often occur in fibromyalgia patients, [6] are risk factors for suicidality. Female patients with a confirmed or possible diagnosis of fibromyalgia have a 10-fold increase in suicide frequency based on a Danish observational study in the referral hospital. ...
An increased risk of suicide ideation and death has been reported in patients with fibromyalgia. This study aimed to evaluate the risk of a suicide event in patients with primary fibromyalgia and in fibromyalgia patients with comorbidities. We used the Longitudinal Health Insurance Database, a subset of the national insurance claim dataset, which enrolled 1 million Taiwanese people from 2000 to 2005, to identify 95,150 patients with incident fibromyalgia (ICD-9-CM 729.0-729.1) and 190,299 reference subjects matched by sex, age, and index date of diagnosis, with a mean of 8.46±2.37 years of follow-up until 2011. The risk of a suicide event (ICD-9-CM, External-Cause Codes 950-959) was analyzed with a Cox proportional hazards model. Stratification analysis was performed by separating fibromyalgia patients and reference subjects with respect to each comorbidity to determine the risk of suicide in fibromyalgia patients with or without comorbidity relative to subjects who had neither fibromyalgia nor comorbidity. In this Taiwanese dataset, there were 347 suicide events in patients with fibromyalgia (4.16 per 104 person-years) and 424 in matched reference subjects (2.63 per 104 person-years) with a significant crude hazard ratio (HR) of 1.58 (95% confidence interval [CI] 1.38-1.83) and an adjusted HR of 1.38 (95% CI 1.17-1.71) for fibromyalgia patients relative to the matched reference subjects. According to the 2-2 stratification analysis, we found that fibromyalgia patients without comorbidity had an independent but mild risk of a suicide event with adjusted HRs ranging from 1.33 to 1.69 relative to subjects with neither fibromyalgia nor comorbidity. Meanwhile, fibromyalgia patients with comorbidity led to a markedly enhanced risk of a suicide event relative to the matched reference subjects, with adjusted HRs ranging from 1.51 to 8.23. Our analysis confirmed a mild-to-moderate risk of a suicide event in patients with primary fibromyalgia. Attention should be paid to the prevention of suicide in fibromyalgia patients with concomitant comorbidities. Copyright © 2016 the Author(s). Published by Wolters Kluwer Health, Inc. All rights reserved.
... Prior research has linked chronic pain to an increased risk of suicide [27]. Fibromyalgia, an illness characterized by widespread pain, has been found to increase the risk of suicide [28][29][30]. Several studies have shown a direct link between the severity of pain and an increased risk of suicide after controlling for psychiatric diagnoses in other illnesses [31,32]. ...
Background: There is a dearth of research examining mortality in individuals with myalgic encephalomyelitis (ME) and chronic fatigue syndrome (CFS). Some studies suggest there is an elevated risk of suicide and earlier mortality compared to national norms. However, findings are inconsistent.
Objective: This study sought to determine if patients are reportedly dying earlier than the overall population from the same cause.
Methods: Family, friends, and caregivers of deceased patients were recruited. This study analyzed data including cause and age of death for 56 individuals.
Results: The findings suggest patients in this sample are at a significantly increased risk of earlier all-cause (M = 55.9 years) and cardiovascular-related (M = 58.8 years) mortality, and they had a directionally lower age of death for suicide (M = 41.3 years) and cancer (M = 66.3 years) compared to the overall U.S. population [M = 73.5 (all-cause), 77.7 (cardiovascular), 47.4 (suicide), and 71.1 (cancer) years of age].
Conclusions: Results suggest there is an increase in risk for earlier mortality in patients. Due to sample size and over-representation of severely ill patients, the findings should be replicated to determine if the directional differences for suicide and cancer mortality are significantly different from the overall population.
... One study (an Abstract) reported data already included in the review under a different first author[45]. Two studies, addressing risk of cardiovascular diseases amongst participants meeting the American College of Rheumatology (ACR) definition for fibromyalgia, were excluded as both the fibromyalgia and the control groups were deemed to have a similar prevalence of non-specific chronic pain conditions[46,47]. ...
Background and aims:
Chronic pain is a potentially disabling condition affecting one in three people through impaired physical function and quality of life. While the psychosocial impact of chronic pain is already well established, little is known about the potential biological consequences. Chronic pain may be associated with an increased prevalence of cardiovascular disease, an effect that has been demonstrated across a spectrum of chronic pain conditions including low back pain, pelvic pain, neuropathic pain and fibromyalgia. The aim of this study was to review and summarize the evidence for a link between chronic pain and cardiovascular disease. We sought to clarify the nature of the relationship by examining the basis for a dose-response gradient (whereby increasing pain severity would result in greater cardiovascular disease), and by evaluating the extent to which potentially confounding variables may contribute to this association.
Methods:
Major electronic databases MEDLINE, EMBASE, Psychinfo, Cochrane, ProQuest and Web of Science were searched for articles reporting strengths of association between chronic pain (pain in one or more body regions, present for three months or longer) and cardiovascular outcomes (cardiovascular mortality, cardiac disease, and cerebrovascular disease). Meta-analysis was used to pool data analysing the association between chronic pain and the three principal cardiovascular outcomes. The impact of pain severity, and the role of potentially confounding variables were explored narratively.
Results:
The searches generated 11,141 studies, of which 25 matched our inclusion criteria and were included in the review. Meta-analysis (of unadjusted study outcomes) demonstrated statistically significant associations between chronic pain and mortality from cardiovascular diseases: pooled odds ratio 1.20, (95% confidence intervals 1.05-1.36); chronic pain and cardiac disease: pooled odds ratio 1.73 (95% confidence intervals 1.42-2.04); and chronic pain and cerebrovascular disease: pooled odds ratio 1.81 (95% confidence intervals 1.51-2.10). The systematic review also found evidence supporting a dose-response relationship, with greater pain intensity and distribution producing a stronger association with cardiovascular outcomes. All of the included studies were based on observational data with considerable variation in chronic pain taxonomy, methodology and study populations. The studies took an inconsistent and incomplete approach in their adjustment for potentially confounding variables, making it impossible to pool data after adjustments for confounding variables, so it cannot be concluded that these associations are causal.
Conclusions:
Our review supports a possible dose-response type of association between chronic pain and cardiovascular disease, supported by a range of observational studies originating from different countries. Such research has so far failed to satisfactorily rule out that the association is due to confounding variables. What is now needed are further population based longitudinal studies that are designed to allow more robust exploration of a cause and effect relationship.
Implications:
Given the high prevalence of chronic pain in developed and developing countries our results highlight a significant, but underpublicized, public health concern. Greater acknowledgement of the potentially harmful biological consequences of chronic pain may help to support regional, national and global initiatives aimed at reducing the burden of chronic pain.
... and for accidental deaths (OR 1.45, 95% CI 1.02-2.06), but not for malignancy (20). Similarly, overall mortality was not increased for a Danish FM cohort followed for a total of 5,295 person-years, but with increased risk of death from suicide, liver disease and cardiovascular disease (21). ...
https://deepblue.lib.umich.edu/bitstream/2027.42/136485/1/acr22970_am.pdf
... Furthermore, the total days lost per year is double among patients with fibromyalgia [3,4] . Death rates from suicide and injury are higher among patients with fibromyalgia [5] . ...
Introduction: Diabetes mellitus can lead to a secondary restless syndrome, the later together with fibromyalgia disturb sleep, thus may
... In fact, a common clinical scenario in neuropsychiatric dementia is the reverse of what is seen in fibromyalgia: clearly discernible cognitive deficits accompanied by minimization, confabulation, or outright denial of these cognitive deficits by the afflicted (Weinstein et al., 1994). Unlike fibromyalgia, these progressive dementias are associated also with obvious physical disability and early mortality (Wolfe et al., 2013). The dyscognition of fibromyalgia appears to be more a problem of subjective cognitive appraisalthe privileged homeostatic sensation that accompanies cognitive tasksthan of actual cognitive performance. ...
The subjective experience of cognitive dysfunction (“fibrofog”) is common in fibromyalgia. This study investigated the relation between subjective appraisal of cognitive function, objective cognitive task performance, and brain activity during a cognitive task using functional magnetic resonance imaging (fMRI). Sixteen fibromyalgia patients and 13 healthy pain-free controls completed a battery of questionnaires, including the Multiple Ability Self-Report Questionnaire (MASQ), a measure of self-perceived cognitive difficulties. Participants were evaluated for working memory performance using a modified N-back working memory task while undergoing Blood Oxygen Level Dependent (BOLD) fMRI measurements. Fibromyalgia patients and controls did not differ in working memory performance. Subjective appraisal of cognitive function was associated with better performance (accuracy) on the working memory task in healthy controls but not in fibromyalgia patients. In fibromyalgia patients, increased perceived cognitive difficulty was positively correlated with the severity of their symptoms. BOLD response during the working memory task did not differ between the groups. BOLD response correlated with task accuracy in control subjects but not in fibromyalgia patients. Increased subjective cognitive impairment correlated with decreased BOLD response in both groups but in different anatomic regions. In conclusion, “fibrofog” appears to be better characterized by subjective rather than objective impairment. Neurologic correlates of this subjective experience of impairment might be separate from those involved in the performance of cognitive tasks.
Background
Fibromyalgia syndrome (FM) is often accompanied by anxiety. Dental anxiety is common in society and negatively affects the application of patients to the dentist.
Aims
We aimed to examine the presence of dental anxiety in FM patients and to compare it with the non-FM controls. The aim was also extended to examine the relationship between FM disease severity and dental anxiety.
Methods
Sixty-three patients diagnosed with FM and 50 age- and sex-matched non-FM controls were included. All participants were asked to answer the Modified dental anxiety scale (MDAS) and the Hospital Anxiety and Depression Scale (HAD anxiety and HAD depression, respectively). FM patients were also asked to answer the Fibromyalgia impact questionnaire (FIQ).
Results
There were 18 (28.57%) participants in the FM group with an MDAS score of ≥ 16 (anxiety), and 3 (6%) participants in the control group. All 10 participants with MDAS score ≥ 19 (dental phobic) were in the FM group (15.87%). There was a moderate positive correlation between FIQ score and MDAS Score. There were significant positive correlations between the MDAS Score and HAD anxiety and HAD depression scores.
Conclusions
The frequency of dental anxiety may be high in FM patients and disease activity may negatively affect dental anxiety. This is the first study to examine the presence of dental anxiety in fibromyalgia syndrome and its relationship with disease severity. This study draws attention to the presence of dental anxiety, which will negatively affect dental interventions and follow-ups in Fibromyalgia, which is quite common.
Objectives:
With the rising elderly population subject to chronic disease, pain becomes crucial to understand and design an appropriate approach to it. While pain is a noted mortality risk factor, limited studies exists due to various causes of pain and subjectivity of pain expression. This study aims to examine the relationship between pain and mortality, controlling for other disease and socio-cultural factors.
Methods:
We used 6,258 community-dwelling individuals aged 45 years or older - population with highest prevalence of pain, using the Korean Longitudinal Study of Aging (2006-2016) data and the Cox proportional-hazards model. Further subgroup analyses were conducted by gender and education level to examine differences in the relationship between pain and mortality.
Results:
The adjusted hazard ratios of mortality were 1.16 (95%CI: 1.00-1.34, Model 1) and 1.12 (95%CI: 0.97-1.29, Model 2) for the individuals in pain depending on the models used, where additional socio-cultural factors were accounted for in Model 2. Importantly, for individuals in severe pain, they were significantly higher with 1.23 (95%CI: 1.08-1.41, Model 1) and 1.16 (95%CI: 1.02-1.32, Model 2). Further subgroup analyses showed that while both male and more educated individuals were less likely to report pain, their severe pain were more associated with mortality, for example 1.29 (95%CI: 1.08-1.55, Model 2) for male and 1.62 (95%CI: 1.15-2.28, Model 2) for more educated individuals.
Conclusion:
Pain showed a statistically significant relationship with the mortality risk. Family members or medical staff need to pay proper attention to it, especially severe pain from male and highly educated individuals.
Women are overrepresented in pain rehabilitation. They seem to be more exposed to comorbidity between mental illness and diseases of the musculoskeletal system than men, implying that besides biopsychosocial factors, gender relations and cultural context should be considered. The aim of the study is to understand the lived experience of women with chronic pain from a caring science and gender perspective. Gadamerian philosophical hermeneutics has been used to analyze interviews from 21 women living with chronic pain in Sweden. The hermeneutical process revealed intertwined experiences of overperformance, loneliness, pain, and exhaustion. Women’s experience of an overwhelming life situation and the significance of mutual dependency seem to be central to health and suffering in women with chronic pain. We suggest, contemporary health care to acknowledge women’s health and suffering in relation to their life situation and prevailing gender roles.
Background:
More than 25 million adults in the United States have chronic pain. Chronic pain has been associated with suicidality, but previous studies primarily examined nonfatal suicidal behaviors rather than suicide deaths associated with chronic pain or the characteristics of such deaths.
Objective:
To estimate the prevalence of chronic pain among suicide decedents in a large multistate sample and to characterize suicide decedents with and without chronic pain.
Design:
Retrospective analysis of National Violent Death Reporting System (NVDRS) data. The NVDRS links death certificate, coroner or medical examiner, and law enforcement data collected by investigators, who often interview informants who knew the decedent to gather information on precipitating circumstances surrounding the suicide. Information is abstracted by using standard coding guidance developed by the Centers for Disease Control and Prevention.
Setting:
18 states participating in the NVDRS.
Participants:
Suicide decedents with and without chronic pain who died during 1 January 2003 to 31 December 2014.
Measurements:
Demographic characteristics, mechanism of death, toxicology results, precipitating circumstances (mental health, substance use, interpersonal problems, life stressors), and suicide planning and intent.
Results:
Of 123 181 suicide decedents included in the study, 10 789 (8.8%) had evidence of chronic pain, and the percentage increased from 7.4% in 2003 to 10.2% in 2014. More than half (53.6%) of suicide decedents with chronic pain died of firearm-related injuries and 16.2% by opioid overdose.
Limitation:
The results probably underrepresent the true percentage of suicide decedents who had chronic pain, given the nature of the data and how they were captured.
Conclusion:
Chronic pain may be an important contributor to suicide. Access to quality, comprehensive pain care and adherence to clinical guidelines may help improve pain management and patient safety.
Primary funding source:
None.
Objective
Fibromyalgia (FM) patients are 10x more likely to die by suicide than the general population. The purpose of this study was to externally validate published models predicting suicidal ideation and attempts in FM and identify interpretable risk and protective factors for suicidality unique to FM.
Methods
This is a case‐control study of large‐scale EHR data collected from 1998‐2017, identifying FM cases with validated PheKB criteria. Model performance was measured through discrimination including area under the receiver operating characteristic (AUC), sensitivity, specificity, and through calibration including calibration plots. Risk factors were selected by L1‐penalized regression with bootstrapping for both outcomes. Secondary utilization analyses converted time‐based‐billing codes to equivalent minutes to estimate face‐to‐face provider contact.
Results
We identified 8,879 individuals with FM, with 34 known suicide attempts and 96 documented cases of suicidal ideation. External validity was good for both suicidal ideation (AUC=0.80) and attempts (AUC=0.82) and excellent calibration. Risk factors specific to suicidal ideation included polysomatic complaints such as fatigue (OR=1.29, 95%CI 1.25‐1.32), dizziness (OR=1.25, 95%CI 1.22‐1.28), and weakness (OR=1.17, 95%CI 1.15‐1.19). Risk factors specific to suicide attempt included obesity (OR=1.18, 95%CI 1.10‐1.27) and drug dependence (OR=1.15, 95%CI 1.12‐1.18). Per utilization analyses, those with FM and no suicidal ideation spent 3.5x more time in follow‐up annually, and those without documented suicide attempts spent over 40x more time face‐to‐face with providers annually.
Conclusion
This is the first study to successfully apply machine learning to reliably detect suicidality in FM, identifying novel risk factors for suicidality and highlighting outpatient engagement as a protective factor against suicide.
This article is protected by copyright. All rights reserved.
The aim of this study is to find out the outcome of 28 patients who got the diagnosis of primary fibromyalgia (pFM) 26 years ago. In 1986, 56 patients with widespread pain were examined and filled in a base questionnaire (BQ). Of them, 42 fulfilled the Yunus criteria for pFM. Twenty-six years later, addresses of 38 patients were found, and an extensive follow-up questionnaire (FupQ) was mailed to them. Of them, 28 (74%) answered the FupQ. This included nine identical questions with the BQ and questions concerning changes in their symptoms and quality of life (Qol). Three patients (11%) had healed from fibromyalgia (FM), and 23% reported having one or several symptomless periods lasting at least 1 year. In others (n = 25), all but pain and ache showed slight deterioration. Despite the aging and FM, the level of functional ability evaluated by Stanford Health Assessment Questionnaire (HAQ) remained at the same level (BQ 0.41 vs. Fup 0.44, p = 0.82). The sum score of reported symptoms (n = 21) did not change significantly (10.8 (SD 2.9) vs. 11.1 (SD 4.1), p = 0.75). Experienced sleeplessness increased most significantly (27 vs. 65%, p = 0.0034). Exercising did not have a significant influence on the changes of the measured parameters. However, the three healed patients exercised regularly. Symptoms of FM have persisted in most patients for decades without significant deterioration of self-reported functional ability. About one fourth of patients had experienced long symptomless periods during their illness. Three patients (11%) reported that they have healed from FM.
Fibromyalgia (FM) represents one of a group of soft tissue pain disorders that affect muscles and soft tissues, such as tendons and ligaments. The widespread body pain is usually associated with a number of manifestations that include fatigue, headache, sleep disorders, and cognitive disturbances. FM is not uncommon. In spite of being under-recognized, it is estimated to affect 2–3% of the worldwide general population. The multiple symptoms of FM are shared with numerous other medical disorders such as autoimmune rheumatic diseases, psychiatric disorders, and other chronic pain conditions. Additionally, there is no measurable or perceived structural damage, and patients have no diagnostic imaging or laboratory abnormal results. For the aforementioned reasons, most of FM patients are, at least initially, subject to wrong or delayed diagnosis. The existence of a comorbidity with a disease can significantly entangle its course starting from puzzling the diagnosis and ending with worsening the prognosis. FM has been linked to a broad spectrum of disorders that occur in FM patients in a higher frequency than that of the control populations. These disorders include cervical spondylosis, low back pain, spondyloarthropathies, rheumatoid arthritis, systemic lupus erythematosus, obesity, obstructive sleep apnea, hypertension, and last but not least coronary atherosclerosis. On the other hand, FM appreciably coexists with a list of diseases that are mainly autoimmune, chronic inflammatory, or rheumatic diseases, including but not limited to rheumatoid arthritis, systemic lupus erythematosus, ankylosing spondylitis, psoriatic arthritis, and inflammatory bowel disease. We here discuss the mutual impact of FM and its comorbidities from the diagnostic, therapeutic, prognostic, and future research points of view.
Fibromyalgia syndrome (FMS) is a complex syndrome that encompasses a myriad of symptoms without objective signs or lesions. With such a background, FMS is perhaps the rheumatic condition that cries out louder for patient reported outcome measures (PROMs). Unfortunately, neither are there many PROMs that can be used in FMS nor have they been well or fully validated. The symptoms in FMS—pain, sleep quality, fatigue, etc.—are very challenging to measure without error and in a valid manner, as they are all very subjective and interrelated, as well as subjected to multiple confounding factors, including gender and cultural factors. We herein present the PROMs developed specifically for FMS or for aspects within the syndrome and highlight their psychometric properties.
Background:
Chronic widespread musculoskeletal complaints (CWMSC) are a prevalent condition with a large impact on quality of life and with a large burden on society. Studies investigating the relationship between CWMSC and mortality have yielded inconsistent results. The present study aimed to clarify this relationship through a systematic review of the existing literature, including meta-analyses, to estimate pooled results and heterogeneity.
Methods:
The MEDLINE, EMBASE and Science Citation Index Expanded databases were searched in February 2016. Broad search terms were used to identify as many observational studies as possible that investigated the association between CWMSC and mortality. The identified studies were evaluated according to predetermined inclusion criteria.
Results:
Six studies fulfilled the inclusion criteria. In pooled unadjusted analyses of three studies evaluating CWMSC, a non-significant tendency of increased overall mortality was found [mortality risk ratio (MRR) 1.69, 95% confidence interval (CI) 0.91-3.14]. However, in pooled analyses of all six studies reporting adjusted results, the non-significant tendency for higher mortality rates in those with CWMSC was nearly eliminated (MRR 1.13, 95% CI 0.95-1.34). Heterogeneity between studies was moderate to high, particularly regarding the use of confounding factors.
Conclusions:
In this systematic review, based on a limited number of studies, pooled data gave no evidence of a higher mortality rate among individuals with CWMSC. The non-significant tendency for a higher mortality rate in unadjusted pooled analyses was nearly eliminated in the adjusted pooled analyses, considering lifestyle factors such as physical activity smoking. In population-based studies evaluating the relationship between CWMSC and mortality rates, we recommend that both unadjusted and adjusted analyses should be presented.
A 36-item short-form (SF-36) was constructed to survey health status in the Medical Outcomes Study. The SF-36 was designed for use in clinical practice and research, health policy evaluations, and general population surveys. The SF-36 includes one multi-item scale that assesses eight health concepts: 1) limitations in physical activities because of health problems; 2) limitations in social activities because of physical or emotional problems; 3) limitations in usual role activities because of physical health problems; 4) bodily pain; 5) general mental health (psychological distress and well-being); 6) limitations in usual role activities because of emotional problems; 7) vitality (energy and fatigue); and 8) general health perceptions. The survey was constructed for self-administration by persons 14 years of age and older, and for administration by a trained interviewer in person or by telephone. The history of the development of the SF-36, the origin of specific items, and the logic underlying their selection are summarized. The content and features of the SF-36 are compared with the 20-item Medical Outcomes Study short-form.
The National Data Bank for Rheumatic Diseases (NDB) is a re s e a rch data bank with a broad agenda and approach to important clinical, regulatory , epidemiological, safety, effectiveness , outcome and patient care questions that cannot be answered by conventional data banks. It has systematic, ongoing quality control programs that assure high quality data. NDB-developed programs result in very efficient analytic capabilities and rapid publication. Introduction The National Data Bank for Rheumatic Diseases (NDB) is a rheumatic diseases research data bank. Many of the details of the this data bank have been described previously in a detailed review (1) and in publications from the NDB (2-12). In this article we describe characteristics of the NDB data bank m e t h o d o l o g y, contrast it with other methods of data banking, and address factors relating to quality control.
This report presents final 2006 data on U.S. deaths, death rates, life expectancy, infant and maternal mortality, and trends by selected characteristics such as age, sex, Hispanic origin, race, marital status, educational attainment, injury at work, state of residence, and cause of death. It also presents more detailed information than previously presented about the mortality experience of the American Indian or Alaska Native and the Asian or Pacific Islander populations.
Information reported on death certificates, which are completed by funeral directors, attending physicians, medical examiners, and coroners, is presented in descriptive tabulations. The original records are filed in state registration offices. Statistical information is compiled in a national database through the Vital Statistics Cooperative Program of the Centers for Disease Control and Prevention's National Center for Health Statistics. Causes of death are processed in accordance with the International Classification of Diseases, Tenth Revision (ICD-10).
In 2006, a total of 2,426,264 deaths were reported in the United States. The age-adjusted death rate was 776.5 deaths per 100,000 standard population, a decrease of 2.8 percent from the 2005 rate and a record low historical figure. Life expectancy at birth rose 0.3 years, from a revised 2005 value of 77.4 years to a record 77.7 years in 2006. Age-specific death rates increased for those aged 25-34 years but decreased for most other age groups: 5-14 years, 35-44 years, 45-54 years, 55-64 years, 65-74 years, 75-84 years, and 85 years and over. The 15 leading causes of death in 2006 remained the same as in 2005. Heart disease and cancer continued to be the leading and second-leading causes of death, together accounting for almost half of all deaths. The infant mortality rate in 2006 was 6.69 deaths per 1,000 live births.
Mortality patterns in 2006, such as the decline in the age-adjusted death rate to a record historical low, were generally consistent with long-term trends. Life expectancy increased in 2006 from 2005.
To test the hypothesis that individuals with regional and widespread pain disorders have an increased risk of mortality.
We conducted a prospective cohort study of 4515 adults. Subjects were an age- and sex-stratified sample who had participated in a population study of pain occurrence during 1996. Based on those reports subjects were classified as having no pain, regional pain or widespread pain. All subjects were identified on the National Health Service Central Register and followed up until April 2005, a total of 8.2 yrs, at which time information was obtained on vital status, and if applicable, date and cause of death. The relationship between pain status and subsequent death is expressed as mortality rate ratios with 95% CIs, adjusted for age, gender, ethnicity and practice.
A total of 35.2% reported regional pain and 16.9% satisfied criteria for widespread pain. In comparison with those without pain, there was a 20% and 30% increased risk of dying over the follow-up period among subjects with regional and widespread pain, respectively. The specific causes of death in excess were cancer and cardiovascular disease. In addition, the mortality risk from both cancer and cardiovascular deaths was found to increase as the number of pain sites that subjects reported increased.
This study supports a previous observation that persons with regional and widespread pain are at an increased risk of cancer death. Possible mechanisms should be explored.
A 36-item short-form (SF-36) was constructed to survey health status in the Medical Outcomes Study. The SF-36 was designed for use in clinical practice and research, health policy evaluations, and general population surveys. The SF-36 includes one multi-item scale that assesses eight health concepts: 1) limitations in physical activities because of health problems; 2) limitations in social activities because of physical or emotional problems; 3) limitations in usual role activities because of physical health problems; 4) bodily pain; 5) general mental health (psychological distress and well-being); 6) limitations in usual role activities because of emotional problems; 7) vitality (energy and fatigue); and 8) general health perceptions. The survey was constructed for self-administration by persons 14 years of age and older, and for administration by a trained interviewer in person or by telephone. The history of the development of the SF-36, the origin of specific items, and the logic underlying their selection are summarized. The content and features of the SF-36 are compared with the 20-item Medical Outcomes Study short-form.
To develop criteria for the classification of fibromyalgia, we studied 558 consecutive patients: 293 patients with fibromyalgia and 265 control patients. Interviews and examinations were performed by trained, blinded assessors. Control patients for the group with primary fibromyalgia were matched for age and sex, and limited to patients with disorders that could be confused with primary fibromyalgia. Control patients for the group with secondary-concomitant fibromyalgia were matched for age, sex, and concomitant rheumatic disorders. Widespread pain (axial plus upper and lower segment plus left- and right-sided pain) was found in 97.6% of all patients with fibromyalgia and in 69.1% of all control patients. The combination of widespread pain and mild or greater tenderness in greater than or equal to 11 of 18 tender point sites yielded a sensitivity of 88.4% and a specificity of 81.1%. Primary fibromyalgia patients and secondary-concomitant fibromyalgia patients did not differ statistically in any major study variable, and the criteria performed equally well in patients with and those without concomitant rheumatic conditions. The newly proposed criteria for the classification of fibromyalgia are 1) widespread pain in combination with 2) tenderness at 11 or more of the 18 specific tender point sites. No exclusions are made for the presence of concomitant radiographic or laboratory abnormalities. At the diagnostic or classification level, the distinction between primary fibromyalgia and secondary-concomitant fibromyalgia (as defined in the text) is abandoned.
Men who did not participate in a prospective study of cardiovascular disease (The British Regional Heart Study) were younger than the participants, more likely to be unmarried, and more likely to be less skilled workers. In the first three years of follow-up, their total mortality rate was significantly higher than that of the participants; thereafter it declined to levels not significantly different from those of the participants. This excess of early deaths could not be attributed to age. There was a small but non significant excess mortality in non-participants due to neoplasms and cardiovascular disease and a somewhat greater excess from all other causes combined. The social characteristics of the non-participant population appear to contribute to their significantly higher total mortality rate, and allowance needs to be made for this in interpreting the study findings. However the death rate from cardiovascular disease was similar in participants and non-participants, suggesting that any analysis related to this particular cause of death should not be biased by non-participation.
Fibrositis is a misnomer for a very common form of nonarticular rheumatism. The name implies an inflammatory process in fibroconnective tissue which has never been verified. The symptoms of fibrositis are ill-defined musculoskeletal pain made worse by stress, cold, noise and unaccustomed exercise; there is usually a significant element of depression, nonrestorative sleep, chronic fatigue and early morning stiffness. Results of physical examination are strikingly normal, apart from painful tender spots which are remarkably consistent in location from patient to patient. It is important to realize that fibrositis can complicate diseases such as rheumatoid arthritis and systemic lupus erythematosus, where its prompt recognition is essential in averting inappropriate medication. Drug therapy alone is seldom effective in alleviating symptoms; a carefully planned education program is necessary to readjust both psyche and soma.
Universal health care systems seek to ensure access to care on the basis of need rather than income and to improve the health status of all citizens. We examined the performance of the Canadian health system with respect to these goals in the province of Ontario by assessing the effects of neighborhood income on access to invasive cardiac procedures and on mortality one year after acute myocardial infarction.
We linked claims for payment for physicians' services, hospital-discharge abstracts, and vital-status data for all patients with acute myocardial infarction who were admitted to hospitals in Ontario between April 1994 and March 1997. Patients' income levels were imputed from the median incomes of their residential neighborhoods as determined in Canada's 1996 census. We determined rates of use and waiting times for coronary angiography and revascularization procedures after the index admission for acute myocardial infarction and determined death rates at one year. In multivariate analyses, we controlled for the patient's age, sex, and severity of disease; the specialty of the attending physician; the volume of cases, teaching status, and on-site facilities for cardiac procedures at the admitting hospital; and the geographic proximity of the admitting hospital to tertiary care centers.
The study cohort consisted of 51,591 patients. With respect to coronary angiography, increases in neighborhood income from the lowest to the highest quintile were associated with a 23 percent increase in rates of use and a 45 percent decrease in waiting times. There was a strong inverse relation between income and mortality at one year (P<0.001). Each $10,000 increase in the neighborhood median income was associated with a 10 percent reduction in the risk of death within one year (adjusted hazard ratio, 0.90; 95 percent confidence interval, 0.86 to 0.94).
In the province of Ontario, despite Canada's universal health care system, socioeconomic status had pronounced effects on access to specialized cardiac services as well as on mortality one year after acute myocardial infarction.
To determine whether there is excess mortality in groups of people who report widespread body pain, and if so to establish the nature and extent of any excess.
Prospective follow up study over eight years. Mortality rate ratios were adjusted for age group, sex, and study location.
North west England.
6569 people who took part in two pain surveys during 1991-2.
Pain status at baseline and subsequent mortality.
1005 (15%) participants had widespread pain, 3176 (48%) had regional pain, and 2388 (36%) had no pain. During follow up mortality was higher in people with regional pain (mortality rate ratio 1.21, 95% confidence interval 1.01 to 1.44) and widespread pain (1.31, 1.05 to 1.65) than in those who reported no pain. The excess mortality among people with regional and widespread pain was almost entirely related to deaths from cancer (1.55 (1.09 to 2.19) for regional pain and 2.07 (1.37 to 3.13) for widespread pain). The excess cancer mortality remained after exclusion of people in whom cancer had been diagnosed before the original survey and after adjustment for potential confounding factors. There were also more deaths from causes other than disease (for example, accidents, suicide, violence) among people with widespread pain (5.21, 0.94 to 28.78).
There is an intriguing association between the report of widespread pain and subsequent death from cancer in the medium and long term. This may have implications for the long term follow up of patients with "unexplained" widespread pain symptoms, such as those with fibromyalgia.
Mortality data are important tools for research requiring vital status information. We reviewed the major mortality databases and mortality ascertainment services available in the United States, including the National Death Index (NDI), the Social Security Administration (SSA) files, and the Department of Veterans Affairs databases.
The content, reliability, and accuracy of mortality sources are described and compared. We also describe how investigators can gain access to these resources and provide further contact information.
We reviewed the accuracy of major mortality sources. The sensitivity (i.e., the proportion of the true number of deaths) of the NDI ranged from 87.0% to 97.9%, whereas the sensitivity for the VA Beneficiary Identification and Records Locator System (BIRLS) ranged between 80.0% and 94.5%. The sensitivity of SSA files ranged between 83.0% and 83.6%. Sensitivity for the VA Patient Treatment File (PTF) was 33%.
While several national mortality ascertainment services are available for vital status (i.e., death) analyses, the NDI information demonstrated the highest sensitivity and, currently, it is the only source at the national level with a cause of death field useful for research purposes. Researchers must consider methods used to ascertain vital status as well as the quality of the information in mortality databases.
To develop criteria for the classification of fibromyalgia, we studied 558 consecutive patients: 293 patients with fibromyalgia and 265 control patients. Interviews and examinations were performed by trained, blinded assessors. Control patients for the group with primary fibromyalgia were matched for age and sex, and limited to patients with disorders that could be confused with primary fibromyalgia. Control patients for the group with secondary-concomitant fibromyalgia were matched for age, sex, and concomitant rheumatic disorders. Widespread pain (axial plus upper and lower segment plus left- and right-sided pain) was found in 97.6% of all patients with fibromyalgia and in 69.1% of all control patients. The combination of widespread pain and mild or greater tenderness in ⩾ 11 of 18 tender point sites yielded a sensitivity of 88.4% and a specificity of 81.1%. Primary fibromyalgia patients and secondary-concomitant fibromyalgia patients did not differ statistically in any major study variable, and the criteria performed equally well in patients with and those without concomitant rheumatic conditions. The newly proposed criteria for the classification of fibromyalgia are 1) widespread pain in combination with 2) tenderness at 11 or more of the 18 specific tender point sites. No exclusions are made for the presence of concomitant radiographic or laboratory abnormalities. At the diagnostic or classification level, the distinction between primary fibromyalgia and secondary-concomitant fibromyalgia (as defined in the text) is abandoned.
Mortality has not been a major area of investigation in osteoarthritis. The author conducted a systematic review and identified seven studies that provided data on either mortality or survival in persons with osteoarthritis; an additional two articles with relevant data were identified through review of reference lists. Studies included persons with radiographic evidence of osteoarthritis as well as clinical samples of patients with osteoarthritis. Results were pooled using the method of best evidence synthesis. Overall, there was moderate evidence of increased mortality among persons with osteoarthritis compared with the general population. Increased cause-specific mortality was observed in some studies from cardiovascular and gastrointestinal disorders. Risk factors for mortality in persons with osteoarthritis included an increased burden of osteoarthritis, advanced age, and presence of comorbid conditions. Possible explanations for the excess mortality include reduced levels of physical activity among persons with osteoarthritis due to involvement of lower limb joints and presence of comorbid conditions, as well as adverse effects of medications used to treat symptomatic osteoarthritis, particularly non-steroidal anti-inflammatory drugs.
A previous study demonstrated an association between self-reported widespread body pain and increased mortality. The aim of this study was to analyze whether fibromyalgia (FM) and FM-like symptoms are related to increased mortality.
From hospital records, we identified 1,361 patients referred during the period 1984-1999 because of the suspicion of FM. The cases were reviewed by reviewers who were blinded to the outcome. The cohort was followed up for a total of 5,295 person-years at risk and was linked to the Danish Mortality Register. Using the number of years at risk and sex-, age-, and calendar-specific mortality rates from the general population, cause-specific standardized mortality ratios [SMRs] were calculated.
We observed no overall increased mortality among patients with FM. Among the 1,269 female patients, the SMRs (95% confidence intervals [95% CIs]) for an increased risk of death from suicide, liver cirrhosis/biliary tract disease, and cerebrovascular disease were 10.5 (95% CI 4.5-20.7), 6.4 (95% CI 2.3-13.9), and 3.1 (95% CI 1.1-6.8), respectively. The suicide risk was increased at the time of diagnosis and remained increased after 5 years. Patients meeting the American College of Rheumatology criteria for FM and patients with possible FM had the same cause-specific mortality pattern. No increased cause-specific mortality was observed in the 84 male patients.
The causes of a markedly increased rate of suicide among female patients with FM are at present unknown but may be related to increased rates of lifetime depression, anxiety, and psychiatric disorders. Risk factors for suicide should be sought at the time of the diagnosis of FM and at followup. The results also suggest that risk factors for liver disease and cerebrovascular disease should be evaluated in patients with FM.
To develop simple, practical criteria for clinical diagnosis of fibromyalgia that are suitable for use in primary and specialty care and that do not require a tender point examination, and to provide a severity scale for characteristic fibromyalgia symptoms.
We performed a multicenter study of 829 previously diagnosed fibromyalgia patients and controls using physician physical and interview examinations, including a widespread pain index (WPI), a measure of the number of painful body regions. Random forest and recursive partitioning analyses were used to guide the development of a case definition of fibromyalgia, to develop criteria, and to construct a symptom severity (SS) scale.
Approximately 25% of fibromyalgia patients did not satisfy the American College of Rheumatology (ACR) 1990 classification criteria at the time of the study. The most important diagnostic variables were WPI and categorical scales for cognitive symptoms, unrefreshed sleep, fatigue, and number of somatic symptoms. The categorical scales were summed to create an SS scale. We combined the SS scale and the WPI to recommend a new case definition of fibromyalgia: (WPI > or =7 AND SS > or =5) OR (WPI 3-6 AND SS > or =9).
This simple clinical case definition of fibromyalgia correctly classifies 88.1% of cases classified by the ACR classification criteria, and does not require a physical or tender point examination. The SS scale enables assessment of fibromyalgia symptom severity in persons with current or previous fibromyalgia, and in those to whom the criteria have not been applied. It will be especially useful in the longitudinal evaluation of patients with marked symptom variability.
To describe and compare the prevalence of lifetime and current self-reported comorbidity and associated quality of life in 4 rheumatic diseases, and to investigate comorbid conditions in light of the overlap between the index condition and comorbid conditions (CC), and in the context of symptom-type diagnoses.
We studied comorbidity in 11,704 patients with fibromyalgia (FM), systemic lupus erythematosus (SLE), rheumatoid arthritis (RA), and noninflammatory rheumatic disorders (NIRD). Patients completed semiannual self-reports relating to 22 present and past illnesses and completed the EuroQol (EQ-5D) utility index.
CC were most common in FM, followed by SLE. FM comorbidity was dominated by depression, mental illness, and symptom-type comorbidity (e.g., gastrointestinal and genitourinary disorders). In SLE, there were substantial increases in hypertension, depression, cataract, fractures, and cardiovascular and cerebrovascular, neurologic, lung, gall bladder and endocrine disorders compared with RA. Any current CC reduced the EQ-5D utility by 0.08 to 0.16 units. The lowest EQ-5D score was noted for current psychiatric illness (0.55) and current depression (0.60).
Four patterns of comorbidity emerged: that associated with aging; that associated with aging but enhanced by the index condition, as in SLE and cardiovascular disease; comorbidity that is part of the symptoms complex of the index condition; and CC that represent lifetime traits or manifestations of the underlying illness. Depression was the most strongly associated correlate of EQ-5D quality of life, and current depression was present in about 15% of patients with RA or NIRD and 34% to 39% of those with SLE and FM.
Previous research has clearly demonstrated a link between chronic pain and poor health, and has suggested a link with increased mortality, though the latter is less consistent. In 1996 a cohort of 6940 individuals was recruited, and information collected, about reported chronic pain status, general health and socio-demographic details. Ten years later, a record linkage was conducted between these data and the routinely collected national dataset for death registration. Primary cause of death was classified according to ICD-10 codes. Survival analysis was conducted to obtain unadjusted and multi-adjusted hazard ratios (HR) for all-cause, system-specific and disease-specific mortality by chronic pain status. A total of 5858 (84.4%) of individuals from the original cohort were linked, including 1557 (26.6%) who had died. Survival analysis found significant associations between any reported chronic pain and all-cause mortality (HR 1.32, 99% CI, 1.14-1.54) and a number of specific causes. However, when we adjusted for socio-demographic factors and reported long-term limiting illness, the significant association was lost. Survival among those reporting severe chronic pain was significantly worse than among those reporting mild or no chronic pain. After adjustment for socio-demographic factors and reported long-term limiting illness, severe chronic pain remained significantly associated with all-cause mortality (HR 1.49, 99% CI 1.21-1.84) and all circulatory system disease deaths (HR 1.68, 99% CI 1.20-2.35). The evident association between any chronic pain and increased mortality can apparently be explained by confounding caused by socio-demographic factors. However, severe chronic pain is associated with increased risk of mortality, independent of socio-demographic factors.
The symptoms of “fibromyalgia” are due to the interaction between referred pain and amplifying factors.
Given that Moldofsky and I described pain amplification related to measurable sleep disturbances1, we yield to no one in recognition of neural factors. Missing from Shleyfer, et al 2 published in a recent issue of The Journal , from 2 commentaries in the current issue3,4, and from the long Wikipedia entry5 is any discussion of referred pain and of tender sites as markers of referred pain. These help identify the underlying somatic pathology, and therefore the necessary treatment and research strategies. Labeling alone doesn’t help; for a full diagnosis, definition of underlying problems and appropriate treatment strategies are required.
But there need be no talk of “war” among friends and colleagues (everybody loses wars). Disagreement should be the beginning of creative discussion.
The scientific study of referred pain began with the work of J.H. Kellgren6, with whom I had the privilege of working. I quote from a letter I received from him dated May 28, 1999, about 2 years before his death: “...When I started the experimental pain studies in 1936, it was believed that pain was accurately localized in all somatic structures and that only viscera gave referred pain through some special reflex. Our work at that time showed this to be false and led to a clinical method for ascertaining the anatomical source of all pains. This had a big impact on clinical diagnosis in medicine and surgery as well as rheumatology but has recently lost its interest since all the scanners and other machines have taken over....”
With great respect, I submit he overstated his case. When I trained, the work of Thomas Lewis and Kellgren was very fresh. We recognized certain features …
This study analyzed the accuracy of the National Death Index when personal identifiers were used that included or excluded Social Security number. Computerized records of the Department of Veterans Affairs were used for comparison. Different combinations of identifiers other than Social Security number correctly identified from 83 to 92 percent of dead and 92 to 99 percent of living persons. These results should prove useful in ascertaining the mortality status of patient populations without information on Social Security numbers.
To obtain descriptive epidemiological data on fibromyalgia and its components in a representative sample of the Finnish population.
Cross sectional study of 8000 Finns aged 30 or more invited for screening and a main examination for musculoskeletal disorders and other major disorders.
A mobile clinic.
7217 subjects who attended the screening phase; 3434 subjects positive on screening who attended the main examination for musculoskeletal disorders.
Musculoskeletal, mental, and other symptoms detected by interview and questionnaire; results of standardised clinical examination of the musculoskeletal system; operational definition of fibromyalgia; mortality at 10 years.
The prevalence of fibromyalgia was low (54 cases; 0.75%) and related to age (peak prevalence at 55-64 years), female sex (twice as prevalent in women), occupation (no cases among 1596 white collar professionals), level of education (strong inverse gradient), and high levels of physical stress at work. No significant associations were found with body mass index, smoking, or mental stress at work. The prevalence of fibromyalgia was sensitive to even minor modifications of the definition. Fibromyalgia was strongly coincident with many other disorders, especially musculoskeletal conditions. Fibromyalgia did not predict mortality.
Descriptive epidemiological data offer little support for the concept of fibromyalgia.