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Query: UMLS:C0016053 (fibromyalgia)
 4,687 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The purpose of this study was to investigate the psychometric properties of a Dutch translation of the Multidimensional Pain Inventory, MPI-DLV. Data was available on 733 chronic pain patients. There were three issues of special interest. The first one related to the comparability between the MPI-DLV and the American and German MPI versions with regard to the psychometric aspects. The second dealt with the construct validity of the MPI-DLV scale 'general activity'. It was predicted that patients with high scores on this scale would be in better physical condition, as measured on a working-to-tolerance bicycle ergometer test. In relation to the third issue, attention was given to the factor-invariance between fibromyalgia patients and back pain patients. From the results obtained it was concluded that (1) the factorial structure of the three MPI parts is replicated and the reliability estimates and validity indicators are similar to those from the American and German versions; (2) patients with high scores on the 'general activity' scale are in better physical condition and (3) MPI-DLVs of fibromyalgia and back pain patients do have similar factorial structures. Evidence was also obtained that the MPI-DLV is sensitive to treatment changes. Applications of the MPI-DLV are discussed.
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PMID:Psychometric properties of the Multidimensional Pain Inventory, Dutch language version (MPI-DLV). 999 Jul 48

Several common chronic pain syndromes come to the attention of the rheumatologist demanding for differentiation from fibromyalgia (FM), although they are often associated with it. They may mimic FM by (1) the occurrence of wide spread pain, (2) the chronicity of complaints, (3) the preponderance of females in some of these, and (4) the lack of objective data to be derived from imaging techniques and laboratory tests. Pain is produced by the disturbance of normal function ("dysfunctional syndromes", MASI, ref. 6). Recognition requires examination of the locomotor system under biomechanical auspices both at rest and during movement in order to diagnose hyper- and hypomobility syndromes; treatment of these conditions is guided by principles to improve biomechanical function. In addition, the skin needs to be examined to detect panniculosis (also called "cellulitis"), which may be mixed up with FM due to its preferential occurrence in peri- or postmenopausal women. It is concluded that the aforementioned differential diagnosis needs to be considered appropriately in coinciding FM and all studies dealing with FM.
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PMID:Other pain syndromes to be differentiated from fibromyalgia. 1002 84

Just as our caveman forebears were frail in the face of predatory animals, we are frail in today's society of childhood neglect or abuse, bumper-to-bumper traffic, frustration at work, and multiple daily hassles. The same neuroendocrine systems and pain regulatory mechanisms that protected early man during acute stress are still encoded in our genome, but may be maladaptive in psychologically and physiologically vulnerable people faced with chronic stress. Many patients with fibromyalgia become vulnerable because of the long-lasting psychological and neurophysiological effects of negative experiences in childhood. Ill-equipped with positive cognitive, emotional, and behavioral skills as adults, they display maladaptive coping strategies, low self-efficacy, and negative mood when confronted with the inevitable stressors of life. Psychological distress ensues, which reduces thresholds for pain perception and tolerance (already relatively low in women) even further. Converging lines of psychological and neurobiological evidence strongly suggest that chronic stress-related blunting of the HPA, sympathetic, and other axes of the stress response together with associated alterations in pain regulatory mechanisms may finally explain the pain and fatigue of fibromyalgia. Vulnerable people who can be classified by the ACR criteria as having fibromyalgia do not have a discrete disease. They are simply the most ill in a continuum of distress, chronic pain, and painful tender points in the general population.
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PMID:Pain in fibromyalgia. 1008 59

Neuropsychiatric diseases viewed as multifaceted expression of a dysfunctional brain in which atypical responses are evoked by various sensory inputs. Disease entities have traditionally been classified according to the predominant manifestation ( ) without regard to the overlapping features of many of the diseases (+/-). Thus, mild to moderate pain, mood, cognitive, and neurosomatic symptoms are frequently present in chronic fatigue syndrome (CFS) patients. Fibromyalgia syndrome (FMS) is listed as an example of a predominantly chronic pain syndrome. Affect (mood) disorders include depression (Depress.), anxiety, panic reactions, blunted affect, mania, etc. Schizophrenia (Schizo.) is listed as an example of a major cognitive psychosis. Autism as well as various forms of dementia would be included in this category. Irritable bowel syndrome (IBS) is an example of a neurosomatic disease.
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PMID:Stealth viruses as neuropathogens. 1015 Jan 89

This article discusses the causes and effects of "subjective disability" on today's workforce and employers. As employees feel out of control with both their careers and demands placed upon them, the number of claims characterized by self-reported symptoms are increasing. Subjective disabilities include chronic syndrome, fibromyalgia, psychiatric claims and chronic pain. The author discusses creative strategies in case studies that have helped employers contain the costs of disability claims, while empowering the employee to take control of their own situation and return to work sooner.
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PMID:The importance of subjective claims management. 1017 81

The main goal of current pain management approaches is to increase the patients' quality of life by improving pain coping skills and by reducing the levels of disability in daily life, often despite persistent pain. Direct measurement of quality of life is of crucial importance in economic evaluation research, in which not only is the estimation of financial costs and benefits included, but so is the evaluation of costs and benefits in terms of changes in health states. The purpose of this study is to compare the psychometric qualities of two instruments for assessing patients' utilities, the rating scale (RS) and the standard gamble (SG). Such instruments are designed for their application in economic evaluation research, but have seldomly been used in chronic pain trials. Both methods provide a single measure between 0 and 1. The relationship between these utility measures and descriptive and domain-specific quality of life measures was examined in 133 fibromyalgia patients and 148 patients with chronic non-specific low back pain. Mean utility score at baseline was 0.43 with the RS and 0.78 for the SG. The correlation between both methods was found to be poor (r = 0.21). Both measures appeared to be fairly stable in a 2-week test-retest period (intra class correlation coefficient (ICC) = 0.74 and 0.77). Scores on the description of patient's own health on six domains, global assessment of change and domain specific measures correlated moderately with the RS scores and low with the SG. Multiple regression analyses demonstrated that 32% of the variance in RS values and only 13% of the variance in SG utilities could be explained by domain-specific measures. These results suggest an acceptable construct validity for the RS but insufficient construct validity for the SG. Valuations of ones own health appear only partially to be related to the assessment of the pain-specific measures and measures of distress. It can be concluded that the RS and domain-specific measures assess partly different, but nevertheless complementary aspects of health-related quality of life. It is therefore recommended to include in economic evaluation studies both domain-specific measures and valuation measures. Finally, in chronic musculoskeletal pain patients, RS scores were found to be more responsive in detecting significant changes in preferences than SG scores. For use in patients with chronic musculoskeletal pain, the RS is preferred to the SG for establishing accurate decisions about the impact of new interventions on their health outcomes.
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PMID:Patient utilities in chronic musculoskeletal pain: how useful is the standard gamble method? 1020 50

There are inconsistent data on the age/sex prevalence pattern of back pain and on chest pain. However, it is possible that for chest pain, the rates are higher in younger women and older men. Neck pain, joint pain, and fibromyalgia all appear to increase with age in both genders, whereas abdominal pain and tension-type headaches decrease with age, and migraine headache and TMD appear to peak in the reproductive years. A concluding example illustrates how epidemiologic data can be used to enhance our understanding of the causes of pain. A higher prevalence in women and a peak prevalence during the reproductive years as seen in TMD suggest that either biologic or psychosocial factors unique to women in this period of life could increase the risk of developing or maintaining this pain. As female reproductive hormones can play a role in migraine, at least for some women, it would be interesting to examine whether hormones play a role in TMD. The situation that occurs when menopause is followed by hormone replacement therapy (HRT) provides a natural experiment similar to a laboratory experiment in which female animals are deprived of the natural sources of hormones and then hormones are replaced exogenously. In women, of course, the decision to receive HRT may be associated with a number of psychosocial variables that might also influence pain. Recognizing these limitations, data from records of a large health maintenance organization were examined to ascertain whether use of estrogen or progestin (or both) in postmenopausal women might be associated with the occurrence of TMD pain and, thus, whether the hormone hypothesis might be worthy of further investigation. More women with TMD than controls used estrogen replacement therapy, and slightly more patients than controls used progestin. The use of estrogen significantly increased the odds of having TMD. Progestin use showed a weaker association, which did not hold up after other factors were controlled. However, the risk of TMD appears to increase with increasing doses of estrogen. A review of the epidemiologic literature indicates that there are definite age and sex differences in the prevalence of many chronic pain conditions. There is little basic information about the source of these differences, such as different onset rates, different probabilities of recurrence, or different durations of pain, or combinations of these in women and men. Nevertheless, a systematic examination of the existing epidemiologic data may be an important step in helping pain researchers to generate hypotheses in the search for a better understanding of chronic pain in both sexes.
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PMID:Chronic pain conditions in women. 1032 86

In order to investigate the significance and outcome of self-reported pain and fibromyalgia (FM) in a female population, 214 women with initially self-reported pain were interviewed and examined in 1990 and 1995. In 1990 the sample was categorised into four pain status groups: 46 individuals (21%) with nonchronic (recurrent) pain, 69 (32%) with chronic regional pain 42 (20%) with chronic multifocal pain and 57 with chronic widespread pain (CWP). The last group comprised 39 (18%) women with FM, fulfilling the American College of Rheumatology 1990 criteria. The frequency of tender points, associated symptoms called historical variables and individuals with low education increased statistically significantly with increasing pain status. In 1995, 48 women had non-chronic pain (23%), 46 (21%) chronic regional pain, 39 (18%) chronic multifocal pain and 81 (38%) CWP; of these, 71 (33%) had FM. Eleven of the 39 women initially with FM no longer fulfilled the criteria. The risk of developing CWP among the 157 individuals with initially a lower pain status was statistically higher in women with chronic multifocal pain than in women with less pain extension. Self-reported pain constitutes a continuum of pain severity and thus of clinical and social significance. The overall outcome was poor with an increase of individuals with CWP and FM. The prognosis of chronic multifocal pain, CWP and FM was especially poor. About half of the women with non-chronic pain or chronic regional pain did not deteriorate. However, because the process of developing FM started with localised pain in most cases, self-reported pain of any severity confers a risk for developing FM. Identifying possible risk factors for FM are at present under study and will be presented separately in another report.
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PMID:A 5.5 year prospective study of self-reported musculoskeletal pain and of fibromyalgia in a female population: significance and natural history. 1035 15

Fibromyalgia (FM) is a common chronic pain syndrome with an obscure etiology, which mostly afflicts middle-aged women. In this study, 14 women with FM were interviewed about the meaning of living with the illness. A phenomenological-hermeneutic method was used to analyze and interpret the interview texts. The findings show that being a woman with FM means living a life greatly influenced by the illness in various ways. The women's experiences of living with FM were presented in three major interlaced themes: loss of freedom, threat to integrity, and a struggle to achieve relief and understanding. This study highlights the importance of meeting people suffering in illness with respect for their human dignity. The care of women with FM must empower the women to bring to bear their own resources so that they can manage to live with the illness.
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PMID:Struggling for dignity: the meaning of women's experiences of living with fibromyalgia. 1055 68

Patients whose symptoms include widespread, diffuse musculoskeletal pain are commonly referred for rheumatological evaluation, even when the underlying cause may lie out with the remit of rheumatology. A diagnosis of fibromyalgia may seem highly probable even from the referral letter, or after a few leading questions during the consultation. However, the lack of specificity of the many symptoms associated with widespread pain means that other diagnoses have to be considered. The history and examination must bear in mind alternative and concomitant musculoskeletal disorders, such as mild systemic lupus erythematosus, polyarticular osteoarthritis, rheumatoid arthritis, polymyalgia rheumatica, hypermobility syndromes and even osteomalacia. Non-rheumatological diseases may also have symptomatic similarities to fibromyalgia, including neoplastic and neurological diseases, hypothyroidism and other endocrine disorders, chronic infections, as well as a variety of psychiatric conditions. A rational approach to investigation will usually allow other diagnostic possibilities to be excluded without reinforcing the abnormal illness behaviour so common in chronic pain states.
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PMID:The differential diagnosis of generalized pain. 1056 69


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