Evidence of disordered symptom appraisal in fibromyalgia: increased rates of reported comorbidity and comorbidity severity. Wolfe F, Hawley DJ Arthritis Research Center, Wichita, Kansas, USA.

OBJECTIVE: Using a large series of unselected consecutive patients, to investigate whether patients with fibromyalgia differ from those with rheumatoid arthritis (RA) or osteoarthritis (OA) in the number of reported comorbid conditions and in their perceived importance, and thereby to investigate differences in symptom appraisal and somatization. METHOD: In a clinical care setting, 1,298 patients with fibromyalgia and 2,396 with RA or OA participating in longitudinal data bank research as part of their routine medical care completed questionnaires concerning the presence or absence of 23 comorbid conditions, and then rated the current importance of each condition to them. Additional information concerning psychological factors and disease severity was also obtained. RESULTS: In analyses adjusted for age and sex, patients with fibromyalgia reported more conditions (4.5 vs. 3.1) than those with RA or OA. In 17 of 23 conditions, the condition was more commonly reported in fibromyalgia than in RA or OA. In 20 of the 23 conditions, the importance attached to the conditions by fibromyalgia patients exceeded that of the importance attributed by RA/OA patients. After adjustment for anxiety, statistical differences between the groups for importance was lost for 6 conditions. CONCLUSIONS: Fibromyalgia patients report more medical conditions and report that they are more important to them than do patients with RA or OA. These differences extend to conditions that might be expected to cause symptoms, as well as to those that are usually symptom free. These data suggest that, on average, patients with fibromyalgia appraise medical symptoms and their importance differently from patients with other rheumatic conditions.

PMID: 10410262, UI: 99338451

Disabil Rehabil 1999 Jan;21(1):23-30 Relationship between traumatic events in childhood and chronic pain. Goldberg RT, Pachas WN, Keith D

Department of Psychiatry, Harvard Medical School, Spaulding Rehabilitation Hospital, Boston, MA 02114, USA.

PURPOSE: The purpose was to examine the relationships between traumatic events in childhood, such as sexual and physical abuse, alcoholism, and drug addiction, and three types of chronic pain: facial pain, myofascial pain, and fibromyalgia. A fourth group, a heterogeneous group of other pain, was used as a comparison group. METHOD: Ninety one patients with chronic pain, age range 20-60, were consecutively recruited from the outpatient clinics of a rehabilitation hospital and a general hospital. Patients were given four measures for completion at evaluation: Childhood History Questionnaire; Childhood Traumatic Events Scale; McGill Melzack Pain Questionnaire; Pain Disability Index. Chi-square was used to test significant differences among four pain groups on sexual, physical, and verbal abuse; alcoholism; drug dependence; medications; major upheaval, childhood illness, death of a family member or friend, and separation or divorce of parents. Logistic regression was used to predict membership in the four pain groups. RESULTS: All pain groups had a history of abuse exceeding 48%: fibromyalgia, 64.7%; myofascial, 61.9%; facial, 50%; other pain, 48.3%. All groups had a history of family alcohol dependence exceeding 38%, and a history of drug dependence ranging from 5.8 to 19.1%. A combined history of pain, child physical abuse, and alcoholism was prevalent in 12.9 to 35.3%. Logistic regression showed patients who were female, with an alcoholic parent, using non-narcotic drugs were more likely to be members of the facial, myofascial, and fibromyalgia groups. CONCLUSIONS: Child traumatic events are significantly related to chronic pain. Since the problem of child abuse is broader than physical and sexual abuse, health and rehabilitation agencies must shift from individualized treatment to interdisciplinary treatment of the family and patient.

PMID: 10070600, UI: 99169806

[finally! someone has research to back up my and many others theory!]-Rachel

Chronic fatigue syndrome differs from fibromyalgia. No
evidence for elevated substance P levels in cerebrospinal
fluid of patients with chronic fatigue syndrome.
Evengard B, Nilsson CG, Lindh G, Lindquist L, Eneroth P,
Fredrikson S, Terenius L, Henriksson KG
Department of Infectious Diseases, Karolinska Institute at
Huddinge Hospital, Stockholm, Sweden.
Pain 1998 Nov;78(2):153-5
NLM citations: PMID: 9839828, UI: 99053563

The authors tested the cerebrospinal fluid of 15 CFS
patients and found normal substance P levels, unlike levels
in FMS, which are normally raised. They conclude this
supports the idea that FMS and CFS are different illnesses
with overlapping symptoms.

There is very little else given in the abstract, which can
be read at: Abstract

[It is not clear from the abstract which definition of CFS
these authors used].

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Fibromyalgia: "Invisible" Disability FMS survivors creed

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Overcoming the aches and pains of fibromyalgia (local news report) Diana Davis, WSB-TV Health News 2 Reporter
The numbers are staggering. Nearly six million Americans suffer from fibromyalgia, an illness that can cause widespread muscle aches and pains and severe fatigue. Many patients with fibromyalgia have been told there's nothing physically wrong with them. But the illness is now recognized by the A.M.A. as a very real syndrome and a major cause of disability. No one knows why, but most sufferers of fibromyalgia are women. The cause is unknown and there's no cure, and treatments vary widely. Fibromyalgia isn't fatal, but the pain and fatigue can be so bad some patients feel like they're dying. In the stressful world we live in, most of us get tired and achy every now and then. So when is it normal, and when is it fibromyalgia?
Fibromyalgia causes headaches and widespread aches and pains. The pain can be so severe that it keeps patients from sleeping. The fatigue makes the pain worse--it's a vicious cycle. Just as patients think they're getting well, a new set of sometimes frightening symptoms may take them down again.
The name fibromyalgia means pain in the muscles and connective tissue. There's no blood test for the illness. Doctors make their diagnosis by first ruling out other conditions, and by the patient's description of symptoms. To be diagnosed, a patient must have tender or sore points in all four quadrants of the body. The American College of Rheumatology has identified 18 tender points. Pain must be present in at least 11 of these.
Fibromyalgia patients may also be affected by depression. For many, anti-depressants help. According to Dr. Jeffrey Kelsey, an Emory psychiatrist, "We want to treat the depression that they get, because if someone is depressed and they have pain, the pain is worse. The depression gets better, the pain doesn't necessarily go away, but it does reduce."
Fibromyalgia treatments are as varied as the patients themselves. Stretching and physical therapy that is part massage, part chiropractic manipulation can sometimes ease pain and increase mobility. Getting patients active again is crucial. One patient says that meditation and a form of therapy called guided imagery have helped her. Even doctors who practice traditional medicine say these alternative medicine therapies can help control fibromyalgia. But they're rarely covered by insurance.
Stress makes fibromyalgia pain worse, and experts say sooner or later, patients must learn to relieve it. But many patients don't. Says Judy Sappington of the DeKalb Medical Center, "These tend to be patients who override the signals that their bodies give them...until the signals get so loud that they really can't ignore them anymore."
Tune in Tuesday night at 5, when Diana Davis introduces you to a controversial doctor who says many patients diagnosed with fibromyalgia really suffer from a different problem altogether. He says it can be treated with surgery on the bones of the skull--we'll take you into the operating room.

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