Fibromyalgia has a larger impact on physical health than on psychological health, yet both are markedly affected: The al-Ándalus project

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Abstract

Objectives

To characterize a representative sample of fibromyalgia women based on a set of relevant factors known to be related to this disease. To distinguish specific factors of the disease from other symptoms that might also exist in non-fibromyalgia women. To test whether fibromyalgia affects more severely physical or psychological outcomes.

Methods

A total of 459 fibromyalgia women vs. 214 non-fibromyalgia (control) women from Southern Spain (Andalusia) took part in this cross-sectional study. Several instruments were used to assess tenderness, impact of fibromyalgia, fatigue, health-related quality of life, mental health, and cognitive performance.

Results

Overall, fibromyalgia women showed a worse status in pain, fatigue, health-related quality of life, depression, and anxiety than controls (P < 0.01). In general, the observed associations presented very large effect sizes (Cohen׳s d from ~1 to ~5.5). No differences between fibromyalgia and controls were observed in cognitive and memory performance, except for delayed recall, but the observed effect size was low (~0.25). The effect size observed for the global physical component (~3.3) was larger than that for the global psychological component (~1.3), all P < 0.001.

Conclusions

Our results reinforce the understanding of fibromyalgia as a polysymptomatic distress condition with pain as its main symptom. Our findings support that fibromyalgia seems to have a greater impact on physical than on psychological outcomes, though both are largely affected.

Introduction

Fibromyalgia is a chronic musculoskeletal pain condition of unknown etiology. General prevalence of fibromyalgia varies from 0.5% to 5% depending on the different countries [1], [2], [3]. Similarly to the differences observed in the fibromyalgia prevalence among countries [1], [2], [3], the specific characteristics and symptoms reported by patients with fibromyalgia might differ depending on the region. In fact, previous studies have shown geographical variations in reported symptoms among patients with chronic widespread musculoskeletal pain [4], [5]. Fibromyalgia patients are a heterogeneous group, and the rating, number, and impact of different symptoms are expected to vary between different populations.

Fibromyalgia has become a worryingly health condition in our modern society, and its treatment implies time-consuming and high economic burdens [1]. Beyond a chronic widespread pain condition, fibromyalgia has recently been defined as a complex dimensional disorder with pain as its main symptom [2], and the inclusion of equally presumable important non-pain symptoms, such as fatigue, stiffness, cognitive problems, depression, anxiety, and a long list of other complaints [2], [6], [7]. This new approach highlights the need to know which of this large variety of symptoms are more characteristic of this disease, which might help in its accurate management.

According to Queiroz [3], epidemiological studies are important to better understand the extent of the problem in specific settings. No previous large population-based studies examining a vast variety of symptoms have been carried out previously in Spanish fibromyalgia patients and an age-matched control group. Furthermore, it is unknown if fibromyalgia affects more severely those components related to physical (e.g., functionality), or psychological domains (e.g., depression). A deep study of the fibromyalgia׳s key symptoms may provide a more fitted and appropriate guidance for treatment decisions and strategies. Therefore, the present study aimed (1) to characterize a representative sample of fibromyalgia patients from Southern Spain (Andalusia) in a set of relevant factors known to be related to this disease. This will provide useful reference values for clinicians and researchers so that they can better interpret their evaluations according to our population-based sample. (2) Many symptoms have been suggested to be related to fibromyalgia, but it is unknown which of them are more specific of the disease. In the present study, we will include a region and age-matched non-fibromyalgia sample in other to distinguish specific factors of the disease from other symptoms that might also exist in non-fibromyalgia women. For this purpose, we will use standardized statistic (effect size) to be able to compare different factors and dimensions. (3) A “global physical component” and a “global psychological component” will be created to clarify which of them is more affected in fibromyalgia patients compared with controls.

Section snippets

Participants

In order to obtain a fibromyalgia sample representative of the Andalusian population, the sample size needed was calculated (n = 300). Then, a sex and province proportional recruitment was planned (Supplementary Table 1). Fibromyalgia patients were recruited from different fibromyalgia associations via e-mail, letter, or telephone. We also asked those fibromyalgia patients interested in participate to recruit a pairwise non-fibromyalgia individual (control) with similar age and

Results

The socio-demographic variables of the study groups are shown in Table 1. BMI differed between fibromyalgia and control women (28.6 vs. 26.7 kg/m2, respectively; P < 0.001). There were differences in educational status between women groups (P = 0.018), with a greater percentage of primary school in fibromyalgia compared to controls (47.8% and 39.0%, respectively) and lower percentage of university higher degree in fibromyalgia compared to controls (5.0% and 9.9%, respectively). Current

Discussion

As expected, the current study showed large differences in general tenderness, impact of fibromyalgia, fatigue, health-related quality of life, depression, and anxiety in fibromyalgia women compared to control women. In addition, the only difference found on cognitive performance was observed in delayed recall, and the effect size was low. Overall, the differences presented very large effect sizes. Pain was confirmed as the most important and characteristic symptom distinguishing fibromyalgia

Conclusions

The results of the present study suggest that fibromyalgia must be understood as a complex dimensional disorder beyond chronic widespread pain condition. Despite pain remains as the primary symptom, the overall impact of fibromyalgia, general fatigue, health-related quality of life, depression, and anxiety are also characteristics to this population. Furthermore, the cognitive performance seems not to be as impaired as it had been suggested. Treatment options should focus on both physical and

Acknowledgements

We thank all the members from the CTS-545 research group involved in the field work. We also gratefully acknowledge all the study participants for their collaboration.

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  • Cited by (0)

    This study was supported by the Spanish Ministry of Science and Innovation (I+D+I DEP2010-15639, grants: BES-2011-047133, RYC-2011-09011); the Consejeria de Turismo, Comercio y Deporte (CTCD-201000019242-TRA); the Spanish Ministry of Education (AP-2010-0963); Granada Research of Excelence Initiative on Biohealth (GREIB), Campus BioTic, University of Granada, Spain; and the European University of Madrid, Escuela de Estudios Universitarios Real Madrid (2010/04RM).

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