Background/Purpose: Patients with the fibromyalgia syndrome (FMS) experience pain, insomnia, fatigue, and memory/concentration problems.  But some fibromyalgia patients also have many additional somatic symptoms.  We surveyed our patients with fibromyalgia to determine if those patients with many physical symptoms, in addition to the core FMS complaints, tended to have more challenging clinical courses, a poor response to treatment and more disabling limitations. 

Methods: Patients from a rheumatology office practice were studied. We reviewed the charts of fibromyalgia patients and counted the number of symptoms from a list of 92 medical complaints as part of a form provided by the American College of Rheumatology.  The total number of symptoms was recorded from the patient’s initial visit.  We then compared the number of symptoms to the patient’s most recent office visit, a patient update form which includes patient recorded visual analog scales for health status in general, pain, fatigue, concentration, sleep, and also a HAQ activity questionnaire.

Results: 66 patients in this study met the 2010 ACR criteria for FMS, the number of symptoms varied from 6 to 55, with a mean number of symptoms 21.5.  We found a relationship between the number of somatic symptoms and the patient’s status with regard to pain, fatigue and overall health and HAQ scores.  Those patients with 19 or more symptoms tended to have worse ability to perform activities and higher levels of pain and fatigue.  (See table.)

Conclusion: FMS patients with many somatic symptoms tend to have a worse course with higher levels of pain, fatigue, insomnia, and fibrofog as well as higher HAQ scores,, indicating diminished physical functioning.  FMS patients with a somatoform clinical picture tend to have a more challenging clinical course.