ACR Meeting Abstracts

ACR Meeting Abstracts

Abstract Number: 1838

Fibromyalgia, Beyond the 2016 Establishment. an Analysis of Novel Symptom Clusters for Differentiating Fibromyalgia from Other Chronic Pain Disorders

Kim Jones1, Robert M. Bennett1, Amanda W. St. John2 and Ronald Friend3, 1Schools of Nursing and Medicine, Oregon Health & Science University, Portland, OR, 2Anesthesiology and Pain Medicine, Oregon Health & Science University, Portland, OR, 3School of Nursing, Oregon Health & Science University, Portland, OR

Meeting: 2018 ACR/ARHP Annual Meeting

Keywords:

Session Information

Date: Monday, October 22, 2018

Title: 4M082 ACR Abstract: Fibromyalgia & Other Clinical Pain Syndromes (1834–1839)

Session Type: ACR Concurrent Abstract Session

Session Time: 2:30PM-4:00PM

Background/Purpose:

Clinicians must commonly differentiate fibromyalgia (FM) from other chronic pain diagnoses. Numerous symptoms, including those from the 2016 criteria, have been proposed to accomplish this differentiation — but little is known about their relative importance. Moreover, other potential symptom candidates have been neglected. Herein we rank 26 symptoms according to how well (or not) they differentiate FM patients from other chronic pain patients. We highlight symptoms that are most important and identify others that have received little or no attention.

Methods:

The data for this study was taken from a previously published paper (2018, J of Evaluation in Clinical Practice, 24(1): 173-179). A total of 352 patients (mean age 50 ± 16.3 years, 70% female) were studied. They comprised of 52 patients (14.8%) who carried a chart diagnosis of FM, 108 (30.7%) with chronic pain but not FM, and 192 who had neither pain nor FM. All patients completed a questionnaire that documented pain at 28 locations, the Revised Symptom Impact Questionnaire (SIQR) which included 10 symptoms and 16 additional novel questions related to other common symptoms often co-occur with FM. The 26 symptoms were ranked in their capacity to predict FM vs. chronic pain no FM using the Somers’ D statistic.

Results:

These data suggests that VAS pain itself is not a useful symptom in diagnosing FM in a population of patients with chronic pain (lowest rank). The most useful clusters for differentiating FM patients from chronic pain patients without FM were: “I have a persistent deep ache over most of my body” combined with 4 other symptoms (poor balance, sensitivity to noise, environmental sensitivity and pain after exercise; Odds ratio =9.30), or the deep ache question in association with poor balance, environmental sensitivity, pain after exercise and tenderness to touch; Odds ratio =9.27). Symptoms used in the Symptom Severity Scale (SSS) of the 2016 Revised Fibromyalgia Criteria, (unrefreshing sleep, dyscognition, fatigue , IBS symptoms, depression and headache) have relatively low discriminatory value (Odds ratio= 2.96).

Conclusion: These data attest to the potential usefulness of a cluster of symptoms that are not commonly used in current diagnostic guidelines for FM. Furthermore, they are notably different from symptoms advocated in the established 2016 revised guidelines.

Somers’D (rank)

Symptom VAS

(range 0-10)

FM Mean

n=50 (rank)

Pain No FM Mean
n=108 (rank)

Mean
difference

.641 (1)

Persistent Deep Ache*

7.40 (5)

3.14 (17)

4.26

.592 (2)

Intolerance to Noise

6.98 (6)

3.27 (15)

3.71

.574 (3)

Environmental Sensitivity*

6.82 (9)

3.04 (20)

3.78

.552 (4)

Balance*

6.26 (16)

3.06 (18)

3.20

.534 (5)

Pain after Exercise*

8.08 (1)

4.07 (7)

4.01

.524 (6)

Muscles Feel Weak

6.92 (7)

3.77 (10)

3.15

.511 (7)

Tenderness to Touch*

6.82 (9)

3.61 (11)

3.21

.505 (8)

Muscle Stiffness

7.68 (3)

4.86 (4)

2.82

.492 (9)

Intolerance to Bright Lights

6.58 (13)

3.41 (14)

3.17

.491 (10)

Tender Muscles

7.90 (2)

4.94 (2)

2.96

.473 (11)

Anxiety

6.26 (15)

3.50 (12)

2.76

.453 (12)

Restless Leg Symptoms

6.02) (18)

3.02 (22)

3.00

.452 (13)

Poor Sleep†

7.54 (4)

4.60 (5)

2.94

.421 (14)

Poor Memory†

5.66 (20)

3.03 (21)

2.63

.414 (15)

Intolerance to Cold

6.62 (12)

3.82 (8)

2.80

.412 (16)

Irritable Bowel Symptoms†

5.68 (19)

3.05 (19)

2.63

.409 (17)

Swollen Joints

6.16 (17)

3.78 (9)

2.39

.398 (18)

Depression†

5.44 (22)

3.17 (16)

2.27

.396 (19)

Stiffness

6.92 (7)

4.54 (6)

2.38

.390 (20)

Chronic Headaches†

5.62 (21)

3.45 (13)

2.17

.371 (21)

Irritable Bladder Symptoms

4.36 (25)

2.25 (26)

2.11

.349 (22)

Energy (Fatigue) †

6.82 (9)

4.92 (3)

1.90

.348 (23)

Skin Bruising

4.90 (23)

2.99 (23)

1.91

.336 (24)

Abdominal Swelling

3.98 (26)

2.44 (25)

1.54

.327 (25)

Intolerance to Perfumes

4.72 (24)

2.86 (24)

1.86

.320 (26)

Pain

6.54 (14)

5.12 (1)

1.42

Symptoms (italicized) measured on Revised Symptom Impact Questionnaire (SIQR)

†symptoms measured on the Symptom Severity Scale (SSS) of the 2016 proposed fibromyalgia criteria

*5 items that best predict fibromyalgia

Disclosure: K. Jones, None; R. M. Bennett, None; A. W. St. John, None; R. Friend, None.

To cite this abstract in AMA style:

Jones K, M. Bennett R, W. St. John A, Friend R. Fibromyalgia, Beyond the 2016 Establishment. an Analysis of Novel Symptom Clusters for Differentiating Fibromyalgia from Other Chronic Pain Disorders [abstract]. Arthritis Rheumatol. 2018; 70 (suppl 9). https://acrabstracts.org/abstract/fibromyalgia-beyond-the-2016-establishment-an-analysis-of-novel-symptom-clusters-for-differentiating-fibromyalgia-from-other-chronic-pain-disorders/. Accessed .

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