Fibromyalgia patients with chronic regional pain have similar illness impact to patients with more widespread pain.

Abstract

Aim: The ACR 2010 fibromyalgia diagnostic criteria allow for the diagnosis of fibromyalgia in two slightly different patient groups. One group has widespread musculoskeletal pain (Widespread Pain Index or WPI >= 7) and central sensitivity symptoms such as abdominal pain, headache or depression (Symptom Severity Score or SSS >= 5). The other group have regional pain (WPI 3-6) combined with more central sensitivity symptoms (SSS >= 9). We aimed to assess illness impact in patients diagnosed with fibromyalgia using the ACR 2010 diagnostic criteria, and to analyse any differences between patients with regional pain compared with those with more widespread pain. Method(s): Consecutive public outpatients diagnosed with fibromyalgia using ACR 2010 criteria were eligible. Demographic, history and physical examination data were collected. The subjects completed a Fibromyalgia Impact Questionnaire (FIQ). Result(s): 221 patients were included (female 90.5%, Caucasian 87.3%, mean age 47 years). 200 patients (90.5%) who met ACR 2010 fibromyalgia criteria had widespread pain (WPI >= 7), while only 21 patients (9.5%) had more regionalised pain (WPI 3-6). Compared to patients with widespread pain, patients with regional pain had significantly less number of associated conditions (eg. Irritable bowel syndrome, multiple chemical sensitivities, migraine) (p = 0.002), lower tenderpoint count (p = 0.001), better quality sleep (p = 0.01), less anxiety (p = 0.003) and felt less depressed (p = 0.005). There was no significant difference between the groups however in age, duration of symptoms, pain severity, levels of fatigue, FIQ score or physical function. Conclusion(s): Most patients diagnosed with fibromyalgia using the ACR 2010 criteria have widespread musculoskeletal pain. The small proportion of patients with fibromyalgia and regionalised pain have the same pain severity, fatigue and illness impact as those with widespread pain. It is important to recognise similar symptom burden in these patients despite more localised pain, to ensure appropriate management.