Compared with normal-weight patients, obese FM patients are more disabled, report more medical comorbidities, exercise less, have a higher incidence of abuse, report increased depressive symptoms, and take more medications for FM. Bivariate analysis showed association of increasing BMI with the Health Assessment Questionnaire Disability Index (not FM impact questionnaire) and depression. We confirm that the prevalence of overweight and obesity is high in FM and believe that physicians treating FM should be aware of our bivariate linear correlations and discuss weight loss with their FM patients. Even if increasing BMI is not intrinsic to FM, it contributes to poor mood and functional outcome and should be a treatment goal.

Objective: Determine the prevalence, socioeconomic, clinical characteristics of fibromyalgia (FM) patients and the factors associated with narcotic drug prescription. Methods: New patients with FM referred for rheumatology evaluation are compared based on narcotic drugs use. Demographic, socioeconomic, clinical, and medication data are collected. Results: Of 305 FM patients 34.8% are taking narcotic medication and these patients (p ≤ 0.05) are older, have longer duration of FM, are socioeconomically more disadvantaged by lower education and employment and higher disability rates; more are obese, and clinically report more extensive and severe pain, higher depression, more disability and higher FM severity, compared to FM patients not prescribed opioid drugs. Patients prescribed opioids are using more medical resources, they take more medications for FM and report more doctor visits and surgeries. Binomial regression analysis demonstrates that pain and stiffness severity, and functional impairment are independent predictors of being prescribed opioid medications. Taking narcotic medications is an independent predictor of FM severity along with pain and depressive symptoms. Conclusion: About one third of patients with FM seen in a tertiary care rheumatology center are taking narcotic medications to treat pain. In this environment, opioid prescription for FM identifies a group of patients with severe FM who have failed the traditional therapeutic options. Characteristics of fibromyalgia patients prescribed opioid medications: Data from the Cleveland Clinic Fibromyalgia registry Research Article more than a month but less than a year, and a year or more.

Patients with severe FM disease activity, high load of symptoms, prolonged morning stiffness, increased disability, lower socioeconomic status and those who take a lot of medications for FM should be evaluated for depressive and manic symptoms.

Background Anosmia is a recognized symptom of COVID-19, but the relationship of SARS-CoV-2 exposure with olfactory dysfunction remains enigmatic. This report adds unique data from healthy students tested as the virus emerged locally. Methods Psychometrically validated measures assessed odor detection, identification and hedonics in healthy university students. Data from asymptomatic students (N=22), tested as SARS-CoV-2 unknowingly emerged locally, were compared to students tested just prior to local virus transmission (N=25), and our normative sample (N=272) tested over the previous 4 years. Results The exposed cohort demonstrated significantly reduced odor detection sensitivity compared to the students in the prior group (P=.01; d=0.77; CI 0.17, 1.36), with a distribution skewed towards less detection sensitivity (P=.03). Categorically, the exposed group was significantly more likely to have hyposmia (OR=7.7; CI, 3.1, 19.4), particularly the subset assessed in the final week before campus closure (OR=13.6; CI, 3.4, 35.7). The exposed group also rated odors as less unpleasant (P<.001, CLES=0.77, CI, 0.51, 1.56) and showed a similarly skewed distribution (P=.005). The groups had similar odor identification performance. Conclusion Psychometric measures of odor detection sensitivity and hedonics may detect early SARS-CoV-2 exposure in asymptomatic and pre-symptomatic persons with normal odor identification. Viral detection by nasal associated lymphoid tissue is known to trigger systemic immune effects, but its activation may also reduce smell sensitivity and shift perception of the environment towards unpleasant, increasing the social isolation that may mitigate viral infection or transmission. Regular testing of odor detection and hedonics may have value for identifying regional viral exposure.

Sudden olfactory loss in the absence of concurrent nasal congestion is now a well‐recognized symptom of COVID‐19. We examined olfaction using standardized objective tests of odour detection, identification and hedonics collected from asymptomatic university students before and as SARS‐CoV‐2 emerged locally. Olfactory performance of students who were tested when the virus is known to be endemic (n = 22) was compared to students tested in the month prior to viral circulation (n = 25), a normative sample assessed during the previous 4 years (n = 272) and those tested in prior years during the same time period. Analyses showed significantly reduced odour detection for the virus exposed cohort compared to students tested before (t = 2.60; P = .01; d = 0.77; CI 0.17, 1.36) and to the normative sample (D = 0.38; P = .005). Odour identification scores were similar, but the exposed cohort rated odours as less unpleasant (P < .001, CLES = 0.77). Hyposmia increased 4.4‐fold for students tested 2 weeks before school closure (N = 22) and increased 13.6‐fold for students tested in the final week (N = 11). While the unavailability of COVID‐19 testing is a limitation, this naturalistic study demonstrates week‐by‐week increase in hyposmia in asymptomatic students as a virus was circulating on campus, consistent with increasing airborne viral loads. The specific hedonic deficit in unpleasantness appraisal suggests a deficit in the TAAR olfactory receptor class, which conveys the social salience of odours. Assessment of odour detection and hedonic ratings may aid in early detection of SARS‐CoV‐2 exposure in asymptomatic and pre‐symptomatic persons.