Clinical Characteristics of Fibromyalgia in a Chronic Pain Population

Abstract

Objective: To compare fibromyalgia (FM) characteristics among patients identified in a community-based chronic pain cohort based on traditional International Classification of Diagnoses 9th revision (ICD-9) diagnostic coding, with that of patients identified using a novel predictive model. Methods: This retrospective study used data collected from July 1999 to February 17, 2015, in multiple chronic pain clinics in the United States. Patients were assigned to the FM case group based on specific inclusion criteria using ICD-9 codes or, separately, from results of a novel FM predictive model that was developed using random forest and logistic regression techniques. Propensity scoring (1:1) matched FM patients (cases) to nonmalignant chronic pain patients without FM (controls). Patient-reported measures (eg, pain, fatigue, quality of sleep) and clinical characteristics (ie, comorbidities, procedures, and regions of pain) were outcomes for analysis.Results: Nine ICD-9 clinical modification diagnoses had odds ratios with large effect sizes (Cohen's d > 0.8), demonstrating the magnitude of the difference between the FM and matched non-FM cohorts: chronic pain syndrome, latex allergy, muscle spasm, fasciitis, cervicalgia, thoracic pain, shoulder pain, arthritis, and cervical disorders (all P < 0.0001). Six diagnoses were found to have a moderate effect size (Cohen's 0.5 < d > 0.8): cystitis, cervical degeneration, anxiety, joint pain, lumbago, and cervical radiculitis. Conclusions: The identification of multiple comorbidities, diagnoses, and musculoskeletal procedures that were significantly associated with FM may facilitate differentiation of FM patients from other conditions characterized by chronic widespread pain. Predictive modeling may enhance identification of FM patients who may otherwise go undiagnosed. &

Parental chronic widespread pain and the association with chronic widespread pain in adult offspring: Family‐linkage data from the Norwegian HUNT Study

“…The negative health consequences of CWP are numerous; with individuals experiencing CWP often reporting poor health‐related quality of life, psychosomatic symptoms and time off‐work due to disability (Burckhardt et al., ; Nicholl et al., ; Viniol et al., ; Gostine et al., ). Furthermore, people with CWP experience excess all‐cause and disease‐specific mortality (due to cancer, cardiovascular and respiratory disease) which is primarily accounted for by obesity and low levels of leisure time physical activity (Macfarlane et al., ).…”

“…However, until genome-wide association studies are replicated in large longitudinal studies, understanding the parentoffspring transmission of CWP can contribute with important knowledge that is relevant for public health policy. The negative health consequences of CWP are numerous; with individuals experiencing CWP often reporting poor health-related quality of life, psychosomatic symptoms and time off-work due to disability (Burckhardt et al, 1993;Nicholl et al, 2009;Viniol et al, 2013;Gostine et al, 2017). Furthermore, people with CWP experience excess all-cause and disease-specific mortality (due to cancer, cardiovascular and respiratory disease) which is primarily accounted for by obesity and low levels of leisure time physical activity (Macfarlane et al, 2017).…”

Characterizing classes of fibromyalgia within the continuum of central sensitization syndrome

“…A previous analysis compared FM characteristics among patients identified in a community-based chronic pain cohort based on this ICD-9 coding with characteristics of patients identified using novel predictive modeling, with the models based on diagnoses and characteristics relevant to FM that were considered potential predictors. 9 While characteristics of the populations were generally similar between the two methods of identifying patients, predictive modeling identified a larger FM population. However, FM has long been proposed as a disease that presents as a continuum rather than a homogeneous entity.…”

“…Therefore, patients with FM in the ProCare Systems’ network of clinics from January 1999 to February 17, 2015 were identified as previously described: either 1 year of physician-assigned ICD-9 code 729.1 (“myositis and myalgia, unspecified”) with two codes separated at least 1 year apart and a length of treatment ≥365 days, or using a predictive model. 9 , 19 Patients were also required to have a combination of more than two office visits, Pain Health Assessments (PHA; ProCare Systems, Inc.; a patient self-assessment instrument) or prescription medications used to treat FM.…”

Where We Come From and Are We Aware of Where We Are Going To?

“…The continuation of the study of the basic mechanisms of pain production, transmission, perception and induced suffering is imperative [114][115][116][117], as is the investigation of new treatment strategies. A very promising area is fibromyalgia [118,119], a condition for which pathological studies are negative [120] in the affected individuals and yet they claim to be in constant pain. This also happens in other medical conditions such as schizophrenia, and nobody will dare to state that schizophrenia does not exist because it lacks a previse pathological correlate [121].…”