Concurrent Fibromyalgia in the Spine Pain Population at a Tertiary Care Pain Clinic
– Source: American Society of Anesthesiologists Annual Meeting, presentation BOC02, Oct 18, 2011
By Chad M Brummett, MD, et al.
Background: Axial spine pain (neck and back) is one of the most common causes of medical disability. Opioid medications are frequently prescribed and, in recent years, there has been an explosion in the number of injections done as a treatment for spine pain (i.e., epidural and facet interventions).
Whereas some patients derive benefit from these interventions, there are many patients who fail to improve.
There is a growing appreciation in the pain community of a subset of patients with altered central pain processing leading to widespread body pain, such as fibromyalgia. These patients may require a different treatment approach.
The purpose of this study was to determine the prevalence and impact of fibromyalgia (FM) within a cohort of axial spine patients presenting to a tertiary care pain clinic for an initial visit.
Methods: 166 new patients with a primary complaint of neck or back pain with or without radicular symptoms presenting to the University of Michigan Back & Pain Center were included.
All were prospectively phenotyped using validated self-report questionnaires, including the Brief Pain Inventory, Hospital Anxiety and Depression Scale, and PainDETECT.
The presence of FM was calculated using the American College of Rheumatology survey criteria for FM. In addition, patients reported previous pharmacologic therapies and interventions and efficacy for each (5-point Likert scale). Data were entered into the APOLO Electronic Data Capture system and analyzed using PASW 18.
• 43.4% of patients met survey criteria for FM.
• Compared to those who did not meet FM criteria, criteria positive patients had greater pain intensity (t =-5.80; P < 0.001) and pain interference (t =-6.78; P < 0.001), as well as higher levels of depression (t =-7.01; P < 0.001) and anxiety (t =-6.58; P < 0.001).
• All findings remained significant after Bonferroni correction.
• FM criteria positive patients were also more likely than criteria negative patients to be positive for neuropathic pain as measured by the PainDETECT (66% and 30.9%, respectively) (x2 = 12.70; P < 0.001).
• 56.6% of FM criteria positive patients were currently taking opioid medications compared to 44.1% of FM criteria negative patients.
• FM criteria positive patients tended to rate opioids as less effective (mean = 2.53) than FM criteria negative patients (mean = 2.93), but the difference was not significant.
• History of epidural interventions were common in both groups (FM criteria positive = 39.6%; FM criteria negative = 40.3%);
• However, the FM criteria positive patients rated epidural injections as less effective (t = 2.13; P = 0.038).
Many patients meeting criteria for FM likely have altered central pain processing that may not be responsive to opioid medications and peripherally mediated interventions, including epidural steroid injections.
Patients with concurrent FM have significantly higher rates of psychiatric comorbidity that should be addressed as a key aspect of the treatment strategy.
Future prospective studies of pain intervention outcomes should incorporate measures of centralized pain as predictors of success/failure.
1. Williams DA, Clauw DJ: Understanding fibromyalgia: lessons from the broader pain research community. J Pain 2009; 10: 777-91
2. Wolfe F, Clauw DJ, Fitzcharles MA, Goldenberg DL, Hauser W, Katz RS, Mease P, Russell AS, Russell IJ, Winfield JB: Fibromyalgia Criteria and Severity Scales for Clinical and Epidemiological Studies: A Modification of the ACR Preliminary Diagnostic Criteria for Fibromyalgia. J Rheumatol 2011
Source: American Society of Anesthesiologists Annual Meeting presentation BOC02, Oct 18, 2011, by Brummett CM, Wasserman R, Goesling J, Rakovitis K, Hassett AL. University of Michigan, Ann Arbor, Michigan, USA.