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Fibromyalgia and Psychological Distress

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By Source: The Back Letter, Sep 1997 v12 n9 p105(1). • • September 1, 1997

Fibromyalgia and psychological distress.

Full Text COPYRIGHT 1997 Skol Corporation

Patients who present with chronic widespread pain and/or fibromyalgia in medical settings display elevated levels of psychological disorders. "Studies of clinic patients with chronic widespread pain indicate that between 30% and 70% have mental disorders, many presenting with features of somatisation," according to G. J. Macfarlane, MD, and colleagues from the University of Manchester Medical School in England. (See Macfarlane et al., 1997.)

Yet patients who come to medical attention because of chronic widespread pain would seem to be the tip of the iceberg. Generalizing about levels of psychological disorders among all patients with chronic widespread pain, based on these biased samples of patients, is hazardous.

To try to come up with a better estimate of the prevalence of psychological problems, Macfarlane et al. recently employed postal questionnaires to study 3004 individuals randomly selected from the registers of a large general medical practice in Manchester. The questionnaire included the General Health Questionnaire (GHQ), a measure of psychological problems.

The researchers performed a structured psychiatric interview of a random sample of subjects who exhibited elevated scores on the GHQ. Three hundred and one of these individuals were interviewed in depth, to assess levels of mental illness as well as well as childhood developmental problems.

"In those who were pain-free, 7% had a mental disorder," according to Macfarlane et al. Of those who had chronic widespreadi pain, however, 22% had a mental disorder.'

Childhood experiences seemed to play a role in the development of chronic widespread pain among some individuals. "Those with chronic widespread pain, in comparison to those who are pain-free, had experienced more childhood events predisposing to somatisation, including serious childhood illness and hospitalization," according to the researchers.

"In a general population sample, the prevalence of mental disorders in those with chronic widespread pain is greater than in those who are pain-free, but less than that reported in [samples from medical clinics]," the authors conclude.


Macfarlane GJ et al., Chronic widespread pain in the community: Consulters and non-consulters, presented at the annual meeting of the British Society for Rheumatology, Harrowgate, UK, 1997; as yet unpublished.

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