A 5.5 year prospective study of self-reported musculoskeletal pain & of fibromyalgia (FM) in a female population: significance & natural history

In order to investigate the significance and outcome of

self-reported pain and fibromyalgia (FM) in a female

population, 214 women with initially self-reported pain were

interviewed and examined in 1990 and 1995. In 1990 the sample

was categorised into four pain status groups: 46 individuals

(21%) with nonchronic (recurrent) pain, 69 (32%) with chronic

regional pain 42 (20%) with chronic multifocal pain and 57

with chronic widespread pain (CWP). The last group comprised

39 (18%) women with FM, fulfilling the American College of

Rheumatology 1990 criteria. The frequency of tender points,

associated symptoms called historical variables and

individuals with low education increased statistically

significantly with increasing pain status. In 1995, 48 women

had non- chronic pain (23%), 46 (21%) chronic regional pain,

39 (18%) chronic multifocal pain and 81 (38%) CWP; of these,

71 (33%) had FM. Eleven of the 39 women initially with FM no

longer fulfilled the criteria. The risk of developing CWP

among the 157 individuals with initially a lower pain status

was statistically higher in women with chronic multifocal pain

than in women with less pain extension. Self-reported pain

constitutes a continuum of pain severity and thus of clinical

and social significance. The overall outcome was poor with an

increase of individuals with CWP and FM. The prognosis of

chronic multifocal pain, CWP and FM was especially poor. About

half of the women with non- chronic pain or chronic regional

pain did not deteriorate. However, because the process of

developing FM started with localised pain in most cases,

self-reported pain of any severity confers a risk for

developing FM. Identifying possible risk factors for FM are at

present under study and will be presented separately in

another report.

Forseth KO, Forre O, Gran JT

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