A cross-sectional survey of 3035 patients with fibromyalgia: Subgroups of patients with typical comorbidities and sensory symptom profiles – Source: Rheumatology, Mar 17, 2010

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Objectives: Patients with FM are heterogeneous. They present with a variety of pain qualities, sensory abnormalities and additional comorbidities. The aim was to identify clinically distinguishable subgroups of patients.

Methods: This investigation uses epidemiological and clinical data of 3035 FM patients from a cross-sectional survey (painDETECT) to (i) describe characteristic epidemiological data and comorbidities and (ii) detect subgroups of patients with typical patterns of sensory symptoms and comorbidities. [Note: Several of the authors worked on development of the painDETECT (PD-Q) questionnaire. Designed to identify neuropathic components in pain patients, it is available in at least 14 languages.]

Results:

• Clinically relevant sensory abnormalities (strongly, very strongly present) included:
– Pressure pain (58%),
– Prickling (33%),
– Burning (30%)
– And thermal hypersensitivity (24%).

• Pain attacks were complained by 40% of patients.

• Moderate to severe comorbid depression occurred in 66% of patients.

• Only approximately 30% of the patients had optimal sleep.

A hierarchical cluster analysis using descriptors of sensory abnormalities as well as the extent of comorbidities revealed five distinct subgroups of patients showing a characteristic clinical profile.

• Four subgroups of patients suffer from severe sensory disturbances in various combinations but lack pronounced comorbidities.

• In one subgroup, however, severe comorbidities dominate the clinical picture.

Differences in pathophysiological mechanisms of pain generation can be attributed to each subgroup.

Conclusions:
. The results of this study indicate that FM patients can be classified on the basis of their sensory symptoms and comorbidities by the use of a patient-reported questionnaire. Subgrouping of patients with FM may be used for future research and to tailor optimal treatment strategies for the appropriate patient.

Source: Rheumatology (Oxford), Mar 17, 2010. PMID: 20236955, by  Rehm SE, Koroschetz J, Gockel U, Brosz M, Freynhagen R, Tölle TR, Baron R. Sektion Neurologische Schmerzforschung und -therapie, Klinik für Neurologie, Universitätsklinikum Schleswig-Holstein, Kiel, Pfizer Pharma GmbH, Berlin, StatConsult GmbH, Magdeburg, Zentrum für Anästhesiologie, Intensivmedizin, Schmerztherapie und Palliativmedizin, Benedictus Krankenhaus Tutzing, Tutzing and Klinik für Neurologie, Technische Universität München, München, Germany. [Email: r.baron@neurologie.uni-kiel.de]

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