Biopsychosocial features of patients with widespread chronic musculoskeletal pain in family medicine clinics

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OBJECTIVES: We aimed to describe the clinical and
psycho-socio-familial features of patients with widespread
chronic musculoskeletal pain (WCMP)/fibromyalgia (FM) in
primary care settings. To detect differences and similarities
between both 'entities'.

METHODS: An observational study was carried out with a
newcoming clinical case series. Five family medicine
 surgeries were included. Patients aged from 18 to 50
attended the clinic to fulfil pain criteria for WCMP. Differences
between WCMP and FM were based on the presence of
'tender points'. Measurements were made of general
characteristics, occupation, pain description, symptoms,
tender points, radiographic and laboratory studies, and
questionnaires to assess self-rated health (NHP), social
support (DUKE), family support (Family-APGAR), and
psychopathological traits (CAQ).

RESULTS: We identified 48 patients (23 WCMP;25 FM) with
a mean age of 38.4 +/- 8.4; 95.8% were females. The back
was the anatomical place most frequently reported (93.7%)
and 34.8% of the patients pointed out the nape as being
the most painful place. The average duration of pain was
6.7 +/- 7 years. Unsteadiness (72.9%), impairment in
symptoms with weather (70.8%), with activity (70.8%) and
general fatigue (68.8%) were the most frequently detected
symptoms. 'Pain' (59.5) and 'energy' (54.4) were the scales
of the NHP test most affected. Half of the patients were
poorly satisfied with the responses of their families to their
needs and over 60% showed psychopathological traits. The
patients with FM reported worse self-rated health than those
with WCMP; the number of years of pain (4.9 versus 8.2) and
the number of symptoms (6.6 versus 8.9) were both greater in
patients with FM.

CONCLUSIONS: The clinical and psychological
features of patients with WCMP-FM are similar to those
reported by others. The self-rated health reported by these
patients is poor and closer to that reported by patients
suffering other chronic osteoarticular diseases. These results
support the hypothesis that FM should be considered as more
advanced clinical stage of the widespread musculoskeletal pain
continuum.

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