Ethnocultural & educational differences in Israeli women correlate with pain perception in fibromyalgia (FM)

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OBJECTIVE: To compare the clinical features of patients with

fibromyalgia (FM) in 2 ethnic groups in Israel.


hundred women with FM participated in the study; 70 were of

Sephardic (Mediterranean) origin and 30 of Ashkenazic

(European-American) origin. Assessment of FM related symptoms,

tenderness, quality of life, and physical functioning was

conducted in all subjects. Analysis of covariance and

multivariate regression were performed to study the

association between these measures and ethnicity, controlling

for age and education.

RESULTS: Sephardic patients with FM

reported more frequent and more severe symptoms than

Ashkenazic patients. They had higher point counts and

decreased quality of life. When the patients were divided into

2 age groups (age 45 being the cutoff point), the differences

were observed only among the older subjects, most of whom were

immigrants. Sephardic older patients had significantly higher

point counts than Ashkenazic patients, and lower tenderness

thresholds. They reported significantly higher levels of pain,

fatigue, and stiffness, and were less satisfied with their

life. However, these differences observed between the 2 ethnic

groups in the univariate data analysis disappeared when age

and education were jointly controlled in multivariate

regression analysis. Age had significantly contributed to the

variation in the point count, the reported pain, and physical

functioning. Education made a significant contribution in

explaining the point count, quality of life, pain, and


CONCLUSION: Education, rather than ethnic identity,

has been found to be an important factor in clinical features

of FM. Future studies should include ethnocultural and

educational assessment, especially in countries with high

immigration rates and diverse ethnic groups, such as the USA

and Canada.

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