Injections for Spinal Pain Not as Effective for Fibromyalgia Patients

Prevalence of the fibromyalgia phenotype in spine pain patients presenting to a tertiary care pain clinic and the potential treatment implications.

By Chad M. Brummett M.D., et al.


Objective: Injections for spinal pain have high failure rates, emphasizing the importance of patient selection. It is possible that detecting the presence of a fibromyalgia-like phenotype could aid in prediction, because in these individuals a peripheral injection would not address pain due to alterations in central neurotransmission. We hypothesized that spine pain patients meeting survey criteria for fibromyalgia would be phenotypically distinct from those who do not meet criteria.

Methods: 548 patients with a primary spine pain diagnosis were studied. All patients completed validated self-report questionnaires, including the Brief Pain Inventory, PainDETECT, Hospital Anxiety and Depression Scale, measures of physical function, and the American College of Rheumatology survey criteria for fibromyalgia.

Results: 42% met survey criteria for fibromyalgia (FM+).

  • When compared with criteria negative patients, FM+ patients were more likely to be younger, unemployed, receiving compensation, have greater pain severity, pain interference and neuropathic pain descriptors, as well as higher levels of depression and anxiety, and lower level of physical function (p < 0.0001 for each comparison).

  • Gender, neuropathic pain, pain interference, physical function, and anxiety were independently predictive of fibromyalgia status in a multivariate analysis (p < 0.01, all variables).

  • ROC analysis showed the strength of association of 0.80 as measured by the cross-validated C-statistic.

Conclusion: Using the survey criteria for fibromyalgia, we demonstrated profound phenotypic differences in a spine pain population. Although centralized pain cannot be confirmed with a survey alone, the pathophysiology of fibromyalgia may help explain a portion of the variability of responses to spine interventions.

Copyright © 2013 American College of Rheumatology.

Source: Arthritis and Rheumatism, September 10, 2013. By Chad M. Brummett M.D., Jenna Goesling Ph.D., Alex Tsodikov PhD, Taha S. Meraj B.S., Ronald A. Wasserman M.D., Daniel J. Clauw MD, Afton L. Hassett Psy.D. Department of Anesthesiology, University of Michigan.

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