Pain, disability, & physical functioning in subgroups of patients with fibromyalgia (FM)

OBJECTIVE: To investigate (1) whether patients with fibromyalgia
(FM) could be subgrouped on the basis of psychosocial and
behavioral responses to pain, and (2) the relationships among
pain severity, perceived disability, and observed physical
functioning, as measured by cervical spinal mobility.

METHODS:
117 patients with FM received a comprehensive examination,
underwent physical performance tasks during the evaluation,
andcompleted self-report inventories.

RESULTS: About 87% of
thepatients could be classified into the Multidimensional
PainInventory clustering groups identified and validated in
patientswith a range of chronic pain problems
(Dysfunctional, Interpersonally Distressed, and Adaptive
Copers). Although the 3groups exhibited comparable levels of
physical functioning, the Dysfunctional and Interpersonally
Distressed patients reported higher levels of pain,
disability, and depression.Interpersonally Distressed
patients also reported significantly lower levels of marital
satisfaction than the other 2 subgroups.There were
significant associations between pain severity and perceived
disability, and pain severity and physical functioning,
defined by spinal mobility tests. The relationship between
disability and physical functioning did not reach statistical
significance. Correlational analyses by subgroups revealed a
significant association between patient perceived disability
and physical functioning in the Adaptive Copers, but not the
Dysfunctional or Interpersonally Distressed patients.

CONCLUSIONS: Patients with FM can be classified into 3
subgroups based on psychosocial and behavioral
characteristics. These subgroups show substantial differences
in clinical presentation of their symptoms. Although the
results should be considered preliminary due to the narrow
range of physical functioning, the differential relationships
between perceived disability and physical functioning across
cluster groups suggest the importance of FM syndrome as a
heterogeneous disorder. Treating patients with FM as a
homogeneous group may compromise research results,impede
understanding of the mechanisms underlying this condition,
and deter development of effective treatment.

MCM: FM pts are not homogeneous.Based on West Haven-Yale
Multidimensional Pain Inventory profiles, they divide up into
3 groups: Dysfunctional (23%), Interpersonally Distressed
(33%), and Adaptive Coper (31%), the remainder classed as
anomalous or hybrid. These groups differed significantly in
opiod use, depression, pain severity, perceived disability,
and level of marital satisfaction…

Turk DC, Okifuji A, Sinclair JD, Starz TW

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