Prevalence & treatment outcome of primary & secondary fibromyalgia (FM) in patients with spinal pain

STUDY DESIGN. This was a prospective cohort study.

To determine the prevalence of primary and secondary
fibromylagia and response to therapy in patients with spinal
pain over a 12-month period.

Fibromyalgia is a syndrome characterized by generalized pain
and widespread tenderness on palpation in specific areas of
the musculoskeletal system, including the cervical and
lumbosacral spine. Primary fibromyalgia is idiopathic, whereas
secondary fibromyalgia occurs in association with underlying
disorders such as ankylosing spondylitis, trauma, or surgery.
The frequency of fibromyalgia in patients with spinal pain has
not been determined.

METHODS. One-hundred-twenty-five
consecutive patients referred to a rheumatologist in a spine
center for evaluation of back pain over a 4-month period were
evaluated for fibromyalgia. Diagnosis at the time of referral
and referring physician were recorded. Fifteen patients, six
with primary fibromyalgia and nine with secondary
fibromyalgia, were identified and followed for 12 months.
Standardized therapy was offered to all patients with
fibromyalgia. Patients with secondary fibromyalgia also
received therapy for their underlying condition.

12 months, the six patients with primary fibromyalgia had an
improvement in symptoms. The treatment outcome for the nine
patients with secondary fibromyalgia was less successful.

CONCLUSIONS. Fibromyalgia is a disorder that occurs in a small
proportion of patients with back pain. Fibromyalgia is not
frequently recognized by referring physicians. In the authors'
limited experience, patients with primary fibromyalgia appear
to improve with conservative care. They have been less
successful with those diagnosed as having secondary

Borenstein D

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