An Observational Study Comparing Fibromyalgia and Chronic Low Back Pain in Somatosensory Sensitivity, Motor Function & Balance, 2021, Mingorance et al

[Andy]

Abstract

Fibromyalgia (FM) and chronic low back pain (CLBP) have shared pathophysiology and have a considerable impact on patients’ daily activities and quality of life. The main objective of this study was to compare pain impact, somatosensory sensitivity, motor functionality, and balance among 60 patients with FM, 60 patients with CLBP, and 60 pain-free controls aged between 30 and 65 years. It is essential to know the possible differences existing in symptomatology of two of the major chronic pain processes that most affect the population, such as FM and CLBP. The fact of establishing possible differences in sensory thresholds, motor function, and proprioceptive measures among patients with FM and CLBP could bring us closer to a greater knowledge of the chronic pain process.

Through an observational study, a comparison was made between the three groups (FM, CLBP, and pain-free controls) evaluating functional performance, postural balance, kinematic gait parameters, strength, depression, fatigue, and sensitivity to pain and vibration. Patients with chronic pain showed worse somatosensory sensitivity (p < 0.001) and motor function (p < 0.001) than pain-free controls. Moreover, patients with FM showed greater pain impact (p < 0.001) and bigger somatosensory (p < 0.001) and motor deficiencies (p < 0.001) than patients with CLBP.

Further research should explore the possible reasons for the greater deterioration in patients with FM in comparison with other chronic pain conditions. Our results, showing the multiple areas susceptible of deterioration, make it necessary to adopt interdisciplinary interventions focused both on physical and emotional dysfunction.

Open access, https://www.mdpi.com/2227-9032/9/11/1533/htm

 

[rvallee]

Fibromyalgia (FM) and chronic low back pain (CLBP) have shared pathophysiology

Uh, citation? Wat? This thing where medicine treats symptoms in isolation, detached from their context, has become a tragic farce blocking most of the progress that could have been done already. Complete nonsense. Context matters, damnit.

 

[Peter T]

Fibromyalgia (FM) and chronic low back pain (CLBP) have shared pathophysiology

Migraine, brain tumour, raised intracranial pressure and carbon monoxide poisoning have some symptom overlap, ie headache, does this mean that they have a ‘shared pathophysiology’ and any differences between them can therefore be treated as psychogenic?

 

[Trish]

They should have checked their data in Table 2 on the PDF more carefully. At a quick glance through I found 6 cases of a decimal point slipped one place, so figures that should have been in the tens were in the hundreds.

The only data they collected on anxiety and depression was from the Fibromyalgia Impact Questionnaire (FIQ). I found it here:
https://www.aafp.org/afp/2007/0715/afp20070715p247-of1.pdf
_______________________

Directions:
...mark the point on the line that best indicates how you felt overall for the past week.

19. How nervous or anxious have you felt?
Not anxious___І ___І___І ___І___І ___І ___І ___І ___І___ Very anxious

20. How depressed or blue have you felt?
Not depressed___І ___І___І ___І___І ___І ___І ___І ___І___ Very depressed
______________________

On the basis of those two simple scales relating to one week, they felt qualified to write a whole section of the discussion about pwFM being anxious, depressed, catastrophising, coping poorly, including this from the discussion:

Depression and anxiety are common predictors of widespread pain [43], opioid misuse [58], and poor pain coping [59]. Moreover, psychological measures, such as emotional or psychosocial distress and somatic awareness, are common phenotypic markers of pain amplification [60]. The psychological attributions for somatic symptoms and the difficulty in emotion description are related to increased anxiety in patients with FM in comparison to patients with CLBP [57]. In consequence, patients with FM may interpret stressful situations as more threatening, increasing pain-related catastrophizing and reducing the adoption of positive coping strategies (e.g., problem solving)...

and that patients need:

... interdisciplinary interventions focused both on physical and emotional dysfunction.

Why assume catastrophising? Why suggest pwFM are not so good at coping? Why so judgemental? Could it just be explained by the fact that they found pwFM had much more pain and loss of function that pwCLBP? By all means offer emotional and practical support to those who want them, but not wrapped in the patient blaming concepts of catastrophising and poor coping.

 

[Lilas]

(With all due respect to those who suffer from it) Even though I have chronic general pain, I am neither anxious nor depressed, I have never abused opioids, I do not tend to overdo my pain levels and I am able to express my emotions well. The main observation that I can make is that these people (the authors), do not listen to all pwFMs, imagine that they cannot be smart enough to be proactive with their physician to find good medications, develop on their own strategies that help them and therefore have necessarily need to be "helped" or "re-educated" cognitively or emotionally. I just think if they really listened to, themselves, they would find that many are brave, resourceful, resilient and would teach them better on FM than they think.

However, if your chronic pain is high and poorly controlled, it is just human that emotions arise (impatience, irritability, moments of discouragement, etc.). For me, at the start of my ME, it was a real obstacle course. But together, my doctor and I, we managed to make my pain more tolerable.