Fibromyalgia and nonfibromyalgia chronic pain: Differences in psychological characteristics and treatment outcomes, 2022, Salaberria et al

[Andy]

Abstract

The aim of this study was to explore differential psychological profiles among patients with chronic pain with and without fibromyalgia, and to determine the results of the cognitive behavioral therapy (CBT) for pain. Thirty patients with chronic pain and 60 patients with fibromyalgia were referred to 10 weekly sessions of CBT in a general hospital and were evaluated in pain-related variables, psychopathological symptoms, coping strategies, resilience, and quality of life. The program was implemented in specific groups for patients with fibromyalgia and nonfibromyalgia chronic pain. After the intervention, patients with fibromyalgia showed higher levels of psychopathology, rated their health status as poorer, and presented larger amplification of symptoms, higher levels of somatization, a more ruminating style of thinking and greater distress. Patients without fibromyalgia achieved better therapeutic results in both pain intensity (d = 0.39 vs. d = 0.12) and psychopathological distress (d = 0.77 vs. d = 0.11) compared to patients with fibromyalgia. Therefore, differential profiles and limited therapeutic results in fibromyalgia patients suggest the need to outline differentiated treatments and include other therapeutic strategies.

Open access, https://onlinelibrary.wiley.com/doi/10.1002/pchj.617

 

[perchance dreamer]

Grrr!!!!!! I'm growling at the article, not you, @Andy. Will researchers never tire of insulting fibromyalgia patients? From the article:

"When comparing patients with chronic pain with and without fibromyalgia, the former have reported higher levels of pain and dysfunction, more somatic complaints, more psychopathological symptoms of anxious hypersensitivity, rate their lives as poorer, and on many occasions, they settle in a sick-role seeking the recognition of others (Pérez-Pareja et al., 2010). Thus, patients with fibromyalgia have physical and functional difficulties similar to patients with lower back pain, lower limb pain, and chest pain, but they have more psychosocial problems (Porter-Moffitt et al., 2006)."

 

[rvallee]

Patients without fibromyalgia achieved better therapeutic results in both pain intensity

People not suffering from chronic pain have less chronic pain than people who do. Public money went to producing this thing of beauty.

Therefore, differential profiles and limited therapeutic results in fibromyalgia patients suggest the need to outline differentiated treatments and include other therapeutic strategies.

It already is. The CBT used for pain is "tailored", in the same way as a psychic séance is tailored to the client, but still this has been the pretense for many decades. Although both generic and bespoke have been tried and they have the same outcome: no difference.

Of course this is sham treatment so it cannot possibly make a difference, but it is distinct to the patient population. Not the patients themselves, it's generic bespoke, which makes no sense, but that is clearly not even desirable. It's specialized in the same way as a mass-produced item is customized with a branded color scheme glued on it: superficially.

 

[Cheshire]

People not suffering from chronic pain have less chronic pain than people who do. Public money went to producing this thing of beauty.

Patients without fibromyalgia have chronic pain:

Thirty patients with chronic pain and 60 patients with fibromyalgia

 

[Hutan]

I'm gobsmacked. The researchers used completely different methods to measure pain for the chronic pain and the fibromyalgia groups. They did this because the hospital's rheumatologists asked them to. So, there's no way to compare the level of pain in each group or the change in pain after the course of treatment. Madness.

Pain severity
The McGill Pain Questionnaire (MPQ, Spanish version, Lazaro et al., 1994) measures of pain severity with chronic pain patients. It consists primarily of three types of descriptors—sensory words, affective words, and evaluative words—which are used by patients to specify subjective pain experience. It also contains an intensity scale and other items to determine the properties of pain experience; the higher the score, the higher the pain intensity. The MPQ has been found to offer adequate psychometric guarantees, and preliminary analyses carried out with the Spanish adaptation has indicated very similar reliability and validity results to those of the original questionnaire.

The Lattinen Index (González-Escalada et al., 2012) consists of five Likert-type subscales which score from 0 to 4 for the following items: Pain Intensity, from 0 (no pain) to 4 (unbearable), Pain Frequency, from 0 (no) to 4 (continuous), Use of Painkillers, from 0 (no) to 4 (a lot), Degree of Incapacity, from 0 (none) to 4 (total), and Hours of Sleep, from 0 (as usual) to 4 (need of hypnotics) in addition to a total score; the higher the score, the worse the assessment of the pain. The average score for the Spanish validation of the Lattinen Index is 11.73. Internal and temporal consistency analyses showed α coefficients of >.70 and an intraclass correlation coefficient of >.85, respectively. This questionnaire was applied with fibromyalgia patients instead of the MPQ at the request of the hospital's rheumatologists.

For pain assessment, patients with chronic pain presented an average pain intensity score on the McGill scale of 2.65 (SD = 1.09). Patients with fibromyalgia presented a score on the Lattinen scale that was above the average of the Spanish validation study (13.66 vs. 11.73).

 

[rvallee]

But fibromyalgia is usually defined as chronic pain. Not that it should but this is how it's used. This makes no sense.

In a recent comparative study conducted in Brazil with patients with knee osteoarthritis, chronic lumbago or lower back pain

So basically patients with worse chronic pain have worse chronic pain. Still makes no sense, this is completely arbitrary. Why those?

Bah, unserious hogwash.

 

[shak8]

From my reading about FM (which seems more now a diagnosis separate from the term 'chronic pain' in lists in medical departments) but whatever:

Some of the literature that emphasizes anxiety and depression in FM---this 'fact' could be attributed to (from what I've read) the degree of brain networks activation by FM that results in higher levels of anxiety than is found in say, knee osteoarthritis pain which is a peripheral pain sources (limited in body's geography, unlike FM).

But of course, there is still the female predominance in FM to blame.

 

[Jonathan Edwards]

It's a nonsense but isn't it back to front as well?
It looks as if the mind-body aspect is more important in the pain in the non-fibromyalgia group because they responded to CBT more.
The conclusion should be that fibromyalgia is less suitable for CBT.
And that psychological problems are not related to mind-body aspects of pain!

 

[Hutan]

The conclusion should be that fibromyalgia is less suitable for CBT.

Yes, that was one good thing, the study is evidence that CBT doesn't help fibromyalgia.

But of course, in the BPS world, that just means more funding is needed to tweak the CBT offering to make it more suitable and/or study the application of some other psychological treatment with a different acronym.

 

[rvallee]

It looks as if the mind-body aspect is more important in the pain in the non-fibromyalgia group because they responded to CBT more.

That sure is one valid way to look at this that the proponents of this nonsense won't be doing.

It flows from everything they said, that it is on the basis of an effective CBT-based treatment that we can say this something is mainly a biopsychosocial issue, and yet it is the opposite here, because this approach does not change reality, medical treatment does, and the reality of people with effective (even if just a little) medical care will obviously have changed, something that CBT can "capture" if they want to.

It leads to the opposite conclusion of the entire model. And yet no one cares.

 

[shak8]

I'm trying to process my doctor visit last week out of my system.

This doctor prides himself on all that he thinks he knows about FM. He verbally bombarded me with his recitation from memory: the FM treatments: FDA meds/tai chi/yoga/mindlessness...I came out of there feeling that I was less of a person because I wasn't trying hard enough to get better and have less pain, etc. and look more like those women in the ads for FDA-approved meds. Smiling and riding their bike.

I've had this illness for 26 years and I've researched the meds for FM ad nauseum. I've tried every treatment that looked promising. I developed through trial and error a small drug regimen that works...to dampen the symptoms a bit.

This doctor's diagnostic logic is faulty. Thinks I needed a rheumatological consult because of an ANA of 1: 160. Without any other signs or symptoms of a systemic rheumatic disease, my academically interesting antibodies are of no clinical importance.

I can't make sense of the medical visit.

Except that in the USA, medical care is a business. People with good insurance get too much (unnecessary) care. People without insurance get much less.

Apologies for off-topic.


Get new doctor is on my longterm to-do list.. because it's important to like your doctor enough to go see them when something comes up that should be looked at.