Pain is not the major determinant of quality of life in fibromyalgia: results from a retrospective “real world” data analysis of [FM] patients, 2021

Objective
To identify correlates of quality of life (QoL) measured with the Quality of Life Scale (QOLS) in participants of a multidisciplinary day hospital treatment program for fibromyalgia (FM).

Results
The following variables could be identified as main correlates for QoL in FM, explaining 56% of the variance of the QOLS (subscale/questionnaire and standardized beta in parenthesis): depression (− 0.22), pain-related interference with everyday life (− 0.19), general activity (0.13), general health perception (0.11), punishing response from others (− 0.11), work status (− 0.10), vitality (− 0.11) and cognitive difficulties (− 0.12). Pain intensity or frequency was not an independent correlate.

Conclusions
More than 50% of QoL variance could be explained by distinct self-reported variables with neither pain intensity nor pain frequency playing a major role. Therefore, FM treatment should not primarily concentrate on pain but should address multiple factors within multidisciplinary therapy.


Restricted access: https://link.springer.com/article/10.1007/s00296-020-04702-5

 

This is such a bizarre analysis. The entire field is genuinely incapable of functioning. The excessive use of a bunch of correlations that are argued to be causative in only one direction is a sign of having given up entirely so long ago no one even remembers why they are doing what they are doing.

I guess we must add "real world" to the list of terms that have become meaningless. And pain, but it was already there.

 

Obviously problematic not being able to read the actual paper but variation in ‘quality of life’ is not necessarily of itself a good indicator of what to direct your intervention at.

With cancer, say if arbitrarily maximum variation in quality of life on questionnaires was linked to depression rather than tumor size, would you then prioritise psychological intervention over removing/eliminating the cancer itself. What benefit is overcoming a reactive depression in the context of a life threatening illness when the consequence of ignoring the underlying condition is death?

This is a slightly unfair comparison in the context of a condition where we do not know the underlying causation and have no treatments for that underlying condition, but the same logic applies even to intervention focused on symptom management. Though specific symptom dimensions may be correlated to the maximum variation in self reported quality of life, it is no guarantee that intervening on that symptom will improve quality of life as some symptoms may be secondary or consequent on other symptoms. For example if depression appears associated with most variation in quality of life, but the depression is triggered by pain and/or by cognitive difficulties, the depression may not be malleable enough that trying to treat it directly will have any effect on quality of life, if you can not treat the pain or the cognitive difficulties too.

 

Treating ME symptoms is pretty difficult, because I think in most cases no one knows what the actual cause of the symptom is. I've managed to treat some of my symptoms very effectively, but those were accidental discoveries. LDN was the only treatment I took intentionally that worked, and even that treated a different symptom than expected.

I'm not going to bother reading the study, since it appears to be based on vague judgements of unmeasurable symptoms. They can make the results say whatever they want them to say.

 

objective = finding reasons to tell patients they can no longer expect any kind of palliative care for pain . this will greatly reduce the financial burden on socially funded medical systems as well as reducing the cost to insurance companies heavily involved in health insurance . papers like this are just something to point to and claim as evidence for new policies .

 

Maybe it relates to how pain signals mess up the pain processing parts of the brain and you get diffuse symptoms that aren't ipso facto felt as pain, but are the result of your brain being bombarded with pain signals.