Fibromyalgia and Soft Tissue Disorders: Morning Poster Session Recap

Dozens of posters were presented under the "Fibromyalgia and Soft Tissue Disorders" umbrella during the morning of day 4 at the American College of Rheumatology/Association of Rheumatology Health Professionals 2009 Annual Scientific Sessions. Among the highlights are the following.

Inadequately Managed Depression in Fibromyalgia Drives Referral to SpecialistsPresentation Number: 1427

Poster Board Number: 160

Researchers: Fitzcharles M, Ceko M, Gamsa, et al.

Purpose: To evaluate the "frequency of depression and treatments thereof, in [fibromyalgia] patients newly referred to a tertiary care" center, as mood disorders reportedly occur frequently in such patients, and recognition "and appropriate management of mood may impact on suffering and quality of life in FM patients, and may be a factor contributing to poor response to standard treatments."

Results: After evaluating 137 consecutively attending fibromyalgia patients who referred to a multidisciplinary clinic, the researchers found that depression was present in 110 (80%) participants, with no difference seen between those with depression and those without in regards to age, employment status, disability status, or pain intensity. Further, it was determined that patients with depression had longer disease duration than non-depressed patients (12.2 years vs 7.3 years) and scored higher for pain catastophizing (30% vs. 21.5%) and anxiety (6.6% vs. 5.5%). "After adjusting for other covariates, duration of pain was the only factor associated with depression in multivariate analysis." The research team concluded that the lack of any treatment to address depression in more than 50% of depressed patients" was of great concern and that poorly "controlled depression may be an important factor driving referral of FM patients for specialist consultation."

What Pain Related Behaviour Tells the MD about a Patient with FibromyalgiaPresentation Number: 1402

Poster Board Number: 135

Researchers: Fitzcharles M, Ceko M, Gamsa A, et al.

Purpose: To examine the frequency and associations of pain-related behavior-behaviour that occurred during the physician interview and examination, appeared out of proportion to that expected for the symptom complaint, and which conveyed the subjective impression of exaggeration of pain and discomfort-" in 136 consecutive patients with fibromyalgia who were attending a specialized, multidisciplinary fibromyalgia clinic in a tertiary care center.

Results: In 28 (21%) patients, pain-related behaviour was present, compared with no presence in 108 (79%) patients, with no differences between the two groups in regards to age, gender, duration of symptoms, or current employment status. Additionally, those in the former group scored higher on all pain assessments that did those in the latter group, and also tended to receive disability compensation more (50% vs. 31%, respectively). Pain-related behavior "may reflect a truly severe pain experience in [fibromyalgia], rather than a manifestation of attention seeking and histrionic behaviour."

Relevance of PROMIS Item Banks to Individuals with FibromyalgiaPresentation Number: 1404

Poster Board Number: 137

Researchers: Williams D, Schilling S, Shibata K, et al.

Purpose: "In 2004, the NIH Roadmap initiative 'Patient-Reported Outcomes Measurment Information System' (PROMIS) began its mission to develop the next generation of patient-reported outcomes measures (PROs) for chronic illnesses facilitated by the methods of item response theory (IRT) and computer adaptive testing (CAT). In practice, large banks of well-calibrated items can be drawn upon to measure a given outcome domain (eg, function). While these item banks were developed to be applied with chronic illnesses generally, the current study sought to assess whether the items within the item banks were relevant to individuals with Fibromyalgia (FM)."

Results: The researchers' data "suggest that the majority of the pain and fatigue items already contained within the PROMIS item banks possess relevance for individuals with FM. The relevance of the items contained within the physical functioning and negative mood banks was more limited. In order to optimize PROMIS as a PRO measurement tool in FM, these item banks may require supplementary work."

Cognitive Dysfunction in Fibromyalgia Assessed by the Multiple Abilities Self-Report QuestionnairePresentation Number: 1417

Poster Board Number: 150

Researchers: Williams D, Glass J, Barjola P, et al.

Purpose: To "(a) assess multiple cognitive difficulties within individuals, (b) compare cognitive difficulties in FM with healthy controls (HC)'s, and (c) identify clinical correlates for the various types of cognitive problems," as people with fibromyalgia often report cognitive difficulties (aka, "fibro-fog").

Results: The Multiple Analysis Of Variance (MANOVA) revealed significant differences on all Multiple Abilities Self-report Questionnaire (MASQ) scales between those with fibromyalgia and healthy controls, with language problems "significantly associated with physical and mental fatigue, stress, and trait depression." Further, visual-spatial "memory was associated with age, trait depression, and stress, and attention/concentration "was associated with physical and mental fatigue and trait depression." The research team concluded that the "MASQ is an assessment tool that can capture multiple dimensions of fibrofog which appear to be related to differing constellations of underlying clinical factors"

Improving Internal Locus of Pain Control in FibromyalgiaPresentation Number: 1418

Poster Board Number: 151

Researchers: Williams D, Ambrose K, Skalski L, et al.

Purpose: To improve internal locus of pain (I-loc)-a "belief in pain being an experience that can be modified through personal effort"-control in patients with fibromyalgia, as possession of a strong I-loc is associated with better outcomes for many diseases, including chronic pain.

Results: I-loc "is modifiable through brief non-pharmacological approaches such as exercise and relaxation. Bolstering the belief in I-loc appears to influence pain by influencing perceptions of illness impact rather than symptom severity in individuals with FM."