Spine Pain Patients: Prevalence of Fibromyalgia in Tertiary Pain Clinic

 Chad M. Brummett, M.D. Assistant Professor, University of Michigan Health System Department of Anesthesiology Division of Pain Medicine 1500 East Medical Center Drive, 1H247 UH, Box 5048 Ann Arbor, MI 48109MedicalResearch.com Interview with:
Chad M. Brummett, M.D.
Assistant Professor, University of Michigan Health System
Department of Anesthesiology
Division of Pain Medicine
1500 East Medical Center Drive, 1H247 UH, Box 5048
Ann Arbor, MI 48109


MedicalResearch.com:  What are the main findings of the study?

Dr. Brummett: The study found that 42% of new patients presenting to a tertiary care pain clinic with a primary spine pain diagnosis met the American College of Rheumatology (ACR) survey criteria for fibromyalgia, which is a measure of widespread body pain and comorbid symptoms (e.g. trouble thinking, fatigue, mood symptoms, etc.).  Patients categorized as fibromyalgia-positive using the survey measure were distinctly different from those not meeting criteria.  In a multivariate regression model, independent predictors of being categorized as fibromyalgia-positive were female sex, higher neuropathic pain scores, anxiety, and lower physical function.

MedicalResearch.com:  Were any of the findings unexpected?

Dr. Brummett: The high percentage (42%) of people meeting the predefined cut point for fibromyalgia-positive was surprising.  These patients all had primary diagnoses of a spine disorder, not fibromyalgia. Hence, the specific spine disorder may in fact be a broader problem characterized by the widespread body pain and comorbid symptoms commonly associated with fibromyalgia.

MedicalResearch.com: What should clinicians and patients take away from your report?

Dr. Brummett: Whereas this does not “diagnose” the patient with fibromyalgia, it suggests that there is a portion of a spine pain cohort that has pain that may be more fibromyalgia-like, rather than having pure spine pain.  This type of presentation has been termed “centralized pain” by some experts due to the observed changes in central nervous system pain processing that occurs in fibromyalgia.  Given that many spine pain interventions/injections target peripheral structures, the presence of fibromyalgia-like phenotype may explain some of the variance and failures seen in procedures like facet/medial branch interventions and epidural steroid injections.

MedicalResearch.com:  What recommendations do you have for future research as a result of this study?

Dr. Brummett: Future research is needed to better understand whether the distinct differences in characteristics in the fibromyalgia-like cohort of spine patients is truly associated with altered neurophysiology or pain processing and whether these differences predict outcomes.

Citation:

Prevalence of the fibromyalgia phenotype in spine pain patients presenting to a tertiary care pain clinic and the potential treatment implications

Chad M. Brummett, Jenna Goesling, Alex Tsodikov, Taha S. Meraj, Ronald A. Wasserman, Daniel J. Clauw and Afton L. Hassett

Accepted manuscript online: 10 SEP 2013 03:34PM EST | DOI: 10.1002/art.38178