J Rheumatol
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The classification of widespread pain, proposed by the American College of Rheumatology (ACR) for use in the clinic as a screen for fibromyalgia, as described, does not require truly widespread pain. Studies considering the epidemiology of widespread pain per se may therefore require a definition with greater face validity, which might also show enhanced associations with other physical and psychological measures. We aimed to develop a more coherent definition of widespread pain for use in epidemiological studies and to compare performance in identifying individuals with significant morbidity. ⋯ A redefinition of widespread pain has produced a group of subjects whose pain is (a) likely to be more "widespread" and (b) is associated more strongly with factors such as psychological disturbance, fatigue, sleep problems, and tender points, and may be more appropriate in epidemiological studies.
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Randomized Controlled Trial Clinical Trial
Cognitive-educational treatment of fibromyalgia: a randomized clinical trial. I. Clinical effects.
This randomized controlled clinical trial evaluates the effectiveness of outpatient group cognitive/educational treatment for patients with the fibromyalgia (FM) syndrome. We hypothesized that the combination of group education with cognitive treatment aimed at developing pain coping skills would be more effective than group education alone. ⋯ The surplus value of a highly structured, 12 session group cognitive treatment added to group education cannot be supported by our study. In EDI, fear reduction might have enhanced pain coping and pain control, while poor compliance, the difficulty of homework assignments, and lack of individual support may have limited the effectiveness of ECO.
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To investigate (1) whether patients with fibromyalgia (FM) could be subgrouped on the basis of psychosocial and behavioral responses to pain, and (2) the relationships among pain severity, perceived disability, and observed physical functioning, as measured by cervical spinal mobility. ⋯ Patients with FM can be classified into 3 subgroups based on psychosocial and behavioral characteristics. These subgroups show substantial differences in clinical presentation of their symptoms. Although the results should be considered preliminary due to the narrow range of physical functioning, the differential relationships between perceived disability and physical functioning across cluster groups suggest the importance of FM syndrome as a heterogeneous disorder. Treating patients with FM as a homogeneous group may compromise research results, impede understanding of the mechanisms underlying this condition, and deter development of effective treatment.