Background The psico-social dimensions of fibromialgia (FM) remain controversial, not only regarding its characterisation but also its possible causal or consequential relationship with the chronic pain status. The usual discrepancy between the self-report instruments of functional impairment and the observed disability favours a process of somatization. The contribution of pain and emotions to general health status are open to debate.
Objectives We attempted to investigate emotional disturbances in patients with fibromialgia and rheumatoid arthritis (RA) and their relationship with self-reported general health.
Methods 58 FM patients and 43 RA patients, fulfilling the ACR criteria, were included on a consecutive basis from our Rheumatology outpatient clinic. Social and demographic data were collected and found to be comparable among the groups, as well as disease duration. The Short-Form Health Survey (SF-36) and the Brief Symptom Inventory (BSI) were applied twice, with 6 months interval. Both instruments were evaluated regarding each of their different dimensions and summary score. Statistical analysis employed Student’s t test.
Results FM patients scored significantly higher in every single BSI dimension (somatization; obsession/compulsion; interpersonal relationship; depression; anxiety; hostility; fobic anxiety, paranoid ideation and psicoticism. FM patients also showed significantly lower levels of general health, as evaluated by SF-36, both in mental and physical components. These differences remained stable in re-evaluation.
Conclusion FM patients have a higher score for associated psychopathologic symptoms. This parallels their higher dissatisfaction with general health, not only in its mental aspects, but also on physical function and performance. These results demonstrate a strong coexistence of pain and psichopatological traits in FM patients, which may have a strong influence on reported functional status. The possibility that such psychological disturbances are a consequence of the disease, and especially chronic pain, is questioned by the much lower prevalence of such disorders in RA patients of similar disease duration.
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