Pain Research

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Researchers Document Severity of Fibromyalgia
Posted: May 26, 2010

You look just fine and nothing is broken, so why do you say you have so much pain, and why don't you have the energy to just get up and go? These are the frustrating questions that people with fibromyalgia face every day. A research study headed up by Fausto Salaffi, M.D., in Milan, Italy, documents the serious impact fibromyalgia has on a person's health-related quality of life.*

"Patients with fibromyalgia report disabilities in daily living activities that are as severe as those reported by patients with rheumatoid arthritis, and more severe than those reported by patients with osteoarthritis or other painful conditions," states Salaffi and co-workers. But how do fibromyalgia patients really compare to rheumatoid arthritis patients when using standardized questionnaires to evaluate both groups? This was the question that Salaffi's study sought to answer.

Salaffi assessed a large group of subjects, which added strength to his study. He enrolled 380 fibromyalgia patients, 693 people with rheumatoid arthritis, and 1,579 healthy control subjects. All participants completed a validated instrument (Short Form 36-item Healthy Survey Questionnaire, SF-36) that measures the following eight components of health-related quality of life:

(1) physical functioning,
(2) role function - physical aspect,
(3) bodily pain,
(4) general health perception,
(5) mental health,
(6) role function - emotional aspect,
(7) social functioning, and
(8) vitality.

For the most part, the scores for each of the eight components of the SF-36 were the same for both the fibromyalgia and rheumatoid arthritis groups. However, fibromyalgia patients scores substantially worse on vitality. Feeling so devoid of any energy, it is no surprise that fibromyalgia patients also scored worse on the mental health component of the SF-36.

"Fibromyalgia patients consider widespread pain, fatigue, and unrefreshing sleep to be the factors that most significantly limit work performance, and our findings are consistent with those of previously published clinical studies," writes Salaffi and co-workers. "Pain is one of the most frequently reported, bothersome and disabling symptoms" he says, adding that the "pain may be more severe than in rheumatoid arthritis."

So how do fibromyalgia patients measure up to the healthy controls? "Comparing adults without frequent pain, patients are 2.6 times more likely to report poor overall health if they experience pain several times a week, and 11.8 times more likely to do so if pain is experienced every day" ... as it is in people with fibromyalgia who have daily widespread pain.

The fatigue factor, which is captured in the terrible vitality score, also plays a major role in how you feel. "Fibromyalgia patients seem to have higher overall fatigue levels and experience greater daily variability than those in other pain groups. The findings of sleep studies suggest that 70-90 percent of fibromyalgia patients complain of non-restorative sleep, which accentuates pain, musculoskeletal stiffness and fatigue."

Comparing the eight component scores of the SF-36 for fibromyalgia patients to the standardized scores established for other illnesses, Salaffi writes that fibromyalgia "resembles the pattern of restrictions generally found in patients with musculoskeletal disorders or other chronic conditions such as congestive heart failure, chronic obstructive pulmonary disease, hypertension, recent acute myocardial infarction, type II diabetes, and malignancy."

If you are functioning well with your fibromyalgia, all the power to you. More than half of patients with rheumatoid arthritis can still maintain function and certainly not everyone with a chronic illness is faced with having to quit their lifelong career. However, if you are struggling or find yourself unable to hang onto a job or continue with your normal chores, let your family know that your exterior lack of visible symptoms or blood tests are not a valid indicator of how you feel. Explain to them that the severity of your symptoms are equal to that of the many serious diseases listed above. Looks can be deceiving.

* Salaffi F, et al. Clin Exp Rheumatology 27(suppl 56):S67-S74, 2009