乌鸦传媒

ATLANTA -- Most aspects of fibromyalgia were substantially worse in patients reporting a history of physical/sexual abuse, a researcher reported here.

Among nearly 600 patients seen at the Cleveland Clinic for fibromyalgia, 38% said they had been beaten, abused sexually, or both, said Carmen Gota, MD, at the American College of Rheumatology annual meeting.

Moreover, out of 30 measures of symptoms, 22 were significantly more severe in those reporting such abuse compared with the others.

These ranged from presence of tender points (56.5% vs 44.3%) and generalized weakness (84.0% vs 76.8%) to numbers of doctor visits in the past 6 months (mean 11.6 vs 8.0).

Substantially more patients with abuse histories also were currently seeing psychiatrists (41.3% vs 26.8%) or had done so previously (73.5% vs 56.8%), and past or present alcohol abuse (17.0% vs 9.7%) was markedly more common as well.

Pain disability index scores averaged 6.0 (SD 2.3) for those with abuse histories versus 5.1 (SD 2.3) for patients without.

Gota explained that abuse had previously been cited as among the factors often associated with fibromyalgia, along with genetic and psychological/psychiatric factors. These, of course, are interrelated, but abuse has stood out as a risk factor for poor outcomes. However, it has not been explored in great detail.

For the current study, Gota and colleagues asked consecutive patients, "Do you have a history of abuse?" as well as numerous other questions related to sociodemographics, comorbidities, and fibromyalgia signs and symptoms. (Four patients who said "no" to the primary screening question about abuse nevertheless said they had been molested or sexually abused, when later asked about it specifically; they were still classed with the "no-abuse" group.)

Those with a history of abuse were more likely to have public versus private insurance and tended to have lower educational attainment. They were also far less likely to identify their childhoods as happy. About 46% of those with abuse histories said they felt loved by both parents, versus 76% of no-abuse patients.

Linear regression analysis indicated that history of abuse was as strongly predictive of overall fibromyalgia severity as was a pattern of unrefreshing sleep, and more so than lack of aerobic exercises. The same was true for analysis of factors predicting scores on a "fibromyalgianess" and symptomatic distress scale.

Gota told 乌鸦传媒 that the findings suggest that clinicians should make a point of asking fibromyalgia patients about abuse history, and refer those who report it for counseling. She said she does so personally, although it remains to be confirmed whether it actually improves their fibromyalgia outcomes.

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