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Fibromyalgia patients often experienced abuse in childhood

Presented by
Dr Carmen Gota, Cleveland Clinic, Ohio, USA
ACR 2019
According to a study including 593 patients, physical and/or sexual abuse in childhood often leads to a diagnosis of fibromyalgia later in life [1].

Many factors have been associated with fibromyalgia syndrome (FMS), among them genetic factors, lack of physical exercise, mood disorders, maladaptive pain responses, and both current and past stressors, including a history of abuse. However, this has not been looked at in detail.

Therefore, Dr Carmen Gota (Cleveland Clinic, Ohio, USA) examined the predictive role of a history of abuse on FMS severity measures, and the association between self-reported abuse and socioeconomic status, symptoms, psychiatric comorbidities, and disability. All consecutive patients clinically diagnosed with FMS (n=593) who answered the question ‘Do you have a history of abuse?’ were enrolled. A history of abuse was reported by 223 patients: sexual abuse by 125 (56.5%), physical abuse by 155 (69.5%), and both by 78 (34.9%).

Out of 30 analysed symptom measures, 22 were significantly more severe in patients reporting abuse compared with the others. Fibromyalgia severity scores and pain disability scores were higher in patients that reported abuse: the latter averaged 6.0 for those with previous abuse versus 5.1 for patients without. Tender points were present in 56.5% of patients who experienced abuse compared with 44.3% in the controls. Their number of doctor visits in the previous 6 months was 11.6 versus 8.0 in the control group. Patients with former abuse were seen significantly more often by a psychiatrist (41.3% vs 26.8%). In addition, a significantly higher percentage of these patients reported past or present alcohol abuse. Fibromyalgia patients with a history of abuse also had worse socioeconomic status, as measured by higher percentages of single and divorced patients, lower education level, lack of private insurance, lower employment rates, and higher disability compared with those without abuse. Naturally, patients with a history of abuse said they had an unhappy childhood. Only 46% of patients with abuse histories felt loved by both parents compared with 76% of patients without abuse. Dr Gota recommended that abuse should be inquired about in all patients evaluated for FMS, and if necessary, patients should be referred for counselling.

    1.  Gota C, et al. Abstract 213. ACR 2019. November 8-13, Atlanta (GA/USA).

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