Biopsychosocial features of patients with widespread chronic musculoskeletal pain in family medicine clinics.

Abstract

We aimed to describe the clinical and psycho-socio-familial features of patients with widespread chronic musculoskeletal pain (WCMP)/fibromyalgia (FM) in primary care settings. To detect differences and similarities between both 'entities'. An observational study was carried out with a newcoming clinical case series. Five family medicine surgeries were included. Patients aged from 18 to 50 attended the clinic to fulfil pain criteria for WCMP. Differences between WCMP and FM were based on the presence of 'tender points'. Measurements were made of general characteristics, occupation, pain description, symptoms, tender points, radiographic and laboratory studies, and questionnaires to assess self-rated health (NHP), social support (DUKE), family support (Family-APGAR), and psychopathological traits (CAQ). We identified 48 patients (23 WCMP;25 FM) with a mean age of 38.4 +/- 8.4; 95.8% were females. The back was the anatomical place most frequently reported (93.7%) and 34.8% of the patients pointed out the nape as being the most painful place. The average duration of pain was 6.7 +/- 7 years. Unsteadiness (72.9%), impairment in symptoms with weather (70.8%), with activity (70.8%) and general fatigue (68.8%) were the most frequently detected symptoms. 'Pain' (59.5) and 'energy' (54.4) were the scales of the NHP test most affected. Half of the patients were poorly satisfied with the responses of their families to their needs and over 60% showed psychopathological traits. The patients with FM reported worse self-rated health than those with WCMP; the number of years of pain (4.9 versus 8.2) and the number of symptoms (6.6 versus 8.9) were both greater in patients with FM. The clinical and psychological features of patients with WCMP-FM are similar to those reported by others. The self-rated health reported by these patients is poor and closer to that reported by patients suffering other chronic osteoarticular diseases. These results support the hypothesis that FM should be considered as more advanced clinical stage of the widespread musculoskeletal pain continuum.