fibromyalgia is often co-morbid in patients with ME and CFS. Dr.
Benjamin Natelson has reported that patients who have both
fibromyalgia and ME and CFS are sicker than patients with only one
disease/condition. This study is a little larger than many studies,
however there is no indication as to whether the patients in this
group also had ME and CFS.
According to McCue et al 2003, the clinical utility of the Hospital
Anxiety and Depression Scale (HADS) in the assessment of anxiety and
depression in CFS appears to be fundamentally compromised by the
presence of a three-dimensional underlying factor structure. This may
or may not be true in fibromyalgia patients and or the HADS may have
been modified. The HADS was developed in the 1980s to assess anxiety
and depression in a non-psychiatric population. It is meant to
differentiate symptoms of depression with those of anxiety. It does
not measure whether the depression or anxiety are directly related to
the disease or condition itself. Depression and anxiety are also a
common response to stigmatization. Nor does it assess whether the
depression/and or anxiety were also present prior to contracting the
disease.
The Comparative Burden of Mild, Moderate and Severe Fibromyalgia:
Results from a Cross-Sectional Survey in the United States
Caroline Schaefer, Arthi Chandran, Meghan Hufstader, Rebecca Baik,
Michael McNett, Don Goldenberg, Robert Gerwin and Gergana Zlateva
Health and Quality of Life Outcomes 2011, 9:71 doi:10.1186/1477-7525-9-71
Published: 22 August 2011
Abstract (provisional)
Background:
Fibromyalgia (FM) is characterized by chronic, widespread pain,
fatigue, and other symptoms; yet few studies have comprehensively
assessed its humanistic burden. This observational study evaluates the
impact of FM severity on patients' symptoms, health-related quality of
life (HRQoL), and productivity in the United States.
Method:
203 FM subjects were recruited from 20 physician offices.
Subjects completed a questionnaire including the EuroQol 5D (EQ-5D),
Fibromyalgia Impact Questionnaire (FIQ), Multidimensional Assessment
of Fatigue (MAF), Medical Outcomes Study Sleep Scale (MOS-SS), and
Hospital Anxiety and Depression Scale (HADS) and questions about
demographics, pain and other symptoms, HRQoL and productivity.
FIQ total scores were used to define FM severity, with 0-<39, 39-<59,
and 59-100, representing mild, moderate, and severe FM, respectively.
Sites recorded subjects' clinical characteristics and FM treatment on
case report forms using medical records. Summary statistics were
calculated for continuous variables and frequency distributions for
categorical variables. Differences across FM severity groups were
evaluated using the Kruskal-Wallis or Chi-square tests. Statistical
significance was evaluated at the 0.05 level.
Results:
Mean (SD) age was 47.9 (10.9); 95% were female. Most (92%) were
prescribed medication for FM; 24% and 66% reported moderate and severe
FM, respectively.
Mean (SD) scores were: 6.3 (2.1) for pain intensity; 0.35 (0.35) for
EQ-5D; 30.7 (14.2) for MAF; 57.5 (18.4) for MOS-SS Sleep Problems
Index; 10.2 (4.8) for HADS anxiety and 9.4 (4.4) for HADS depression.
Subjects with worse FM severity reported significantly increased pain
severity, HRQoL, fatigue, sleep disturbance, anxiety and depression
(p<0.001). Overall, 50% of subjects reported some disruption in their
employment due to FM; this differed across severity levels (p<0.001).
Employed subjects missed a mean (SD) of 1.8 (3.9) workdays during the
past 4 weeks; this also differed across severity levels (p=0.03).
Conclusions
FM imposes a substantial humanistic burden on patients in the United
States, and leads to substantial productivity loss, despite treatment.
This burden is higher among subjects with worse FM severity.
The full study may be found here:
http://www.hqlo.com/content/pdf/1477-7525-9-71.pdf
The HADS questionairre can be found here:
http://www.eardoctor.org/pdf/Hospital%20Anxiety%20and%20Depression%20Scale.pdf
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