Abstract: Diagnosing fibromyalgia

Article:
Development and Testing of the Fibromyalgia Diagnostic Screen for Primary Care

– Source: Journal of Women’s Health, Dec 14, 2011

By Lesley M Arnold, Leslie J Crofford, et al.

[Note: the screen mentioned here apparently refers to the "Arnold Fibromyalgia Diagnostic Screen." A report on multicenter testing of its component questions, presented at the 2011 ACR/ARHP conference in Chicago, is found HERE. We are unsure how it may differ if at all from the “ACR Preliminary Diagnostic Criteria for FM & Measurement of Symptom Severity” published in May 2010.]

Abstract:
Background: The Fibromyalgia Diagnostic Screen* was developed for use by primary care clinicians to assist in the diagnostic evaluation of fibromyalgia, a disorder that predominantly affects women.

Methods: The screen was designed to have a patient-completed questionnaire and a clinician-completed section, which included a brief physical examination pertinent to the differential diagnosis of fibromyalgia.

The items in the questionnaire were based on patient focus groups and clinician and patient Delphi exercises, which resulted in a ranking of the most common and troublesome fibromyalgia symptoms.

One hundred new chronic pain patients (pain more than 30 days) and their primary care physicians completed the screen.

The patients were grouped as fibromyalgia or nonfibromyalgia by an independent fibromyalgia specialist, who was blind to screen responses.

Logistic regression was used to model the probability of fibromyalgia as a function of physician-reported and patient-reported variables.

Best subset regression was used to identify a subset of symptoms that were summed to form a single measure. Receiver operating characteristic (ROC) analysis was then used to select thresholds for continuous variables. The symptom and clinical variables were combined to create candidate prediction rules that were compared in terms of sensitivity and specificity to select the best criterion.

Results: Two final models were selected based on overall accuracy in predicting fibromyalgia: One used the patient-reported questionnaire only, and the other added a subset of the physical examination items to this patient questionnaire.

Conclusion: A patient-reported questionnaire with or without a brief physical examination may improve identification of fibromyalgia patients in primary care settings.

Source:  Journal of Women’s Health, Dec 14, 2011. PMID:22165952, by Arnold LM, Stanford SB, Welge JA, Crofford LJ. University of Cincinnati College of Medicine , Cincinnati, Ohio; University of Kentucky, Lexington, USA. [Email: Lesley.arnold@uc.edu]

Marriage improves gay men's health

Gay men's health improves when their state legalizes same-sex marriage, a new study finds.
The results showed gay and bisexual men in Massachusetts had significant fewer medical- and mental-health-care visits, and lower mental-health-care costs in the year after the state legalized gay marriage, compared with the previous year.

This amounted to a 13-percent reduction in total health-care visits, and a 14-percent reduction in health-care costs for this group. The reductions were similar for partnered and single gay men.

Previous research has shown that excluding lesbian, gay and bisexual individuals from marriage has a stressful impact on this population, according to the study.

There were also reductions in cases of hypertension and depression, according to the study. Both conditions are associated with stress.

The findings suggest that legalizing same-sex marriage could benefit public health "by reducing the occurrence of stress-related health conditions in gay and bisexual men," said study researcher Mark Hatzenbuehler, of Columbia University's Mailman School of Public Health.

However, among HIV-positive men, there was no reduction in HIV-related visits, suggesting that those in need of HIV/AIDS care continued to seek needed health-care services, the researchers said.

The researchers surveyed 1,211 patients from a large, community-based health clinic in Massachusetts that focuses on serving these groups.

Because the clinic was in a large metropolitan city, these results may not be generalized among people living in more-rural communities, the researchers said.

The study is published online today (Dec. 15) in the American Journal of Public Health.

Chronic Pain a common child complaint

Chronic pain is usually thought of as a problem affecting adults. But a new study shows that chronic pain is also highly prevalent in children and that more kids today suffer from pain compared to two decades ago.

Researchers in Nova Scotia analyzed data from 41 studies on pain in children published since 1991, which was the last time such an analysis was completed. They found that chronic pain conditions are more common in girls than boys and that pain problems tend to increase with age.

Headache is the most common type of chronic pain in kids, with 23 percent of children age 7 to 18 reporting weekly headaches and 5 percent reporting daily headaches. But abdominal, back and musculoskeletal pain were common, too. Recurrent abdominal pain was reported by 12 percent of children. And, in two studies that looked at back pain, 21 percent of the children reported back pain for at least one month.

Understanding pain patterns in children may alleviate their suffering and help explain how and why adult chronic pain occurs, the authors said.

"(R)esults of this review indicate that persistent and recurrent chronic pain is overwhelmingly prevalent in children and adolescents and should be recognized as a major health concern in this population."
The study appears in the December issue of the journal Pain.