Increased absence due to sickness among employees with fibromyalgia

Suicidal Ideation Profiles in Patients with Fibromyalgia Using Transdiagnostic Psychological and Fibromyalgia-Associated Variables

Several studies have emphasized the heterogeneity of fibromyalgia patients. Furthermore, fibromyalgia patients are considered a high-risk suicide group. The ideation-to-action framework proposes a set of transdiagnostic psychological factors involved in the development of suicidal ideation. The present study aims to explore the existence of different subgroups according to their vulnerability to suicidal ideation through these transdiagnostic psychological variables and a set of variables typically associated with fibromyalgia. In this cross-sectional study, 151 fibromyalgia patients were assessed through the Revised Fibromyalgia Impact Questionnaire, Beck Depression Inventory-II, Plutchik Suicide Risk Scale, Interpersonal Needs Questionnaire, Defeat Scale, Entrapment Scale, Psychache Scale, and Beck Hopelessness Scale. A K-means cluster analysis identified two clusters, one (45.70%) according to a low vulnerability, and a second (54.30%) with a high vulnerability to suicidal ideation. These clusters showed statistically significant differences in suicidal ideation and suicide risk. However, no differences were observed in most socio-demographic variables. In conclusion, fibromyalgia patients who present a clinical condition characterized by a moderate-high degree of physical dysfunction, overall disease impact and intensity of fibromyalgia-associated symptoms, along with a high degree of perceived burdensomeness, thwarted belongingness, defeat, entrapment, psychological pain and hopelessness, form a homogeneous group at high risk for suicidal ideation.

Is type of work associated with physical activity and sedentary behaviour in women with fibromyalgia? A cross-sectional study from the al-Ándalus project

OBJECTIVES

To analyse the association between the type of work (productive vs reproductive work) and the levels of physical activity and sedentary behaviour in women with fibromyalgia.

METHOD

This cross-sectional study involved 258 women with fibromyalgia from southern Spain. Of them, 55% performed reproductive work (unpaid, associated with caregiving and domestic roles) exclusively, while 45% had productive job (remunerated, that results in goods or services). Physical activity of light, moderate and vigorous intensity in the leisure time, at home, at work, and totally were measured through the leisure time physical activity instrument and with the physical activity at home and work instrument, respectively. Sedentary behaviour was measured by the Sedentary Behaviour Questionnaire.

RESULTS

After adjusting for age, fat percentage, education level and marital status, the multivariate analysis of covariance model informed the existence of significant differences between type of work groups (p<0.001). Women with productive work engaged in more light physical activity at work (mean difference =448.52 min; 95 % CI 179.66 to 717.38; p=0.001), and total physical activity of light (809.72 min; 535.91 to 1085.53; p<0.001) and moderate (299.78 min; 97.31 to 502.25; p=0.004) intensity. Women with reproductive work engaged in more light physical activity at home (379.14; 175.64 to 582.64; p<0.001). Leisure time physical activity and sedentary behaviour were similar in both groups (p>0.05 for all comparisons).

CONCLUSIONS

Women with productive work had greater levels of physical activity compared with those who only did reproductive work, except for physical activity at home. Having productive work might facilitate movement of women with fibromyalgia towards a more active lifestyle.

Fibromyalgia in the workplace: risk factors for sick leave are related to professional context rather than fibromyalgia characteristics- a French national survey of 955 patients

Background

Work and workplace factors are important in fibromyalgia management. We investigated factors associated with sick leave in professionally active women living with fibromyalgia.

Methods

A questionnaire for fibromyalgia patients in employment was developed by pain and occupational physicians and patients' organizations. Women in full-time work, screened for fibromyalgia with the FiRST questionnaire, were recruited for a national online survey. Sick leave over the preceding year was analyzed.

Results

In 5 months, we recruited 955 women, with a mean of 37 days of sick leave in the previous year: no sick leave (36%), up to 1 month (38%), 1 to 2 months (14%), more than 2 months (12%). In the groups displayed no differences in demographic characteristics, fibromyalgia symptoms, functional severity and psychological distress were observed. However, they differed in workplace characteristics, commute time, stress and difficulties at work, repetitive work, noisy conditions, career progression problems and lack of recognition, which were strong independent risk factors for longer sick leave. Sedentary positions, an extended sitting position, heavy loads, exposure to thermal disturbances and the use of vibrating tools did not increase the risk of sick leave.

Conclusions

Women with fibromyalgia frequently take sick leave, the risk factors for which are related to the workplace rather than fibromyalgia characteristics.

Perspective

This is the first study to assess the impact of occupational and clinical factors on sick leave in women living with fibromyalgia. Risk factors were found to be related to the workplace rather than fibromyalgia and personal characteristics. Workplace interventions should be developed for women with fibromyalgia.

Subtle changes of gray matter volume in fibromyalgia reflect chronic musculoskeletal pain rather than disease-specific effects

Fibromyalgia syndrome (FMS) is a chronic pain syndrome. Neuroimaging studies provided evidence of altered gray matter volume (GMV) in FMS but, similarly, in chronic pain of other origin as well. Therefore, the purpose of this study was to evaluate the disease specificity of GMV alterations in FMS by direct comparison. Structural MRI data of the brain were acquired in 25 females with FMS and two different control groups: 21 healthy subjects and 23 patients with osteoarthritis. Regional GMVs were compared by voxel-based morphometry and additional ROI-analyses. In conclusion, we did not identify significant GMV alterations in either FMS or OA patients compared to healthy controls when adopting a conservative statistical approach with multiple comparison correction. However, even under a more liberal approach no FMS-specific GMV changes were found because both pain groups presented increased gray matter volumes in the precentral gyrus and decreased GMV in the angular gyrus/middle occipital gyrus and middle temporal gyrus in comparison with healthy controls. Since no differences between both pain groups could be detected cortical GMV changes in FMS should not be interpreted as FMS-specific but might rather reflect changes in chronic pain in general. This previously held notion is confirmed in this study by direct comparison with a control group consisting of another pain disorder.

The Patient-Reported Outcomes Thermometer-5-Item Scale (5T-PROs): Validation of a New Tool for the Quick Assessment of Overall Health Status in Painful Rheumatic Diseases

Objective

To investigate the construct validity, reliability (internal consistency and retest reliability), and feasibility of the patient-reported outcomes thermometer–5-item scale (5T-PROs), a new tool to measure overall health status in patients with painful chronic rheumatic diseases such as rheumatoid arthritis (RA), psoriatic arthritis (PsA), axial spondyloarthritis (axialSpA), and fibromyalgia (FM).

Methods

Consecutive patients have been involved in this study. The following analyses were performed to establish the validity of the 5T-PROs: (1) principal component factor analysis was used to identify the presence of a relatively small number of underlying latent factors than can be used to represent relations among sets of many variables; (2) Cronbach's alpha was calculated as an indicator of internal consistency; and (3) Pearson product-moment correlations were conducted to assess the convergent validity. The 5T-PROs was also administered a second time (two weeks after the initial administration) to a subset of sample (n = 426) to allow for calculation of test-retest reliability. We used the intraclass correlation coefficient (ICC) as an estimate of test-retest reliability. Additionally, discriminant validity was tested using analysis of variance (ANOVA) with Bonferroni post hoc multiple comparisons, in different disease conditions. Feasibility was analyzed by the time taken in completing the 5T-PROs and the proportion of patients able to complete the 5 item.

Results

1,199 patients (572 with RA, 251 with axialSpA, 150 with PsA, and 226 with FM) were examined. The mean age was 55.7 (standard deviation: 13.1; range: 20 to 80) years. Factor analysis yielded two factors which accounted for 62.54% of the variance of the 5T-PROs. The first factor “Symptom Summary Score” (35.57% of the variance) revealed a good internal consistency (alpha = 0.88); the internal consistency of the second factor “Psychological Summary Score” (26.97% of the variance) was moderate (alpha = 0.69). The reliability of the whole instrument was good (alpha = 0.82). A very high correlation was obtained between Symptom Summary Score and SF-36 PCS and between pain thermometer intensity and SF-36 bodily pain. For all five items and summary scale scores of the SF-36, there was strong evidence that the mean rank of the scores differs significantly between the groups (Kruskal–Wallis tests, p < 0.001). Discriminant validity, assessed by comparing the 5T-PRO dimensions in patients with different states of disease activity, showed that the 5T-PROs show moderate association with the presence of comorbidities. It was also noted that it was inversely correlated (p=0.01) to years of formal education.

Conclusion

The 5T-PROs is easily administered, reliable and a valid instrument for evaluating the extensive multidimensional impact associated with chronic painful rheumatic conditions.

Gray Matter Atrophy within the Default Mode Network of Fibromyalgia: A Meta-Analysis of Voxel-Based Morphometry Studies

Over the years, studies have demonstrated morphological changes in the brain of fibromyalgia (FMS). We aimed to conduct a coordinate-based meta-analytic research through systemic review on voxel-based morphometry (VBM) imaging results to identify consistent gray matter (GM) difference between FMS patients and healthy subjects. We performed a comprehensive literature search in PubMed (January 2000–December 2015) and included six VBM publication on FMS. Stereotactic data were extracted from 180 patients of FMS and 123 healthy controls. By means of activation likelihood estimation (ALE) technique, regional GM reduction in left medial prefrontal cortex and right dorsal posterior cingulate cortex was identified. Both regions are within the default mode network. In conclusion, the gray matter deficit is related to the both affective and nonaffective components of pain processing. This result also provided the neuroanatomical correlates for emotional and cognitive symptoms in FMS.

Chronic diseases are strongly associated with sickness absences in a sample of Italian public employees

OBJECTIVES

Data on the prevalence of chronic diseases and their relationship with sickness absence in the Italian public employees are rather scarce. Therefore, in the first place, we assessed the distribution of chronic diseases in the employees of the University of Ferrara. As a next step, we investigated the possible associations between each chronic disease and cumulative days of all-cause sickness absence, and finally we investigated the odds ratio of each single chronic disease on sickness absence.

MATERIAL AND METHODS

A total of 514 employees, 269 sick-listed and 245 not sick-listed in 2012, were studied. Demographical/clinical characteristics and chronic diseases were obtained from all study participants during medical surveillance procedures. Sickness absence days and job seniority data were obtained from the administrative office.

RESULTS

Gastrointestinal and psychiatric diseases were the most reported in the sick-listed sample (p = 0.01 and p = 0.02, respectively, compared to the not sick-listed). In the interquantile regression analysis, the sickness absence days were associated with psychiatric diseases (β = 65.1, 95% CI: 13.2-117.1, p = 0.01) and with the presence of 2 or more chronic diseases (β = 23.3, 95% CI: 4.5-42, p = 0.02). Furthermore, the logistic regression analysis showed that the odds of sickness absence were increased 2 fold by psychiatric diseases (OR = 2.2, 95% CI: 1.01-4.93, p = 0.04), and gastrointestinal diseases (OR = 1.9, 95% CI: 1.07-3.42, p = 0.02) and, to a lesser extent, by high body mass index (OR = 1.05, 95% CI: 1-1.11, p = 0.03). Conversely, female gender reduced by half the odds of sickness absence (OR = 0.5, 95% CI: 0.3-0.8, p = 0.04).

CONCLUSIONS

This study highlights the relevant association between chronic diseases and sickness absence in Italian public employees. Our findings indicate the importance of considering the health status when designing preventive interventions aimed at decreasing sickness absences in this population.

Fibromyalgia: disease synopsis, medication cost effectiveness and economic burden

Fibromyalgia (FM) primarily affects women, and it is increasingly recognized by health care providers as more patients seek assistance for their chronic pain conditions. FM patients suffer from reduced quality of life, daily functioning and productivity. A single FM patient can cost society tens of thousands of dollars each year, with the overall expense increasing alongside disease severity. Indirect costs account for the majority of total expenditures and involve losses in productivity, reduced work hours, absenteeism, disability, unemployment, early retirement, informal care and other out-of-pocket costs. Health care utilization increases in concert with the severity of illness. Moreover, FM patients often have several comorbid illnesses (e.g. depression, anxiety and sleep disturbances), resulting in extreme escalation of overall health care expenditures. Medications with the best efficacy in the treatment of FM include the tricyclic antidepressants amitriptyline and nortriptyline, cyclobenzaprine (a skeletal muscle relaxant), tramadol, duloxetine, milnacipran, pregabalin and gabapentin. Corticosteroids, nonsteroidal anti-inflammatory drugs, benzodiazepines and opioid analgesics, with the exception of tramadol, are not considered efficacious. Medication selection should be individualized and influenced by the severity of illness and the presence of comorbidities and functional disabilities.

Fibromyalgia in patients with axial spondyloarthritis: epidemiological profile and effect on measures of disease activity

To determine the prevalence of fibromyalgia (FM) in patients with ankylosing spondylitis (AS) or psoriatic arthritis (PsA) characterized by axial involvement (axial-PsA), and to assess the discriminative ability of different versions of the Ankylosing Spondylitis Disease Activity Score (ASDAS) and the Bath Ankylosing Spondylitis Activity Disease Activity Index (BASDAI) in measuring disease activity in three different cohorts of patients with axial spondyloarthritis (axial-SpA), FM, or both (axial-SpA + FM), this study was divided into two phases: (1) 402 patients with definite AS or axial-PsA were examined to diagnose FM and estimate its prevalence; and (2) 419 patients (111 with axial-SpA, 248 with FM, and 60 with aSpA + FM) were evaluated using the different versions of the ASDAS and BASDAI to assess the effect on disease activity. The overall prevalence of FM in the axial-SpA population was 14.9 %, significantly higher among women (p < 0.0001); the estimated prevalence in AS was 12.7 % and in axial-PsA was 17.2 %. Although the BASDAI scores correlated with those of ASDAS-C-reactive protein (CRP) and ASDAS-erythrocyte sedimentation rate (ESR) (p < 0.0001), only ASDAS had sufficient discriminatory ability to assess disease activity. The addition of only one marker of inflammation led to an adequate level of significance (ASDAS-CRP, p = 0.0018; ASDAS-ESR, p = 0.003). FM is common in axial-SpA and more prevalent in female patients. Our findings suggest that ASDAS is better than BASDAI in distinguishing patients with disease activity from those with functional impairment. The use of ASDAS may be very useful in clinical practice as it allows treating patients with the most appropriate therapy.

Cumulative incidence of sickness absence and disease burden among the newly sick-listed, a cross-sectional population-based study

Background

Sickness absence is a public health problem with economic consequences for individuals and society. Although sickness absence and chronic diseases are correlated, few studies exist concerning the role of chronic disease in all-cause sickness absence. The aim was to assess the cumulative incidence of sickness absence and examine the accompanying burden of chronic diseases among the sick-listed.

Methods

A cross-sectional study was performed with data from 2008. Cumulative incidence of all-cause sickness absence (≥14 days) was calculated based on all newly sick-listed individuals (N = 12,543). The newly sick-listed sample and a randomized general population sample (n = 7,984) received a questionnaire (participation rates: 54% and 50%).To assess the burden of self-reported chronic diseases, standardized incidence ratios (SIR) were calculated.

Results

Estimated one-year cumulative incidence was 11.3% (95% CI: 11.2–11.3), 14.0% (13.9–14.1) for women and 8.6% (8.5–8.6) for men. Gender differences were consistent across all age groups, with highest cumulative incidence among women aged 51–64 years, 18.2% (18.0–18.5). For women, the burden of chronic disease was significantly higher for nine out of twelve disease groups, corresponding numbers for men were nine out of eleven disease groups (standardized for age and socio-economic status). Neoplastic diseases had the highest SIR with 4.3 (3.4–5.2) for women and 4.2 (2.8–5.6) for men. For psychiatric and rheumatic diseases the respective SIR’s were 1.7 for women and 1.8 for men. The remaining disease groups had an elevated risk of 20-60% (SIR 1.2–1.6). The risk of reporting a co-morbidity was increased for women (SIR 1.4 (95% CI 1.4–1.5)) and men (SIR 1.5 (1.4–1.7)) among the sick-listed.

Conclusions

Register data was used to estimate of the cumulative incidence of sickness absence in the general population. A higher burden of chronic disease among the newly sick-listed was found. Targeting long-term health problems may be an important public health strategy for reducing sickness absence.

Factors promoting sustainable work in women with fibromyalgia

PURPOSE

To examine and describe the factors promoting sustainable work in women with fibromyalgia (FM).

METHODS

A qualitative interview study. Twenty-seven gainfully employed women with FM participated in five focus group interviews. Their median age was 52 years, ranging from 33 to 62. The interviews were recorded, transcribed verbatim and analysed by qualitative latent content analysis.

RESULTS

Four categories were identified describing factors promoting sustainable work: the meaning of work and individual strategies were individual promoters while a favourable work environment and social support outside work were environmental promoters. The meaning of work included individual meaning and social meaning. The individual strategies included handling symptoms, the work day and long-term work life. A favourable work environment included the physical and psychosocial work environment. Social support outside work included societal and private social supports.

CONCLUSIONS

Promoting factors for work were identified, involving individual and environmental factors. These working women with FM had developed advanced well-functioning strategies to enhance their work ability. The development of such strategies should be supported by health-care professionals as well as employers to promote sustainable work in women with FM.

IMPLICATIONS FOR REHABILITATION

Work disability is a common consequence of fibromyalgia (FM). Working women with FM appear to have developed advanced well-functioning individual strategies to enhance their work ability. The development of individual strategies should be supported by health-care professionals as well as employers to promote sustainable work and health in women with FM.

A combination of illness invalidation from the work environment and helplessness is associated with embitterment in patients with FM

OBJECTIVES

The aim of this study in employed people with FM was to test the hypothesis that embitterment is a function of the joint experience of invalidation from the work environment and helplessness regarding one's illness.

METHODS

Sixty-four full-time (36%) or part-time (64%) employed patients with FM (60 females, mean age 45 years) completed the Illness Invalidation Inventory (3*I) to assess work-related discounting and lack of understanding, the Illness Cognition Questionnaire (ICQ) to assess helplessness and the Bern Embitterment Inventory (BEI) to assess embitterment. Hierarchical regression analysis was performed.

RESULTS

Sixteen percent of the participants experienced embitterment levels in the clinical range. The interaction or combination of discounting and helplessness (P = 0.02) and the combination of lack of understanding and helplessness (P = 0.04) were associated with greater embitterment.

CONCLUSIONS

The construct of embitterment has substantial face validity and may result from a combination of invalidation and helplessness. Whereas helplessness is a common target of cognitive-behavioural therapy, evidence-based interventions to redress invalidation and embitterment are needed. It is possible, however, to target invalidation by educating people in the work environment about the consequences of FM and patients' valid needs for work that is manageable, given each patient's specific health-related limitations.

Characteristics of suitable work from the perspective of patients with fibromyalgia

OBJECTIVES

The evaluation of work ability of patients with FM is difficult. Our aim was to investigate the characteristics of suitable work from the perspective of patients with FM.

METHODS

Interviews with patients yielded statements about characteristics of suitable work. Patients individually sorted these statements according to similarity. Hierarchical cluster analysis was applied to these sortings.

RESULTS

The hierarchical structure included 74 characteristics of suitable work. The 10 clusters at the lowest level included (i) recovery opportunities, (ii) pace of work, (iii) not too high workload, (iv) keeping energy for home and free time, (v) match between work and capabilities, (vi) development opportunities, (vii) understanding from colleagues, (viii) help from colleagues, (ix) support from management and (x) work agreements with management.

CONCLUSIONS

According to patients with FM, suitable work is paced in such a way that one can perform the job well and with satisfaction while keeping energy for home and free time and having acknowledgement and help from management and colleagues. The brief suitable work checklist that is provided can help patients with FM to negotiate with employers and job professionals to improve the match between job demands and capabilities.

The prevalence of fibromyalgia among textile workers in the city of Denizli in Turkey

AIM

Fibromyalgia (FM) is characterized by chronic widespread pain, fatigue, reduced sleep quality and multiple tender points. A recent population study from Turkey found the prevalence of FM as 3.6%. A prevalence study among workers has not yet been performed. We performed a prevalence survey among working population in the city of Denizli in Turkey.

METHODS

The field survey was done in two stages. In the first stage 655 (523 female, 132 male) textile workers from four factories were asked to fill a screening questionnaire. In the next stage, participants who had widespread pain were examined by an experienced rheumatologist. Patients who had 11 tender points according to ACR 1990 FM classification criteria were diagnosed as FM syndrome and later a detailed clinical and laboratory evaluation was done.

RESULTS

Forty-eight patients (7.3%) (one male [0.76% of males], 47 females [9.0% of females]) among 655 textile workers were diagnosed as FM. The clinical features were as follows: all patients had widespread pain, 12.5% had arthralgia, 14.6% had Raynaud's phenomenon, 41.6% had sleep disturbance, 87.5% had headache, 52% had irritable bowel disease. Age, gender, marital status, income level, education level, smoking status, and body mass index level of workers were evaluated by logistic regression analysis; multiple analysis. Only three variables (age, gender and annual income level) were significantly affected FM prevalence.

CONCLUSION

This is the first study investigating FM prevalence among workers from Turkey. The prevalence of FM appears higher among females, older workers, and workers with low annual money income.

Diagnosis and management of fibromyalgia: how and why

SUMMARY Fibromyalgia is a medically controversial disorder consisting of widespread muscular pain, fatigue and sleep disturbance. There are some similarities to chronic fatigue syndrome and it may have a significant psychological component. Comorbidities such as irritable bowel and restless legs syndromes are common; new diagnostic criteria have recently been formulated to take account of the multiple symptoms. Onset of fibromyalgia may follow physical or mental injury and can have a disruptive effect on normal life. Despite medical ambivalence, courts see fibromyalgia as a life-changing illness and grant substantial damages if a culpable injury is considered to have been the trigger. There is increasing evidence that the perceived pain and other symptoms involve dysfunction in central sensory processing systems. The mainstays of treatment are serotonin- and noradrenaline-boosting antidepressants, GABA analog anticonvulsants and cognitive behavioral therapy with graded exercise, but most patients gain only partial benefit despite their physicians’ best endeavors.

Fibromyalgia syndrome: prevalence, pharmacological and non-pharmacological interventions in outpatient health care. An analysis of statutory health insurance data

OBJECTIVE

Fibromyalgia syndrome (FMS) is a chronic pain condition impacting on quality of life, causing physical and psychological impairment resulting in limited participation in professional and social life. The objective of this study was to assess the prevalence, recommended pharmacological and non-pharmacological interventions of FMS, patients' characteristics and to compare findings to current research.

METHODS

About 1.6 Mio patients of a German statutory health insurance company (GEK) in 2007 were analyzed for: (a) the prevalence of FMS (ICD-10: M79.7); (b) and comorbid depression (ICD-10: F32/33); (c) the recommended pharmacological and non-pharmacological intervention rates; (d) and characteristics of patients associated with being prescribed recommended interventions.

RESULTS

The (a) standardized prevalence of FMS in 2007 was 0.05% in men and 0.4% in women. (b) 51.9% of the patients with prevalent FMS had a comorbid depression in 2007 (88.2% female). (c) 66% of FMS patients received the recommended pharmacological treatment, 59% physical therapy, 6.1% cognitive-behavioural therapy and 3.4% a combination of these (multi-component therapy, MCT). (d) One year increase in age was associated with a 3% decrease in the predicted odds of receiving MCT (95%, CI 0.95-0.99).

CONCLUSION

The current data indicate an FMS-prevalence that differs from epidemiological surveys and screenings, probably due to methodological differences. Especially females with comorbid depression are affected. The likelihood of receiving MCT is not associated with gender, but with younger age. Yet, the findings seem to indicate insufficient and inadequate treatment, but FMS warrants more research.

Factors associated with temporary work disability in patients with fibromyalgia

Temporary work disability (TWD) is more common in patients with fibromyalgia (FM) than among the rest of the workers. To describe the differences between patients who take sick leave (TWD group) and those who continue to work regularly (control group). To determine what factors are associated with TWD. Multicentre, cross-sectional study with a cohort of patients with FM seen in rheumatology clinics throughout Spain. The following information was recorded: demographic data, clinical manifestations, comorbidities, health self-perception, emotional issues, functional capacity, physical function tests, utilization of healthcare resources, TWD during the past 12 months, and quitting paid employment due to the disease. Descriptive statistics was used to compare variables between the TWD group and the control group. A logistic regression analysis was done to determine which factors are associated with TWD. The study cohort was composed of 301 patients with FM (women: 96.7%) with a mean age of 48.7 ± 8.5 years and a disease duration of 11.5 ± 9.1 years. There were 56.8% active workers, of whom 67.8% had had some TWD. The mean TWD length was 44 ± 69.6 days/year. TWD correlated significantly with sedentary work, clinical manifestations, comorbidities, self-perceived health, poor functional capacity, physical function, and healthcare resource utilization. The factors independently associated with TWD are sedentary work, more clinical manifestations, fatigue, and poor flexibility. Of the cases of people who quit their jobs, 66.9% were associated with FM. TWD in patients with FM is associated with sedentary work, a worse clinical situation, and worse functional capacity.

Burden of fibromyalgia and comparisons with osteoarthritis in the workforce

OBJECTIVES

To calculate the fibromyalgia (FM) burden of illness (BOI) from the employer perspective and to compare annual prevalence, work output, absence, and health benefit costs of employees with FM versus osteoarthritis (OA).

METHODS

Retrospective regression model analysis comparing objective work output, total health benefit (health care, prescription drug, sick leave, disability, workers' compensation) costs, and absence days for FM, versus OA and NoFM cohorts, while controlling for differences in patient characteristics.

RESULTS

FM prevalence was 0.73%; OA 0.90%. Total health benefit costs for FM were $8452 versus $11,253 (P < 0.0001) for OA and $4013 (P < 0.0001) for NoFM, with BOI = $4439. Total absence days were 16.8 versus 19.8 (P < 0.0001) and 6.4 (P < 0.0001), respectively. FM had significantly lower annual work output than NoFM (19.5%, P = 0.003) but comparable with OA.

CONCLUSION

FM places a significant cost, absence, and productivity burden on employers.

A controlled examination of medical and psychosocial factors associated with low back pain in combination with widespread musculoskeletal pain

BACKGROUND

Little is known about chronic low back pain (CLBP) in combination with widespread musculoskeletal pain (WMP).

OBJECTIVE

This study examined factors that may be common to these conditions, with the objective of detecting factors that could improve the course of these diseases.

DESIGN

This was a prospective case control study.

PATIENTS AND INTERVENTION

A group of patients with CLBP and WMP (CLBP+WMP group, n=97) was compared with a group of individuals who were pain-free and without a history of musculoskeletal problems (control group, n=97) and with a group of patients with CLBP but without WMP (CLBP-only group, n=52). The mean age of the participants was 42.9 years (SD=8.74); 76% were women, and 24% were men.

MEASUREMENTS

A total of 74 variables were measured, including sociodemographic, physical, and psychosocial variables. After univariate examination for group differences and analyses of variables available for all 3 groups, logistic regression on selected factors was performed. The alpha level was set at .05, but was adjusted to avoid randomly significant results.

RESULTS

For a number of variables, significant differences among the 3 groups were observed. For regression model 1 for the CLBP+WMP and control groups, 4 out of 9 variables showed significant likelihood tests: income (lower in the WMP group), depression, anxiety, and fear-avoidance behavior. For regression model 2, 2 out of 13 variables showed significant likelihood tests: endurance capacity (more in the CLBP+WMP group) and balance capability (worse in the CLBP+WMP group). The models predicted at least 91.2% of all cases to the correct group. The regression analysis regarding the CLBP+WMP and CLBP-only groups predicted 86.7% of all cases to the correct group. Three out of 10 variables showed significant likelihood tests: high disability, fear-avoidance behavior, and number of treatments.

LIMITATIONS

Some variables in testing the patients with WMP and the individuals who were pain-free were not used with the patients with CLBP only.

CONCLUSIONS

Patients with CLBP and WMP should be examined for indicated physical and psychosocial factors. Therapeutic management should consider them in the early stage of the disease. These findings also might apply to patients with fibromyalgia or myofascial pain.

Societal and patient burden of fibromyalgia syndrome

Fibromyalgia syndrome (FMS) is an under-diagnosed disorder of unknown aetiology, characterized by chronic widespread muscular pain, often accompanied by somatic and psychological symptoms. Several studies have described the impact of FMS on patients' functionality, disability and quality of life. Other studies have reported on the burden to patients, healthcare payers and society. This review brings the existing evidence together and concludes that the patient burden of fibromyalgia is very high in comparison with many other conditions. The burden to healthcare payers and society is important as well, and can be mostly explained by factors not directly related to the treatment of FMS. Data suggest that the cost before diagnosis may even be higher than the cost after diagnosis. It is very likely that the combination of symptoms not only complicates the recognition and treatment of FMS, but also magnifies the burden of FMS. Despite the complex and controversial construct of this syndrome, the results in terms of patient, healthcare payer and societal burden are quite consistent.

Non-invasive brain stimulation approaches to fibromyalgia pain

Fibromyalgia is a poorly understood disorder that likely involves central nervous system sensory hypersensitivity. There are a host of genetic, neuroendocrine and environmental abnormalities associated with the disease, and recent research findings suggest enhanced sensory processing, and abnormalities in central monoamines and cytokines expression in patients with fibromyalgia. The morbidity and financial costs associated with fibromyalgia are quite high despite conventional treatments with antidepressants, anticonvulsants, low-impact aerobic exercise and psychotherapy. Noninvasive brain stimulation techniques, such as transcranial direct current stimulation, transcranial magnetic stimulation, and electroconvulsive therapy are beginning to be studied as possible treatments for fibromyalgia pain. Early studies appear promising but more work is needed. Future directions in clinical care may include innovative combinations of noninvasive brain stimulation, pharmacological augmentation, and behavior therapies.

[Definition, classification and diagnosis of fibromyalgia syndrome]

BACKGROUND

Interdisciplinary guidelines for the definition, classification and diagnosis of chronic widespread pain (CWP) and fibromyalgia syndrome (FMS) were developed by collaboration of 10 German medical and psychological associations and 2 patient self-help organizations.

METHODS

A systematic literature search was performed in the Cochrane Library (1993-12/2006), Medline (1980-2006), PsychInfo (1966-12/2006), and Scopus (1980-12/2006). Levels of evidence were assigned according to the classification system of the Oxford Centre for Evidence-Based Medicine. Grading of the strength of recommendation was done according to the German program for disease management guidelines. Standardized procedures to reach a consensus on recommendations were used.

RESULTS

CWP is defined by the criteria of the American College of Rheumatology (ACR--strong consensus). FMS can be diagnosed for clinical purposes by symptom-based criteria (without tender point examination) as well as by the ACR criteria (strong consensus).

Cost-utility of an 8-month aquatic training for women with fibromyalgia: a randomized controlled trial

Introduction

Physical therapy in warm water has been effective and highly recommended for persons with fibromyalgia, but its efficiency remains largely unknown. Should patients or health care managers invest in this therapy? The aim of the current study was to assess the cost-utility of adding an aquatic exercise programme to the usual care of women with fibromyalgia.

Methods

Costs to the health care system and to society were considered in this study that included 33 participants, randomly assigned to the experimental group (n = 17) or a control group (n = 16). The intervention in the experimental group consisted of a 1-h, supervised, water-based exercise sessions, three times per week for 8 months. The main outcome measures were the health care costs and the number of quality-adjusted life-years (QALYs) using the time trade-off elicitation technique from the EuroQol EQ-5D instrument. Sensitivity analyses were performed for variations in staff salary, number of women attending sessions and time spent going to the pool. The cost effectiveness acceptability curves were created using a non-parametric bootstrap technique.

Results

The mean incremental treatment costs exceeded those for usual care per patient by € 517 for health care costs and € 1,032 for societal costs. The mean incremental QALY associated with the intervention was 0.131 (95% CI: 0.011 to 0.290). Each QALY gained in association with the exercise programme cost an additional € 3,947/QALY (95% CI: 1,782 to 47,000) for a health care perspective and € 7,878/QALY (3,559 to 93,818) from a societal perspective. The curves showed a 95% probability that the addition of the water-based programme is a cost-effective strategy if the ceiling of inversion is € 14,200/QALY from a health care perspective and € 28,300/QALY from a societal perspective.

Conclusion

The addition of an aquatic exercise programme to the usual care regime for fibromyalgia in women is cost effective in terms of both health care costs and societal costs. However, the characteristics of facilities (distance from the patients' homes and number of patients that can be accommodated per session) are major determinants to consider before investing in such a programme.

Trial registration

Current controlled trials ISRCTN53367487.

Increased sickness absence in diabetic employees: what is the role of co-morbid conditions?

AIMS

Diabetes is thought to be associated with increased risk of sickness absence in working populations. We examined the contribution of co-morbidity to this association.

METHODS

Records of physician-certified sickness absence episodes (> 3 days) over a 1-year period were obtained from employers' records after a survey of chronic diseases and risk factors in 638 diabetic and 32 510 non-diabetic public sector employees in Finland (the Public Sector Study).

RESULTS

Diabetic employees had a 2.15-fold (95% confidence interval 1.92-2.40) age- and sex-adjusted excess risk of sickness absence compared with their colleagues with no chronic disease. In absolute terms, diabetes was related to 59 extra absence episodes per 100 person years. Of this excess risk, 55% was attributable to co-occurring non-cardiovascular diseases, such as depression, prolapsed intervertebral disc and bronchitis. The contribution of cardiovascular complications to the excess sickness absence was small (7%).

CONCLUSIONS

In this occupational cohort, the excess risk of sickness absence in diabetic employees was largely accounted for by non-cardiovascular co-morbidity. Intervening multiple chronic conditions may be important in programmes to reduce sickness absence in diabetic employees.