PREVALENCE AND TREATMENT OUTCOME OF PRIMARY AND SECONDARY FIBROMYALGIA IN PATIENTS WITH SPINAL PAIN

Study Design. This was a prospective cohort study. Objectives. To dete rmine the prevalence of primary and secondary fibromylagia and respons e to therapy in patients with spinal pain-over a 12-month period. Summ ary of Background Data. Fibromyalgia is a syndrome characterized by ge neralized pain and widespread tenderness On palpation in specific area s of the musculoskeletal system, including the cervical and lumbosacra l spine. Primary fibromyalgia is idiopathic, whereas secondary fibromy algia occurs in association with underlying disorders such as ankylosi ng spondylitis, trauma, or surgery. The frequency of fibromyalgia in p atients with spinal pain has not been determined. Methods. One-hundred -twenty-five consecutive patients referred to a rheumatologist in a sp ine center-for evaluation of back pain over a 4-month period were eval uated for fibromyalgia. Diagnosis at the time of referral and referrin g physician were recorded. Fifteen patients, six with primary fibromya lgia and nine with secondary fibromyalgia, were identified and followe d for 12 months. Standardized therapy was offered to all patients with fibromyalgia. Patients with secondary fibromyalgia also received ther apy for their underlying condition. Results. At 12 months, the six pat ients with primary fibromyalgia had an improvement in symptoms. The tr eatment outcome for the nine patients with secondary fibromyalgia was less successful. Conclusions. Fibromyalgia is a disorder that occurs i n a small proportion of patients with back pain. Fibromyalgia is not f requently recognized by referring physicians. In the authors' limited experience, patients with primary fibromyalgia appear to improve with conservative care, They have been less successful with those diagnosed as having secondary fibromyalgia.