Banafsheh Ghavidel-Parsa1, Ali Bidari2, Sepehr Tohidi3, Irandokht Shenavar1, Ehsan Kazemnezhad Leyli4, Kazem Hosseini1, Mohammad-Javad Khosousi5. 1. Rheumatology Research Center, Razi Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran. 2. Department of Rheumatology, Iran University of Medical Sciences, Tehran, Iran. 3. Student Research Committee, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran. 4. Road Trauma Research Center, Guilan University of Medical Sciences, Rasht, Iran. 5. Gastrointestinal and Liver Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran. mj.khosousi@gmail.com.
Abstract
OBJECTIVES: The invalidation or social pain is an important but neglected issue in polysymptomatology of fibromyalgia (FM). This study sought whether tracing-perceived invalidation could be effective to discriminate between the presence and absence of FM in chronic pain patients with respect to five different sources, including spouses, family, colleagues, health professionals, and social services. METHODS: A total of 207 consecutive chronic pain patients were evaluated for the presence of FM by rheumatologic assessment. Invalidation was measured by the Illness Invalidation Inventory (3*I). Receiver operator characteristic (ROC) analyses were used to evaluate the ability of 3*I dimensions and sources to discriminate having FM among chronic pain patients. Binary logistic regression analyses were performed. RESULTS: The perceived discounting and lack of understanding from spouse and family sources were higher in FM rather than non-FM patients. ROC analyses demonstrated that invalidation dimensions stemming from spouse and family could appropriately discriminate between the presence and absence of FM. The area under the curve (AUC) for other sources showed non-significant values. Adjusted logistic regression analysis by age, education level, and work status showed that discounting by family and lack of understanding by the spouse could be significant predictors of FM (OR 2.30; 95% CI 1.29-4.11, P = 0.005; OR 1.72; 95% CI 1.08-2.74, P = 0.022, respectively). CONCLUSIONS: This study elucidated the discriminatory power of invalidation in identification of FM from non-FM patients, especially when originated from spouse and family. Our results provide a basis to propose the invalidation as a salient component in the FM dictionary parallel to other famous FM symptoms. Key Points • The incorporation of newly highlighted social definition of pain seems warranted in the pain practice. • Despite proposing invalidation in painful conditions, its diagnostic role in FM remains unexplored. • Acknowledging of invalidation or social pain in polysymptomatology of FM could shift the paradigm of diagnosis of FM.
OBJECTIVES: The invalidation or social pain is an important but neglected issue in polysymptomatology of fibromyalgia (FM). This study sought whether tracing-perceived invalidation could be effective to discriminate between the presence and absence of FM in chronic painpatients with respect to five different sources, including spouses, family, colleagues, health professionals, and social services. METHODS: A total of 207 consecutive chronic painpatients were evaluated for the presence of FM by rheumatologic assessment. Invalidation was measured by the Illness Invalidation Inventory (3*I). Receiver operator characteristic (ROC) analyses were used to evaluate the ability of 3*I dimensions and sources to discriminate having FM among chronic painpatients. Binary logistic regression analyses were performed. RESULTS: The perceived discounting and lack of understanding from spouse and family sources were higher in FM rather than non-FMpatients. ROC analyses demonstrated that invalidation dimensions stemming from spouse and family could appropriately discriminate between the presence and absence of FM. The area under the curve (AUC) for other sources showed non-significant values. Adjusted logistic regression analysis by age, education level, and work status showed that discounting by family and lack of understanding by the spouse could be significant predictors of FM (OR 2.30; 95% CI 1.29-4.11, P = 0.005; OR 1.72; 95% CI 1.08-2.74, P = 0.022, respectively). CONCLUSIONS: This study elucidated the discriminatory power of invalidation in identification of FM from non-FMpatients, especially when originated from spouse and family. Our results provide a basis to propose the invalidation as a salient component in the FM dictionary parallel to other famous FM symptoms. Key Points • The incorporation of newly highlighted social definition of pain seems warranted in the pain practice. • Despite proposing invalidation in painful conditions, its diagnostic role in FM remains unexplored. • Acknowledging of invalidation or social pain in polysymptomatology of FM could shift the paradigm of diagnosis of FM.
Entities:
Keywords:
Chronic pain syndromes; Diagnosis; Fibromyalgia; Invalidation; Pain; Social pain
Authors: M B Kool; H van Middendorp; M A Lumley; Y Schenk; J W G Jacobs; J W J Bijlsma; R Geenen Journal: Ann Rheum Dis Date: 2010-05-24 Impact factor: 19.103
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