Department of Family and Community Medicine, University of California San Francisco, San Francisco, California.
Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis, Missouri, USA.
Pain Med. 2019 Nov 1;20(11):2129-2133. doi: 10.1093/pm/pnz084.
Comorbid psychiatric and pain-related conditions are common in patients with fibromyalgia. Most studies in this area have used data from patients in specialty care and may not represent the characteristics of fibromyalgia in primary care patients. We sought to fill gaps in the literature by determining if the association between psychiatric diagnoses, conditions associated with chronic pain, and fibromyalgia differed by gender in a primary care patient population.
Retrospective cohort.
Medical record data obtained from 38,976 patients, ≥18 years of age with a primary care encounter between July 1, 2008, to June 30, 2016.
International Classification of Diseases-9 codes were used to define fibromyalgia, psychiatric diagnoses, and conditions associated with chronic pain. Unadjusted associations between patient demographics, comorbid conditions, and fibromyalgia were computed using binary logistic regression for the entire cohort and separately by gender.
Overall, 4.6% of the sample had a fibromyalgia diagnosis, of whom 76.1% were women. Comorbid conditions were more prevalent among patients with vs without fibromyalgia. Depression and arthritis were more strongly related to fibromyalgia among women (odds ratio [OR] = 2.80, 95% confidence interval [CI] = 2.50-3.13; and OR = 5.19, 95% CI = 4.62-5.84) compared with men (OR = 2.16, 95% CI = 1.71-2.71; and (OR = 3.91, 95% CI = 3.22-4.75). The relationship of fibromyalgia and other diagnoses did not significantly differ by gender.
Except for depression and arthritis, the burden of comorbid conditions in patients with fibromyalgia is similar in women and men treated in primary care. Fibromyalgia comorbidities in primary care are similar to those found in specialty care.
纤维肌痛患者常合并精神疾病和与疼痛相关的疾病。该领域的大多数研究都使用了来自专科治疗患者的数据，可能无法代表初级保健患者的纤维肌痛特征。我们试图通过确定在初级保健患者人群中，精神疾病诊断、与慢性疼痛相关的疾病与纤维肌痛之间的关联是否因性别而异，来填补文献中的空白。
回顾性队列研究。
从 2008 年 7 月 1 日至 2016 年 6 月 30 日期间在初级保健机构就诊的年龄≥18 岁的 38976 名患者的医疗记录数据。
使用国际疾病分类第 9 版代码来定义纤维肌痛、精神疾病诊断和与慢性疼痛相关的疾病。使用二元逻辑回归计算患者人口统计学特征、合并症与纤维肌痛之间的未调整关联，对整个队列以及按性别分别进行计算。
总体而言，样本中有 4.6%的患者被诊断为纤维肌痛，其中 76.1%为女性。与无纤维肌痛的患者相比，合并症更为常见。与男性相比，女性纤维肌痛与抑郁症（比值比[OR] = 2.80，95%置信区间[CI] = 2.50-3.13）和关节炎（OR = 5.19，95%CI = 4.62-5.84）的关系更强（OR = 2.16，95%CI = 1.71-2.71；OR = 3.91，95%CI = 3.22-4.75）。纤维肌痛与其他诊断之间的关系在性别之间没有显著差异。
除了抑郁症和关节炎，在初级保健中治疗的女性和男性纤维肌痛患者的合并症负担相似。初级保健中的纤维肌痛合并症与专科治疗中发现的相似。
