Prevalence and treatment outcome of primary and secondary fibromyalgia in patients with spinal pain.

STUDY DESIGN

This was a prospective cohort study.

OBJECTIVES

To determine the prevalence of primary and secondary fibromylagia and response to therapy in patients with spinal pain over a 12-month period.

SUMMARY OF BACKGROUND DATA

Fibromyalgia is a syndrome characterized by generalized pain and widespread tenderness on palpation in specific areas of the musculoskeletal system, including the cervical and lumbosacral spine. Primary fibromyalgia is idiopathic, whereas secondary fibromyalgia occurs in association with underlying disorders such as ankylosing spondylitis, trauma, or surgery. The frequency of fibromyalgia in patients with spinal pain has not been determined.

METHODS

One-hundred-twenty-five consecutive patients referred to a rheumatologist in a spine center for evaluation of back pain over a 4-month period were evaluated for fibromyalgia. Diagnosis at the time of referral and referring physician were recorded. Fifteen patients, six with primary fibromyalgia and nine with secondary fibromyalgia, were identified and followed for 12 months. Standardized therapy was offered to all patients with fibromyalgia. Patients with secondary fibromyalgia also received therapy for their underlying condition.

RESULTS

At 12 months, the six patients with primary fibromyalgia had an improvement in symptoms. The treatment outcome for the nine patients with secondary fibromyalgia was less successful.

CONCLUSIONS

Fibromyalgia is a disorder that occurs in a small proportion of patients with back pain. Fibromyalgia is not frequently 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.