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Representations of Symptom History in Women with Fibromyalgia vs Chronic Low Back Pain: A Qualitative Study

Authors

  • Christine Cedraschi PhD,

    Corresponding author
    1. Division of Clinical Pharmacology and Toxicology, Multidisciplinary Pain Centre, Geneva University Hospitals & University of Geneva, Geneva, Switzerland
    • Divisions of General Medical Rehabilitation, Geneva University Hospitals & University of Geneva, Geneva, Switzerland
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  • Christophe Luthy MD,

    1. Divisions of General Medical Rehabilitation, Geneva University Hospitals & University of Geneva, Geneva, Switzerland
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  • Elodie Girard MD,

    1. Divisions of Emergency and Liaison Psychiatry, Geneva University Hospitals & University of Geneva, Geneva, Switzerland
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  • Valérie Piguet MD,

    1. Division of Clinical Pharmacology and Toxicology, Multidisciplinary Pain Centre, Geneva University Hospitals & University of Geneva, Geneva, Switzerland
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  • Jules Desmeules MD,

    1. Division of Clinical Pharmacology and Toxicology, Multidisciplinary Pain Centre, Geneva University Hospitals & University of Geneva, Geneva, Switzerland
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  • Anne-Françoise Allaz MD

    1. Divisions of General Medical Rehabilitation, Geneva University Hospitals & University of Geneva, Geneva, Switzerland
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  • Conflicts of interests: None.
  • This study was supported by a grant of the Swiss National Research Foundation (grant SNF-NRP 4053-104645).

Reprint requests to: Christine Cedraschi, PhD, Division of General Medical Rehabilitation (SMIR-BS), Geneva University Hospitals, 26, Avenue Beau-Sejour, 1211 Geneva 14, Switzerland. Tel: 41-22-382-35-40; Fax: 41-22-382-35-65; E-mail: christine.cedraschi@hcuge.ch.

Abstract

Objective.

To compare fibromyalgia (FM) and chronic non-specific low back pain (LBP) patients’ narratives about symptom onset. This investigation aimed to better understand how patients with FM relate to their pain problem and the physicians in charge of making the diagnosis.

Design.

Qualitative study.

Subjects and Methods.

We included 56 female patients with FM and 29 with LBP. Semi-structured interviews were conducted, eliciting patients’ representations of symptom onset. Interviews were tape-recorded and transcribed, and content analysis was performed.

Results.

Patients with FM and LBP were comparable for socio-demographic characteristics and pain duration. Content analysis identified five dimensions: psychological issues, somatic concerns, occupational problems, diagnostic issues, and issues related to chronicity. FM patients emphasized psychological issues, as single events and long-lasting distress. Regarding somatic concerns, gynecological events were prominent in FM while LBP patients emphasized accidents, awkward movements, and physical work conditions. Both groups expressed pessimistic views about pain evolution. FM patients reported diagnosis as an area of major uncertainty in an illness perceived as spreading all over the body.

Conclusions.

The narratives of patients with FM expressed high psychological loads and dramatic connotations and emphasized legitimacy issues. In contrast, patients with LBP stressed overload, wear and tear, and treatment inefficacy. The combination of chronicity and lack of specificity may render FM and LBP prone to raise skepticism in the therapists. Investigating and discussing patients’ perceptions allows overcoming the apparent uniformity of patients’ complaints. It contributes defining realistic and shared treatment goals and help therapists cope with pain chronicity.

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