Researchers have reported that people with fibromyalgia appear to be less able to cope with symptoms of their illness than patients with other rheumatic conditions.

Attendees at an American College of Rheumatology meeting last weekend heard that fibromyalgia patients rated their coping ability significantly lower than people suffering from rheumatoid arthrities and other conditions according to data gathered from questionnaires and visual analog scales.

The presentation was given by Robert S. Katz, M.D., of Rush University Medical Center in Chicago who led a study to determine how patients with different rheumatic conditions cope with their symptoms.

Dr. Katz said: "The intensity of fibromyalgia syndromes can be overwhelming for the fibromylagia patient and their families, and also very challenging for physicians and nurses treating these patients."

In the study, Dr. Katz and his team asked 110 patients with various rheumatic diseases to complete questtionaires made up of 13 questions designed to determine pain-coping ability. Of the 110 study participants, 100 also completed 13 visual analog scales rating how well they handled their symptoms of pain and fatigue.

A visual analog scale, or VAS, is a visual tool used to help people rate the intensity of subjective sensations such as pain. A VAS is usually a straight line with the end at the left representing no pain and the end at the right representing the worst pain imaginable. Patients are asked to mark a point on the line that matches the amount of pain they feel. Such tools are often used in research studies such as this but also in clinical settings to determine the dose of medications required.

Fifty of the study participants had fibromyalgia, 22 had rheumatoid arthritis, 13 had systemic lupus erythematosus, nine had regional musculoskeletal pain, seven had osteoarthritis, and nine had other inflammatory rheumatic diseases.

After statistical analyses of the data the researchers found with a high level of certainty that fibromyalgia patients were less able to cope with their symptoms than patients with any other type of rheumatic disease.

Among the other rheumatic conditions no significant differences among participants' self-rating of their ability to cope were noted.

The information gathered from the visual analog scales provided specific details of how fibromyalgia patients differ from patients with related conditions in their ability to cope. Fibromyalgia patients consistently gave higer ratings on items that included:

• worrying about whether their pain will end
• thinking their pain is never going to get better
• anxiously wanting the pain to go away
• thinking about how much their pain hurts
• thinking about how badly they want the pain to stop
• not being able to stop thinking about their pain
• fearful the pain will get worse
• unable to reduce their pain intensity
• unable to stand their pain

"It is possible that the coping strategy of this group is different," Dr. Katz commented. "Maladaptive coping may predict greater emotional distress."

Dr. Katz and his team said it was important to study coping skills in fibromyalgia patients so that more effective treatment regimes can be developed that are more appropriate to the condition.

At present fibromyalgia patients are typically handed prescriptions for painkilling drugs that are used effectively in other rheumatic conditions. The problem is that many of these drugs are now known to have little effect in fibromyalgia. And although fibromyalgia is classed as a rheumatic condition this classification could be questioned since it is much less well understood and also has much in common with non-rheumatic conditions such as chronic fatigue syndrome (CFS).

Where as rheumatoid arthritis has relatively few symptoms other than pain, fibromyalgia patients have a long list of other troubling symptoms to deal with, such as fatigue, cognitive difficulties, digestive upsets, and mood disorders, and are usually offered no treatment for many of these.

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