Comorbidities and FM


Experts discuss common comorbidities for patients with fibromyalgia (FM).


Wendy Wright, DNP, ANP-BC, FNP-BC, FAANP, FAAN, FNAP: We've already talked a little bit about this, but maybe each of you could just list out a few of overlapping disorders that you often see in people with fibromyalgia. I heard migraine, I heard irritable bowel syndrome, I heard tension type headaches. Other overlapping disorders?

Kostas Botsoglou, MD: Depression.

Benjamin Natelson, MD: We've looked at that and we've seen specifically, on every patient I see I look for FM irritable bowel and something called multiple chemical sensitivity, which is one of these poorly defined. And I also look now for mast cell activation syndrome. And we've published several papers that it's the presence of these comorbid diagnoses and not the psychiatric comorbidity that makes them worse and leads to disability. If you have a patient who you find to have chronic fatigue syndrome, fibromyalgia, irritable bowel syndrome, and chemical sensitivity to smells and odors, that patient is going to be the worst of all of them in your practice.

Wendy Wright, DNP, ANP-BC, FNP-BC, FAANP, FAAN, FNAP: Other conditions overlapping?

Daniel Clauw, MD: We mentioned some of them, but basically, every subspecialty developed a name for someone that came in with pain in our region of the body that we couldn't find an organic basis for. So that's what basically nonbacterial prostatitis and interstitial cystitis, now bladder pain syndrome or the urologic pain syndromes, vulvodynia, pelvis. But anywhere in the body, literally there's sort of a regional pain condition temporal mandibular disorder for the dentist. With that basically, where the person has pain in that region of the body, but there isn't any anatomical cause for the pain. And these are all now being called chronic overlapping pain conditions. And by the way, outside of the US we don't use the ICD [The International Classification of Diseases] criteria nearly as rigidly in the US as outside of the US. All these conditions like fibromyalgia, irritable bowel, low back pain is being called primary pain in the new ICD criteria, and the reason for this is that the pain is the primary problem. It's not secondary to rheumatoid arthritis or lupus or- so the new ICD criteria acknowledge that these nociplastic pain conditions like fibromyalgia, that is the problem. That is called primary pain outside of the US.

Transcript edited for clarity.

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