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The Journal of Pain • Volume 11, No. 12, December 2010

Relationship Between Fibromyalgia and Obesity in Pain, Function, Mood, and Sleep

Akiko Okifuji, Gary W. Donaldson, Lynn Barck, Perry G. Fine; University of Utah

Afflicting up to 5% of the U.S. population, mostly women, fibromyalgia is characterized by widespread pain and a range of function problems. A new study in The Journal of Pain reports there is a close association between obesity and disability in fibromyalgia patients.

The purpose of the study, conducted by University of Utah researchers, was to evaluate the relationship between fibromyalgia and obesity. They hypothesized that obesity significantly adds to the disease and disability burden of the condition. Two hundred fifteen fibromyalgia patients were evaluated in the study and given several physical tests to measure strength, flexibility, range of motion, and strength. Heart rates and sleep quality also were assessed.

The authors reported that consistent with previous studies, obesity is common among those with fibromyalgia. Half the study sample was obese, and an additional 30% were overweight. Also consistent with previous findings, obese patients in this study showed increased pain sensitivity, which was more pronounced in lower body areas. The obese patients also had impaired flexibility in the lower body and reduced strength.

The study concluded that obesity is a common comorbidity of fibromyalgia that may compromise clinical outcomes. The adverse impact of obesity is evidenced by hyperalgesia, disability, impaired quality of life, and sleep problems. The authors also noted that recent evidence suggests weight loss improves fibromyalgia symptoms, perhaps resulting from patients adopting healthier lifestyles and taking more positive attitudes toward symptom management and overall quality of life.

How Do Parents of Preverbal Children with Acute Otitis Media Determine How Much Ear Pain Their Child Is Having?

Nader Shaikh, Diana H. Kearney, D. Kathleen Colborn, Tracy Balentine, Wentao Feng, Yan Lin, Alejandro Hoberman; University of Pittsburgh School of Medicine

Levels of pain severity from ear aches observed and reported by parents of preverbal children can be influenced as much by socioeconomic status and other nonclinical factors as symptoms unless physicians ask about specific observable symptoms, according to research in The Journal of Pain.

Researchers at the University of Pittsburgh studied 69 parents of preverbal children to determine the information parents use to gauge the severity of ear pain, also known as otalgia. Since ear pain is the most useful symptom for diagnosing acute otitis media infections, physicians rely on parental assessment of pain when deciding to prescribe antibiotics. The subjects were asked to comment on hypothetical cases in which various symptoms were present. Several observable symptoms of ear arches were chosen, including fussiness, ear tugging, eating less, fever, sleeping difficulty, and playing less. Specifically, the parents were asked, “We are trying to find out how parents can tell when their child is in pain. Below are eight descriptions of what a 1-year-old with an ear infection might have. If you were the parent of this child, how would you rate the pain level?”

Although no symptom dominated the parental assessments, ear tugging and fussiness most frequently influenced parental pain perceptions. But the researchers reported that overall pain levels described by parents may depend not only on observed symptoms but other child and parental factors. Most notably, maternal education and insurance status, which indicate higher socioeconomic status, appear to influence pain assessments. Because pain ultimately is a subjective determination, the authors concluded it is likely to be influenced by biological, psychological, and social factors. In the study, observable behaviors accounted for only 50% of the pain levels.

To guide physicians in diagnosing ear infections, the study suggests that asking parents to report individual symptoms and pain behavior (rather than describing overall pain levels) is less subject to bias and variability from nonclinical factors. Therefore, asking about observable behaviors, such as ear tugging and fussiness, should follow a general question about ear pain and give physicians better insights on specific symptoms from which to base possible treatments.

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