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Cluster system helps categorize Fibromyalgia severity

Tuesday 18 March 2014


From Medscape:


Doctor and patient

Cluster System Helps Categorize Fibromyalgia Severity

Nancy A. Melville
March 12, 2014

PHOENIX, Arizona — Using a comprehensive symptom panel, researchers have proposed a system of categorizing patients with fibromyalgia into clusters subsets, described in a new study.

"Intuitively, a cluster analysis of fibromyalgia patients makes sense because we see patients who fall into different categories of symptom severity," said lead author Ann Vincent, MD, MBBS, former medical director of the Mayo Fibromyalgia Clinic and an internist in the Division of General Internal Medicine at Mayo Clinic in Rochester, Minnesota.

While noting that additional research with other samples is needed to validate the findings, Dr. Vincent said that an approach such as this may help clinical fibromyalgia care.

"Clinicians currently now tend to have their own ad hoc methods of managing fibromyalgia, but since this is a heterogenous disorder, management may need to be customized to a patient's symptom constellation and severity," she told Medscape Medical News.

"Though most clinicians may use the American College of Rheumatology (ACR) fibromyalgia classification criteria, that really only tells you if patients meet criteria for the illness — then clinicians have to determine where to go with the treatment. That is where this can help."

Their results were presented here at the American Academy of Pain Medicine (AAPM) 30th Annual Meeting.

Outcome Measures

For the study, Dr. Vincent and her colleagues considered core symptom domains recommended by the fibromyalgia working group of the Outcome Measures in Rheumatoid Arthritis Clinical Trials (OMERACT) initiative in analyzing 581 women with a diagnosis of fibromyalgia.

The patients, who had a mean age of 55.1 years, completed the outcome measures recommended by OMERACT, including the Brief Pain Inventory, 30-item Profile of Mood States, Medical Outcomes Sleep Scale, Multidimensional Fatigue Inventory, Multiple Ability Self-Report Questionnaire, Fibromyalgia Impact Questionnaire-Revised, and Medical Outcomes Short Form-36.

Using those responses, the researchers grouped patients into 4 clusters that classified fibromyalgia according to differences in pain severity and symptoms, including the key factors of physical fatigue, sleep problems, function, stiffness, anxiety, and depression.

The system ranges from cluster 1, representing the lowest in severity, to cluster 4, the highest.

Patients with moderate symptoms in clusters 2 and 3 were further categorized into subsets, with patients in cluster 2 having lower levels of depression, anxiety, and dyscognition but higher levels of pain, stiffness, dysfunction, sleep disturbances, and fatigue than those in cluster 3.

Dr. Vincent said future research will determine issues such as cluster stability and the feasibility of the approach in a clinical setting.

Stratifying Severity

Chronic pain specialist Brinder Vij, MD, from the Cleveland Clinic in Ohio, agreed that such a classification system could be beneficial in the care of patients with fibromyalgia.

"What these researchers are trying to do is to stratify the severity of fibromyalgia," he told Medscape Medical News. "I think it's interesting and could be very helpful."

"In my own management of these patients, I tend to use a hypothetical scale in my mind, pulling together while there are other objective tools and pain scales," he noted.

The ability to categorize patients gives clinicians a better idea of what their starting point should be in providing care and what approaches simply may not be worthwhile, he said.

"If patients are moderate, for instance, then an interdisciplinary approach might be beneficial, but if they are not severe enough, you don't want to focus on the components of care that are not suited for the severity of their symptoms."

"The study indeed needs to be checked for validity and reproducibility," he added, "but the value of this kind of clustering can be to tailor the treatment to the patient's needs upfront and that I think that can have benefit."

The study was supported in part by the Center for Translational Science Activities at the Mayo Clinic. The center is funded in part by a grant from the National Center for Research Resources, a component of the National Institutes of Health. The authors and Dr. Vij have disclosed no relevant financial relationships.

American Academy of Pain Medicine (AAPM) 30th Annual Meeting. Abstract 121. Presented March 6, 2014.


The above originally appeared here.


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