In the newest Fibromyalgia AWARE edition, Volume 23, Dana Herrera wrote an article entitled “Comparing Apples and… Apples, Creating FM Subgroups.” I was excited to read more about this topic, as I am anxious to see how it will help us create treatment plans in the future.

The article discussed how individuals with fibromyalgia often exhibit different symptoms, at different intensities at different times. Because of our inconsistent symptoms we are left to try one thing after another to manage our fibromyalgia, until we find the shoe that fits. One of my new favorite quotes came from Herrera, “Fibromyalgia patients are a bit like snowflakes. No two are alike.” (From now on I will think of all my fellow “snowflakes” with fibromyalgia every time I see it snow!)

Luckily patients aren’t the only ones who have wanted to understand more about the differences with symptoms in fibromyalgia. Pain researchers are trying to learn more about what lies behind our differences and trying to find patterns. A study published in 2003 split fibromyalgia patients into three subgroups:

1. Extreme tenderness with no psychological/cognitive issues.
2. Moderate tenderness and normal mood.
3. Major mood and cognitive factors that may influence symptom reports.

Thorsten Giesecke, MD and colleges formed these subgroups after studying fibromyalgia symptoms from three angles: psychological, cognitive and severity of tenderness. Other researchers have created subgroups by studying symptom patterns in genetic variations, pain severity, cognitive and psychological factors, physical symptoms, age, gender, medical conditions, socioeconomic factors and triggering events such as trauma and associated medical conditions. At the University of Washington Department of Anesthesiology and Pain Medicine Dennis Tuck, PhD and his colleges created three Fibromyalgia categories using coping mechanisms:

1. Dysfunctional: 35% of patients reported serve pain symptoms, less control over their environment, and less control over their life
2. Adaptive copers: 20% of patients were more physically active, gave up fewer activities, and seemed less stressed
3. Interpersonal: 45% of patients reported severe pain symptoms similar to the dysfunctional group, but felt much less supported by people in their environment, and perceived far more negative comments.

Turk did not find that age, education level, socioeconomic status, gender or onset of symptoms made a difference in how patients perceived their fibromyalgia. Interestingly, they found the same three categories of people coping and adapting with pain in those that have regional cancer, chronic headaches, back pain and facial pain. Even more interesting is the fact that those with fibromyalgia were 20% more likely than other chronic pain groups to be in the interpersonal category.

So what does all this mean to us? It means that in the future, we might not have to keep trying various treatments until we find the best one for us. The hope is that once we have figured out which subgroup we belong to, we will be able to use the therapies that have already been identified to help that group the best. The good news is that research is already being done on which treatments help which subgroups as well!

Fibromyalgia Aware, Volume 23