Indian Journal of Pain

LETTER TO THE EDITOR
Year
: 2014  |  Volume : 28  |  Issue : 1  |  Page : 51--52

Fibromyalgia and abnormal illness behavior: A catch-22


Geetha Desai, Santosh K Chaturvedi 
 Department of Psychiatry, National Institute of Mental Health and Neuroscience, Bengaluru, Karnataka, India

Correspondence Address:
Geetha Desai
Department of Psychiatry, National Institute of Mental Health and Neuroscience, Bengaluru - 560 029, Karnataka
India




How to cite this article:
Desai G, Chaturvedi SK. Fibromyalgia and abnormal illness behavior: A catch-22.Indian J Pain 2014;28:51-52


How to cite this URL:
Desai G, Chaturvedi SK. Fibromyalgia and abnormal illness behavior: A catch-22. Indian J Pain [serial online] 2014 [cited 2020 Jan 25 ];28:51-52
Available from: http://www.indianjpain.org/text.asp?2014/28/1/51/128901


Full Text

Sir,

Thanks to the editor for publishing such an interesting article on fibromyalgia - an under recognized, undertreated condition, and an often misdiagnosed and missed diagnosis condition! This article by Prasanna [1] highlights the important diagnostic aspects of fibromyalgia and alludes to the etiological aspects of this condition. Fibromyalgia patients are often silent sufferers as the pain they experience is poorly localized and widespread associated with poor sleep and fatigue. When the doctors are unable to find any positive findings on routine investigation they may label it as being psychological (which often may be a comorbid condition rather than the primary diagnosis), malingering and may just not be considered worthy of pain relief and be referred to mental health professionals. The patient often ends up visiting many health professionals and 'doctor shopping' for relief of symptoms. They exhibit features of abnormal illness behavior (AIB). AIB [2] is an important issue in fibromyalgia. Illness behavior is defined as 'the ways in which given symptoms may be differentially perceived, evaluated, and acted (or not acted) upon'; [3] whereas, AIB is a maladaptive ways of perceiving one's health status. [2] Another related concept is the 'sick role' which may be of relevance in fibromyalgia. [4] In fibromyalgia, patients experience pain, fatigue, and poor sleep and consider themselves ill; however, the health professionals may not find any objective evidence of illness and resulting in discrepancy in patient's illness behavior and the health professional's assessment. Thus, it appears that fibromyalgia patients may have AIB or a sick role.

In a study on patients presenting with predominant AIBs with chronic pain or fatigue as presenting complaint were examined for fibromyalgia and nearly 33% of these patients fulfilled criteria for fibromyalgia as per American College of Rheumatology (ACR) criteria. [5] In fact, majority had one or more tender points and 33 patients had more than 10 tender points. The tender points were more common in patients who are diagnosed as somatoform disorder, on left side than on right side and were higher in females. The study emphasized that the features of fibromyalgia need to be looked for in somatizers in order to diagnose and treat them appropriately. [6]

This is a catch-22 situation in pain practice! On one hand, it appears that patients with fibromyalgia perceive symptoms in the absence of any positive laboratory tests, but seek consultations for symptom relief and a diagnostic label for the symptoms. In this way, they fulfill criteria for AIB. [2] On the other hand, patients with fibromyalgia receive a diagnosis after many consultations and may be dubbed as having AIB while they actually are suffering and need treatment for the same!!! Pain practitioners need to be aware about AIB in their patients reporting chronic pain (especially non-organic) or multiple sites of pain, as in fibromyalgia. Studies on AIB in chronic pain patients in Indian settings have been already reported, [7] and the authors are involved in an ongoing study on AIB in chronic pain patients.

References

1Prasanna A. Fibromyalgia-A clinical entity. Indian J Pain 2011:102-4.
2Pilowsky I. Abnormal illness behaviour. Br J Med Psychol 1969;2:347-51.
3Mechanic D. The concept of illness behaviour. J Chronic Dis 1962;15:184-94.
4Parsons T. Social structure and Personality. London: Collier MacMillan; 1964.
5Wolfe F, Smythe HA, Yunus MB, Bennett RM, Bombardier C, Goldenberg DL, et al. The American College of Rheumatology 1990 Criteria for the classification of Fibromyalgia. Report of the multicenter committee. Arthritis Rheum 1990;33:160-72.
6Somshekar BS, Chaturvedi SK, Desai G, Faruq U. Fibromyalgia tender points in chronic pain patients. Indian J Psychiatry 2002;44:68.
7Varma VK, Malhotra AK, Chaturvedi SK. Illness behaviour questionnaire (IBQ): Translation and adaptation in India. Indian J Psychiatry 1986;28:41-6.