title: Representations of symptom history in women with fibromyalgia vs chronic low back pain: a qualitative study.
abstract: OBJECTIVE
  To compare fibromyalgia (FM) and chronic non-specific low back pain (LBP) patients' narratives about symptom onset. This investigation aimed to better understand how patients with FM relate to their pain problem and the physicians in charge of making the diagnosis.
  
  
  METHODS
  Qualitative study.
  
  
  METHODS
  We included 56 female patients with FM and 29 with LBP. Semi-structured interviews were conducted, eliciting patients' representations of symptom onset. Interviews were tape-recorded and transcribed, and content analysis was performed.
  
  
  RESULTS
  Patients with FM and LBP were comparable for socio-demographic characteristics and pain duration. Content analysis identified five dimensions: psychological issues, somatic concerns, occupational problems, diagnostic issues, and issues related to chronicity. FM patients emphasized psychological issues, as single events and long-lasting distress. Regarding somatic concerns, gynecological events were prominent in FM while LBP patients emphasized accidents, awkward movements, and physical work conditions. Both groups expressed pessimistic views about pain evolution. FM patients reported diagnosis as an area of major uncertainty in an illness perceived as spreading all over the body.
  
  
  CONCLUSIONS
  The narratives of patients with FM expressed high psychological loads and dramatic connotations and emphasized legitimacy issues. In contrast, patients with LBP stressed overload, wear and tear, and treatment inefficacy. The combination of chronicity and lack of specificity may render FM and LBP prone to raise skepticism in the therapists. Investigating and discussing patients' perceptions allows overcoming the apparent uniformity of patients' complaints. It contributes defining realistic and shared treatment goals and help therapists cope with pain chronicity.
authors.affiliation: Divisions of General Medical Rehabilitation, Geneva University Hospitals & University of Geneva, Geneva, Switzerland. christine.cedraschi@hcuge.ch
authors.forename: Christine
authors.initials: C
authors.lastname: Cedraschi
authors.forename: Christophe
authors.initials: C
authors.lastname: Luthy
authors.forename: Elodie
authors.initials: E
authors.lastname: Girard
authors.forename: Valérie
authors.initials: V
authors.lastname: Piguet
authors.forename: Jules
authors.initials: J
authors.lastname: Desmeules
authors.forename: Anne-Françoise
authors.initials: AF
authors.lastname: Allaz
mesh_terms: D000328:Adult; D000368:Aged; D059350:Chronic Pain / Q000175:diagnosis / Q000503:physiopathology* / Q000523:psychology; D004651:Employment / Q000523:psychology; D005260:Female; D005356:Fibromyalgia / Q000175:diagnosis / Q000503:physiopathology* / Q000523:psychology; D006801:Humans; D017116:Low Back Pain / Q000175:diagnosis / Q000503:physiopathology* / Q000523:psychology; D008875:Middle Aged; D036301:Qualitative Research; D013315:Stress, Psychological