Background, Comorbidities, and Experiences of Care among Finnish Patients with Fibromyalgia, with a Special Focus on Depression and Hypothyroidism

Research output: Book/ReportDoctoral thesisCollection of Articles

Abstract

Fibromyalgia is a somatic syndrome that is characterized by chronic widespread pain and other somatic symptoms. The majority of patients with a fibromyalgia diagnosis are female. A growing number of studies have shed light on the factors behind this syndrome, but its exact aetiopathogenesis and long-term course of symptoms are still somewhat unclear. However, it has become evident that several external factors such as psychological stress can trigger fibromyalgia.

Previous studies have shown that various adverse life events are linked to chronic widespread pain and might also be linked to the onset of fibromyalgia, but the association has not been confirmed by larger studies. Furthermore, there are only a few studies addressing the long-term effects of childhood peer bullying victimization and none of them focus on fibromyalgia.

There are also several difficulties relating to the diagnostic process of fibromyalgia, and many patients find this time confusing and burdensome. Furthermore, a fibromyalgia diagnosis does not always provide an adequate explanation for the patient’s experiences, and this uncertainty together with repetitive rule-out tests for other diseases might also lead to the overdiagnosis of the subclinical manifestations of these diseases, such as hypothyroidism. However, there is a lack of studies on over- and underdiagnosis relating to fibromyalgia especially from the patient’s point of view.

This thesis consists of two sets of data: the Health and Social Support (HeSSup) postal questionnaire study and the Patients with Fibromyalgia in Finnish Primary Health Care study conducted at Nokia Health Centre. We had four research questions: 1. Is there an association between fibromyalgia and childhood adversities in the general population (HeSSup)? 2. Is there an association between self-reported bullying victimization in childhood and self-reported fibromyalgia in adulthood (HeSSup)? 3. What are the experiences of patients with fibromyalgia during the diagnostic process, and how do patients with fibromyalgia wish their treatment to be improved (Nokia data)? 4. What was the occurrence of thyroid hormone treatment among patients with fibromyalgia, and were care guidelines followed (Nokia data)? Furthermore, we had the unpublished results of the one-year follow-up from the Nokia Health Centre data.

In the HeSSup study, we used answers to postal questionnaires from 1998, 2003, and 2012 to allocate respondents to a group that had self-reported fibromyalgia (n=515) or else to a group not reporting fibromyalgia (n=11,409). We used these data to analyse associations between six childhood adversities and fibromyalgia, as well as associations between peer bullying victimization in childhood and fibromyalgia. In the Patients with Fibromyalgia in Finnish Primary Health Care study initiated in 2015, we identified 208 patients with fibromyalgia from the patient records at Nokia Health Centre (population 33,000). We sent an information letter with five questionnaires to patients, and an appointment with a GP was scheduled for those responding to the questionnaires (n=103). Altogether 96 patients had fibromyalgia and were included in the study after the GP’s appointment. Information on the use of levothyroxine and the patient’s thyroid function was obtained from the patient records. For the qualitative part of the study, four focus groups including 18 patients in total were formed using purposive sampling. The interviews were recorded and an interview guide was followed. The experiences of patients with fibromyalgia were coded according to a thematic analysis process resulting in seven themes.

The main findings of these studies show that all six childhood adversities had a significant association with fibromyalgia. Furthermore, peer bullying victimization was also associated with fibromyalgia, but if depression was added as a covariate, this association was no longer statistically significant. Thus, depression seems to have a role in the development of later-life fibromyalgia, but this is a subject for further studies. In the qualitative study, patients appreciated continuity of care as well as a good patient-doctor relationship. Uncertainty was present on several occasions during the diagnostic process and treatment. We also found that there was a considerable overdiagnosis of subclinical hypothyroidism in our study population, suggesting that patients with fibromyalgia might be prescribed unnecessary levothyroxine. In our follow-up, depressed patients seemed to slightly benefit from treatment for depression.

The findings of adverse childhood experiences and peer bullying are in line with the previous literature. In our qualitative study, a new finding was the contradiction that patients had experienced at several levels in health care and in society. Some patients were even advised to hide their diagnosis from other health care professionals in order to retain their credibility. In our study, levothyroxine use for subclinical hypothyroidism was more common than in some other studies, but on the other hand similar numbers have been suggested in the recent literature. As a result, we suggest that further studies seek to confirm the potential association between fibromyalgia and inappropriate thyroid hormone treatment, which might be an example of a situation in which a patient with a functional syndrome is being overtreated for a subclinical condition. We also suggest further studies on the role of depression in patients with fibromyalgia in the development of symptoms. In addition, the effectiveness of treatment of depression for patients with fibromyalgia is a subject for further studies.
Original languageEnglish
Place of PublicationTampere
ISBN (Electronic)978-952-03-2996-9
Publication statusPublished - 2023
Publication typeG5 Doctoral dissertation (articles)

Publication series

NameTampere University Dissertations - Tampereen yliopiston väitöskirjat
Volume838
ISSN (Print)2489-9860
ISSN (Electronic)2490-0028

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