Fibromyalgia: An Environmental Scan
Table of Contents
5.2 Research Notes
Considering the ‘state of affairs’ of chronic pain, there are selected items of importance when engaging in activities within this domain: 1) Funding Allocation for Pain Research, 2) Need for Multidisciplinary Approaches to Research, 3) Impact of Diagnostic Methods, 4) Influence of Cultural Diversity, and 5) Consequences of Pain Definitions and Reporting.
Despite the overwhelming numbers of individuals who suffer from chronic pain along with the tremendous costs to healthcare, little research money is dedicated to making advances in the area of chronic pain. “[P]ain accounts for more than 20% of medical visits and 10% of prescription drug sales, but only .6% of National Institutes of Health research funds.” (Max 2003). Furthermore, the majority of pain research is conducted by relatively few clinical specialties and most often involves neurology, anesthesiology, cancer and dentistry. It is imperative that research expand to include more multidisciplinary teams such as cardiology, gastroenterology and urology in order to have an improved and broader focus of chronic pain and establish better collaboration in both research and treatment (Max 2003). In 2003, Bradshaw and colleges published a study in the Journal of Pain investigating funding patters of the NIH awards for 3 different areas, one being pain and demonstrated the need for resources in pain research. There is much to do in the progress of understanding the etiology of chronic pain, establishing specific diagnostic tools and developing effective treatments to reduce both the individual and social burden of disease caused by chronic pain disorders.
Another area to be cognitive of is diagnoses of chronic pain and specifically fibromyalgia. It is important to know that the present diagnostic criteria of the ACR method of diagnosing fibromyalgia influence the number and severity of fibromyalgia cases that are diagnosed. Originally, the ACR criterion for fibromyalgia was a classification system versus a diagnostic tool and focuses largely on pain compared to other aspects of the syndrome. A broader definition of fibromyalgia is necessary. It is feasible that the ACR approach identifies those individuals with more severe or pronounced fibromyalgia rather than an overall accurate diagnosis (Perrot et al. 2008). The diagnostic situation significantly impacts epidemiological estimates of the incidence and prevalence of fibromyalgia along with influencing what we know about risk factors, age at onset and other specific areas of inquiry. Given the importance of early and accurate diagnoses in not only fibromyalgia but all chronic pain disorders, paying particular attention to this area will aid in our ability to treat individuals suffering with chronic pain earlier with the goal of reducing morbidity.
The influence of culturally diverse characteristics is important as pain also has particular culturally relevant associations and to fully understand chronic pain from a holistic perspective more attention to the unique and heterogeneous characteristics of pain among various culturally diverse groups will lead to a better understanding of diagnosing, treating and managing not only fibromyalgia but all chronic pain disorders.
Future research must consider that the measurement of pain is challenging due to the subjective nature of reporting and interpreting pain. Attention to the numerous definitions of pain used among studies is important when comparing results across different research. Frequently a number of studies across a specific area are compared without really being aware of how different or even dissimilar the definitions of pain were constructed, measured and interpreted. Beginning the discourse around standardizing the operational definitions of pain would produce more methodologically sound research, making comparisons among studies more relevant and aid researchers and clinicians in clinical management decisions along with ultimately developing best practice guidelines.