THU0351

NEGATIVE LIFE EVENTS BEFORE THE DISEASE ONSET AND DISEASE OUTCOME IN LONG TERM FOLLOW UP OF PAIN, SLEEP, FATIGUE AND GENERAL WELL-BEING

M. L. Kukkurainen ^1,*M. Sallinen ²M. Mikkelsson ³U. M. Anderberg ⁴H. Kautiainen ⁵

¹The Finnish Society of Rheumatology Nurses, Heinola, ²Satakunta University of Applied Sciences, Pori, ³Päijät-Häme Central Hospital, Lahti, Finland, ⁴Department of Public Health and Caring Sciences/Social Medicine and Department of Neurosciences/Psychiatry , Uppsala University, Uppsala, Sweden, ⁵MedCare Foundation, Äänekoski, Finland

Background: There is some evidence that the effects of stressful events experienced in childhood, adolescence and adulthood before the disease onset run a high risk of chronic pain. Several unresolved stressors, the combination of childhood abuse and current post-traumatic stress disorder substantially increase the risk of later pain. Negative life events predict weak outcomes in long term follow-up. Chronic pain as such is stressful and may increase the incidence of negative life events.

Objectives: The objective of this study is to describe the long term outcomes of pain, quality of sleep, fatigue and general well-being status in juxtaposition to the experienced stressfulness of certain negative events which occurred in the lives of the subjects before the onset of fibromyalgia.

Methods: The data were gathered by postal inquiry from 93 women with fibromyalgia. The mean age was 54 (SD 8), and the mean number of years after the diagnosis was 11 (SD 3). Pain, quality of sleep, fatigue and general well-being status were measured on a Visual Analogue Scale (VAS) of 100 mm. Questions about negative events 1-3 years before the disease onset were presented in eight areas: conflict with partner, conflict with child, close relative or friend, support for close relative or friend, physical or psychological abuse, sexual assault, disease or accident of close relative, death of close relative or friend, and financial problems. The experience of the stressfulness of the event was measured on the scale 0-3 (no event 0, event with no significantly negative effects 1, event with quite significantly negative effects 2, and event with very negative effects 3) . The total scores ranged 0-27. Cronbach's alpha of the life event measure was 0.72 (95% CI: 0.61 to 0.82). The statistical significance for the hypotheses of linearity was evaluated with generalized linear models with appropriate distribution and link functions.

Results: The mean sum total score of the life events was 6.2 (range 0-20). The most stressful events were financial problems (mean 1.01, SD 1.14), conflict with partner (mean 0.92, SD 1.02), and conflict with child, close relative or friend (mean 0.86, SD 1.00). The tertiles of negative life experiences differed significantly (p for linearity) in quality of sleep, fatigue and general well-being. At 11 years after the diagnosis, the VAS scores of sleep, fatigue and general well-being were the highest in the group in which the scores of experienced stressful life events were the highest. (Table 1.)

Table 1. Pain, quality of sleep, fatigue and general well-being in tertiles of negative live events

* P for linearity; adjusted for age and duration of diagnosis. 

Conclusions: Fibromyalgia patients' economic situations and conflicts with partners have been identified as their key negative experiences. Life situations and resources must be assessed early in the diagnostic process in order to help them cope and solve their problems, thereby minimizing the effects of such problems on the symptoms in the long term.

Disclosure of Interest: None Declared