Signs, symptoms, and disability related to the musculo-skeletal system : studies of home care personnel and patients with fibromyalgia

Abstract: Low back pain (LBP) and neck/shoulder pain are the major reasons for sickness absence and disability pensions in Sweden. The working situation of home care personnel in Sweden frequently requires heavy lifting and forward bending and workers report high prevalences of work-related musculo-skeletal pain and high frequencies of work accidents, especially lower back injuries. Most back pain patients are treated with non-surgical methods such as physical therapy, which includes manipulation, training of posture and co-ordination, lifting techniques, etc. There is limited scientific evidence with respect to clinical signs used in physical medicine. The clinical relevance of these signs with respect to symptoms and disability is unclear.In Nyköping, Sweden, 607 home care personnel women were examined regarding pain prevalence and intensity in 9 body regions, other common symptoms, and disability. A clinical examination (conducted by 3 physiotherapists) investigated the following conditions: posture and sagittal spinal mobility (using kyphometer); joint laxity (Beighton score); segmental mobility and segmental pain from T10 down to L5-S1; and tender point (TP) palpation on 60 sites including the 18 ACR-criteria spots. In addition, a reliability study of 150 subjects was performed by two of the physiotherapists.The 7-day prevalence of LBP was 48%. The reliability of manually investigated segmental mobility and pain was good, especially in L4-S 1 (kappa ≈o. 7). There was a positive correlation between segmental and total sagittal mobility (kyphometry) indicating criterion validity of the former. Sagittal hypomobility, segmental pain, hyper- and hypomobility, and tender point score correlated positively to pain intensity and many disability parameters. Neck-shoulder pain was more often combined with pain in other body regions and more strongly correlated to tender point score. The prevalence of fibromyalgia (FS) was 2%. There are many causes of FS. Central sensitisation is very likely essential and psychological factors and stress are discussed.The personality profile of 33 female FS patients (FS-group) and 31 female controls (C-group) with local but not widespread pain was investigated, using MMPI and the Defence Mechanism Technique modified (DMTm). We found no sigos of serious personality abermtions in either group. A higher vulnerability for threatening experiences was found in the FS-group. Both symptoms and TP-score correlated positively to disability in both groups. The results of MMPI and DMTm indicate that cognitive coping strategies are suitable for FS patients. Because symptoms and sigos correlated to disability, the overall conclusion was that a multidisciplinary approach is appropriate in future investigations of pain problems.