Pain Coping Strategies and Quality of Life in Women with Fibromyalgia:
Does Age Make a Difference?

Journal of Musculoskeletal Pain, Vol. 9(2) 2001, pp. 5-18

Carol S. Burckhardt, PhD, RN; Sharon R. Clark, PhD., RN and
Robert M. Bennett, MD, FRCP

Carol S. Burckhardt. PhD, RN, is Professor of Nursing and
Assistant Professor of Medicine [Research], Sharon R. Clark, PhD, RN, is
Associate Professor of Nursing and Assistant Professor of Medicine
[Research], and Robert M. Bennett, MD, FRCP, is Professor of Medicine,
all in the Division of Arthritis and Rheumatic Diseases, Department of
Medicine, School of Medicine, Oregon Health Sciences University,
Portland. Oregon.

Address correspondence to: Carol S. Burckhardt, PhD. PMHNP. School of
Nursing, SN-5N, Oregon Health Sciences University, 3181 SW Sam Jackson
Park Road, Portland. OR 97201 [E--mail: mailto:burckhac@ohsu.edu ].

Submitted: June 29, 2000
Accepted without revisions: September 19, 2000

ABSTRACT.
Objectives: To characterize and compare the demographics, symptom
profiles, pain coping strategies, and quality of life in three age groups
of women with fibromyalgia [FMS]
.
Methods: Self-report questionnaires. including the Fibromyalgia Impact
Questionnaire [FIQ], Beck Depression Inventory, Coping Strategies
Questionnaire, and Quality of Life Scale, were filled out by 343
consecutive women who were participating in FMS treatment programs.
Patients were divided into three age groups for purposes of data
analysis.

Results: The youngest age group had their symptoms for a significantly
shorter period of time than the middle age and older age groups. Tender
point pain score, the FIQ physical functioning and well-being items, and
perceived ability to decrease pain were significantly worse for the
youngest age group when compared to the other two groups. The youngest
group had significantly higher catastrophizing scores and lower quality
of life than the oldest age group. Discriminant function analysis between
the youngest and oldest groups revealed that a combination of six
variables: length of symptoms, quality of life, tender point pain score,
morning tiredness, behavioral activity strategies, and a pain
control/rational thinking factor were 84% accurate in classifying these
patients into their original groups. When length of symptoms was
excluded, the remaining five variables were 79%, accurate in classifying
the patients.

Conclusions: Young women with FMS perceive the severity of FMS to be
higher and respond with more distress than older women with FMS. This
finding is largely independent of symptom length.

KEYWORDS. Fibromyalgia, women, fibromyalgia impact questionnaire, coping
strategies questionnaire, quality of life scale

Introduction:
Coping with chronic illness is a life-long task that cuts across
developmental stages. For women with fibromyalgia [FMS], these stages may
range from childhood to old age. Fibromyalgia is known to affect children
and adolescents as well as adults (1,2); however, the average age at
onset is about 45-48 years (3). Thus, much of the research to date has
focused on women in midlife. Nevertheless, many women in their 20's and
30's are diagnosed with FMS at the same time that they are taking on the
roles and responsibilities of work, marriage, and parenthood.

Most younger as well as middle-aged women with FMS worry that their
symptoms will become worse as they grow older. The general belief among
many clinicians is that symptom severity is enduring and less amenable to
treatment the longer symptoms have been present. To date, this belief has
not been subjected to scientific scrutiny in FMS clinical groups.
Although symptoms tend to remain persistent for many patients with FMS
(4-6), two studies have found that a majority of women with FMS rate
their symptoms as decreased in intensity from when they were first
diagnosed (7,8). Another report, which compared elderly women with FMS to
younger FMS patients, found that symptoms of anxiety as well as symptom
aggravation by weather, mental stress, and poor sleep were significantly
less common among the elderly women (9). Additionally, a 4.5 year
follow-up study of FMS patients given a 14 week course of treatment found
that increasing age predicted lower levels of pain and lack of energy
(10). Whether these findings represent changes in the symptoms
themselves, changes in coping with symptoms, adaptation to life
circumstances, or simply faulty memory is largely unknown. In any case,
one thing is clear, longitudinal studies to date have failed to confirm
any pattern of worsening with age.

The possibility exists that FMS may be at its highest intensity in the
early years after diagnosis. Getting through the period of uncertainty,
learning about the illness and its treatment, coming to terms with having
a chronic problem, and establishing new patterns of living are stressful
tasks to accomplish at any time in life (I I-13). When these tasks are
coupled with the heavily task-oriented work of young adulthood, one might
expect that symptom severity and distress would be unusually high and
that satisfaction with one's quality of life might be lower (14). If this
is the case, more attention should be paid to developing strategies that
assist young women with FMS to better cope with symptoms and decrease
them to manageable levels so that they can concentrate more fully on the
developmental tasks of young adulthood.

Earlier we reported the use of coping strategies by a group of women who
entered and a subsample that completed an FMS treatment program. The use
of positive coping strategies was found to be associated with positive
outcomes. Depression and negative beliefs, such as catastrophizing, were
significantly related to more symptoms and decreased quality of life
(15). In this paper we extend the work to a larger cohort of patients
from two sites. Specifically, we report the results of analyses designed
to answer the question of whether a set of demographic and role
variables, FMS symptoms, depression, perceived control, coping
strategies, and quality of life assessment could distinguish younger from
older patients with FMS.


© 2001 by The Haworth Press, Inc. All rights reserved.