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Implication of invalidation concept in fibromyalgia diagnosis

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Abstract

Objectives

The invalidation or social pain is an important but neglected issue in polysymptomatology of fibromyalgia (FM). This study sought whether tracing-perceived invalidation could be effective to discriminate between the presence and absence of FM in chronic pain patients with respect to five different sources, including spouses, family, colleagues, health professionals, and social services.

Methods

A total of 207 consecutive chronic pain patients were evaluated for the presence of FM by rheumatologic assessment. Invalidation was measured by the Illness Invalidation Inventory (3*I). Receiver operator characteristic (ROC) analyses were used to evaluate the ability of 3*I dimensions and sources to discriminate having FM among chronic pain patients. Binary logistic regression analyses were performed.

Results

The perceived discounting and lack of understanding from spouse and family sources were higher in FM rather than non-FM patients. ROC analyses demonstrated that invalidation dimensions stemming from spouse and family could appropriately discriminate between the presence and absence of FM. The area under the curve (AUC) for other sources showed non-significant values. Adjusted logistic regression analysis by age, education level, and work status showed that discounting by family and lack of understanding by the spouse could be significant predictors of FM (OR 2.30; 95% CI 1.29–4.11, P = 0.005; OR 1.72; 95% CI 1.08–2.74, P = 0.022, respectively).

Conclusions

This study elucidated the discriminatory power of invalidation in identification of FM from non-FM patients, especially when originated from spouse and family. Our results provide a basis to propose the invalidation as a salient component in the FM dictionary parallel to other famous FM symptoms.

Key Points

• The incorporation of newly highlighted social definition of pain seems warranted in the pain practice.

• Despite proposing invalidation in painful conditions, its diagnostic role in FM remains unexplored.

• Acknowledging of invalidation or social pain in polysymptomatology of FM could shift the paradigm of diagnosis of FM.

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Acknowledgments

The authors thank all the colleagues at the Guilan University of Medical Sciences, Rasht, Iran, who contributed in this research.

Funding

This work was supported by Guilan University of Medical Sciences, Rasht, Iran.

Author information

Authors and Affiliations

  1. Rheumatology Research Center, Razi Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran

    Banafsheh Ghavidel-Parsa, Irandokht Shenavar & Kazem Hosseini

  2. Department of Rheumatology, Iran University of Medical Sciences, Tehran, Iran

    Ali Bidari

  3. Student Research Committee, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran

    Sepehr Tohidi

  4. Road Trauma Research Center, Guilan University of Medical Sciences, Rasht, Iran

    Ehsan Kazemnezhad Leyli

  5. Gastrointestinal and Liver Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran

    Mohammad-Javad Khosousi

Authors
  1. Banafsheh Ghavidel-Parsa
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  2. Ali Bidari
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  3. Sepehr Tohidi
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  4. Irandokht Shenavar
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  5. Ehsan Kazemnezhad Leyli
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  6. Kazem Hosseini
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  7. Mohammad-Javad Khosousi
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Sepehr Tohidi, Irandokht Shenavar masooleh, Ehsan Kazemnezhad Leili, Kazem Hosseini, Mohammad-Javad Khosousi. The first draft of the manuscript was written by Banafsheh Ghavidel-Parsa and Ali Bidari, and all authors commented on the previous versions of the manuscript. The final review and editing were performed by Banafsheh Ghavidel-Parsa and Ali Bidari. All authors read and approved the final manuscript. Mohammad-Javad Khosousi was responsible for the project administration.

Corresponding author

Correspondence to Mohammad-Javad Khosousi.

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Ethics approval

This study was approved by the ethics committee at the Guilan University of Medical Sciences (IR.GUMS.REC.1396.438) according to the principles of the Declaration of Helsinki, and informed consent was obtained from each patient.

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Ghavidel-Parsa, B., Bidari, A., Tohidi, S. et al. Implication of invalidation concept in fibromyalgia diagnosis. Clin Rheumatol 40, 2369–2376 (2021). https://doi.org/10.1007/s10067-020-05515-4

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