Common and Contrasting Characteristics of the Chronic Soft-Tissue Pain Conditions Fibromyalgia and Lipedema

Figures & data

Table 1 Socio-Demographic and Disease-Relevant Data (n=189)

Characteristic	Fibromyalgia (n=77)	Lipedema (n=112)	p
Proportion of sample (%)	40.7	59.3	–
Inpatients (%)	100.0	36.6	<0.001
Living situation (%)			0.336
Alone	20.8	28.4
With spouse/partner	63.6	61.5
With other persons	15.6	10.1
Education (%)			0.513
Basic school (8–9 years)	18.2	11.8
Vocational training	57.1	56.4
College/high/technical school	11.7	17.3
University	13.0	14.5
Smoking (%)	29.9	11.3	0.002
Sports (hours/week; %)			<0.001
0	48.1	19.8
1–2	37.7	43.4
>2	14.3	36.8
Comorbidities (number; %)			0.013
None	3.9	9.1
1	7.8	17.3
2	10.4	21.8
3	23.4	24.5
4	22.1	11.8
≥5	32.4	15.5
Working place (hours/week; %)			<0.001
0	44.1	12.9
1–21	14.7	17.8
22–41	25.0	37.6
≥42	16.2	31.7
Household (hours/week; %)			0.078
0	3.9	0.0
1–21	80.5	75.5
22–41	14.3	19.6
≥42	1.3	4.9
BMI (kg/m^2): Mean (s)	27.4 (5.7)	33.7 (7.5)	<0.001
Range	18.8–42.1	20.0–49.9
Age (years): Mean (s)	49.3 (9.5)	45.4 (13.1)	0.026
Range	19.1–65.3	19.5–77.5

Abbreviations: BMI, body mass index; s, standard deviation; p, type I error (2-tailed, Chi-square or t-test for independent samples).

Table 2 Score Data of Fibromyalgia (n=77) and Lipedema (n=112)

		Fibromyalgia				p	Lipedema				p	Difference
		Score	Norm	SMD			Score	Norm	SMD			SMD		p
SF-36 (0–100=best)
Physical functioning	m	44.9	78.5	–1.85		<0.001	68.1	81.1	–0.74		<0.001	–1.08		<0.001
	s	19.7	16.3	–2.22	–1.47		22.5	22.8	–1.01	–0.47		–1.39	–0.77
Role physical	m	29.7	71.5	–2.29		<0.001	61.7	74.5	–0.64		<0.001	–1.34		<0.001
	s	19.1	17.2	–2.69	–1.89		26.4	23.4	–0.91	–0.37		–1.66	–1.02
Bodily pain	m	19.4	52.5	–2.20		<0.001	43.4	56.6	–0.73		<0.001	–1.18		<0.001
	s	13.7	16.2	–2.60	–1.81		23.8	20.7	–1.00	–0.46		–1.49	–0.86
General health	m	35.4	59.9	–1.79		<0.001	53.8	62.7	–0.63		<0.001	–1.08		<0.001
	s	14.7	12.5	–2.16	–1.42		18.6	16.5	–0.89	–0.36		–1.38	–0.77
Vitality	m	25.8	53.0	–2.28		<0.001	43.3	54.1	–0.76		<0.001	–0.96		<0.001
	s	16.0	5.2	–2.68	–1.88		19.6	7.4	–1.03	–0.49		–1.26	–0.65
Social functioning	m	38.0	80.1	–2.35		<0.001	65.5	81.3	–0.82		<0.001	–1.05		<0.001
	s	24.7	5.1	–2.76	–1.94		26.9	7.8	–1.09	–0.55		–1.36	–0.74
Role emotional	m	40.2	81.3	–1.90		<0.001	68.6	83.1	–0.72		<0.001	–1.00		<0.001
	s	29.2	8.4	–2.28	–1.52		27.8	11.3	–0.99	–0.45		–1.30	–0.69
Mental health	m	40.1	65.8	–1.79		<0.001	61.1	67.1	–0.44		0.001	–1.09		<0.001
	s	19.6	5.3	–2.16	–1.42		19.0	6.4	–0.71	–0.18		–1.40	–0.78
PCS	m	32.9	44.3	–1.60		<0.001	41.9	45.7	–0.53		<0.001	–1.10		<0.001
	s	6.5	7.5	–1.96	–1.24		9.1	10.1	–0.79	–0.26		–1.41	–0.79
MCS	m	30.3	48.2	–2.14		<0.001	42.2	48.5	–0.73		<0.001	–0.99		<0.001
	s	11.6	2.2	–2.53	–1.74		12.2	2.5	–1.00	–0.46		–1.30	–0.69
6MWD (meters)	m	425	-	-			437	-	-			–0.09		0.640
	s	133					128					–0.48	0.30
FSQ (0–31=worst)	m	22.0	-	-			16.9	-	-			–1.09		0.001
	s	4.8					2.7					–0.42	–1.77

Abbreviations: Difference, SMD between fibromyalgia and lipedema; SF-36, Short Form 36 (0=worst, 100=best); PCS, physical component summary; MCS, mental component summary; 6MWD, 6 minute walking distance (in meters; available for all fibromyalgia, ie n=77, and n=38 inpatient lipedema subjects); FSQ, Fibromyalgia Survey Questionnaire (0=best, 31=worst; available for all fibromyalgia, ie n=77, and n=10 lipedema subjects); m, arithmetic mean; s, standard deviation (for the scores and norms) or the 95 confidence interval (for the SMDs); SMD, standardized mean difference (a negative value reflects that the score is worse than the norm or fibromyalgia has worse health than lipedema); p, type I error of the test between the scores and the norms or that the SMD≠0 (2-tailed, independent samples), respectively.

Table 3 Summary of Characteristics of Fibromyalgia and Lipedema

Characteristic		Fibromyalgia	Lipedema	Reference
Women	Reference empiric	++ to +++ 92%	+++ 100%	Shavit 2018^Citation3 Skaer 2017^Citation31 Häuser 2015^Citation28
Onset: Puberty to menopause	Reference	All ages, mainly midlife	Puberty to menopause	Skaer 2017^Citation31 Häuser 2018^Citation38
Association to pos. family history  1^st degree relatives:	Reference	++ OR=8.0	++ 16–64%	Shavit 2018^Citation3 Bauer AT 2019^Citation30 Okhovat 2015^Citation29 Häuser 2015^Citation28
Pain level	Reference empiric	+++ NRS=8.1	++ NRS=5.7	Salaffi 2019^Citation33 Skaer 2017^Citation31
Localization of pain:  Musculature, tendo-periostal  Back  Subcutaneous fat tissue  Generalized widespread	Reference	+++ +++ (+) +++	(+) (+) +++ +	Salaffi 2019^Citation33 Skaer 2017^Citation31 Häuser 2015^Citation28
Allodynia	Reference	+++	+++	Shavit 2018^Citation3 Skaer 2017^Citation31
Hyperalgesia/spontaneous pain	Reference	+++	++	Shavit 2018^Citation3 Skaer 2017^Citation31
Edema	Reference	-	+	Shavit 2018^Citation3
Capillary fragility/hematoma	Reference	-	++	Shavit 2018^Citation3
Comorbidities	Reference empiric	+++ median: n=4	++ n=2	Fitzcharles 2018^Citation32 Skaer 2017^Citation31
Obesity	Reference empiric	++ 33%	+++ 88%	Gensior 2019 Gota 2015^Citation6
Ancillary symptoms:  Fatigue  Nonrestorative sleep  Cognitive dysfunction  Headaches  Depression	Reference	+++	++	Häuser 2015^Citation28 Skaer 2017^Citation31 Wolfe 2016^Citation11
Depression	Reference empiric	++ NRS=6.0	+ NRS=3.9	Fitzcharles 2018^Citation32 Salaffi 2019^Citation33
Physical Dysfunction	Reference empiric	++ NRS=5.5	+ NRS=3.2	Salaffi 2019^Citation33
Role physical	Reference empiric	+++ NRS=7.0	+ NRS=3.8	Salaffi 2019^Citation33
Pain-depression association cross-sectional	Reference empiric	+ r=0.362	+ (to ++) r=0.396	Angst 2020^Citation34
Pain-depression association longitudinal	Reference empiric	++ r=0.467	++ r=0.452	Angst 2020^Citation34
Fibromyalgia diagnosis (ACR 2016)	Empiric	100%	34%	Wolfe 2016^Citation11

Notes: Level/frequency: +++=high, ++=moderate, +=low, -=no/absent. Severity levels are given as Numeric Rating Scale (NRS) from 0=no pain/depression/disability to 10=maximal pain/depression/disability, calculated by the SF-36 scores (by 10-SF-36 score/10, see Table 2). Reference=results out of reviewed literature. Empiric=results from our study (see Tables 1 and 2).

Abbreviations: OR, Odds Ratio; r, Pearson correlation coefficient; ACR, American College of Rheumatology.

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