Fifty-five consecutive patients who applied to low-pack pain outpatient clinic with degenerative or mechanical CLBP were enrolled to study during July 2006-February 2007. The patients were between the ages of 30-60 and had mechanical type CLBP at least for 3 months. Patients with acute-subacute radiculopathy, pregnancy, infection, malignancy and fracture induced low back pain, inflammatory type of back pain and previous lumbar surgery were excluded from the study.
Clinical assessment was done by two-blinded physicians with a detailed, standardized form. Socio-economic features, demographic data, pain character (onset, duration of symptoms provoking or relieving factors, quality, presence of widespread pain, radiation of pain), concomitant diseases and symptoms (irritable bowel disease, headache, paresthesia, morning stiffness, fatigue, dysuria, Raynaud's syndrome, etc.), physical examination findings, number of tender points were evaluated. The severity of low back pain was measured by 10 cm Visual Analogue Scale (VAS). Nottingham Health Profile (NHP) was used to evaluate patients' perceived emotional, social and physical health status. NHP includes 38 yes/no questions in 6 categories (energy, pain, physical mobility, sleep, emotional reactions and social isolation) and it has Turkish validity and reliability6. The impact on the health status on disability was evaluated by Health Assessment Questionnaire (HAQ). The questionnaire has Turkish reliability and consists of a disability index (20 questions), pain scale (1 question), and global health status (1 question) assessment7. Dressing and self care, raising, eating, walking, hygiene, reach, grip and activities were evaluated. Information about the psychological status was assessed with Beck Depression Inventory (BDI)8.
The patients were diagnosed as FMS by 1990 ACR Fibromyalgia Classification Criteria5. According to this criteria; patients with widespread pain which has been present for at least 3 months and presence of 11 of 18 tender points on digital palpation was accepted as FMS. The widespread pain was considered as pain in the left and right side of the body, pain above and below the waist. Aditionaly, axial skeletal pain (cervical spine or anterior chest or thoracic spine or low back) should be present. Digital palpation was performed with an approximate force of 4 kg. For a tender point to be considered “positive” the subject must state that the palpation was painful. Eighteen tender points were; the suboccipital muscle insertions, the anterior aspects of the intertransverse spaces at C5-C7, the midpoint of the upper border of trapezius muscle, origins of supraspinatus muscle above the scapula spine near the medial border, second rib at the second costochondral junctions, just lateral to the junctions on upper surfaces, lateral epicondyle at 2 cm distal to the epicondyle, gluteal region in upper outer quadrants of buttocks in anterior fold of muscle, greater trochanter, medial fat pad proximal to the knee joint line bilaterally. Two blinded physicians independently provided FMS diagnosis according to history and physical examination. The patients who were diagnosed as FMS commonly by two different physicians were accepted as patients with FMS and CLBP.
The statistical analyses were performed with Statistical Package for the Social Science Program (SPSS Version 12.0). The main characteristics of patients were evaluated by descriptive statistics. Difference between mean values was analyzed by Mann Whitney U, and categorical values were analyzed by chi-square test. P values lower than 0.05 was accepted as statistically significant.
The study protocol was approved by the local ethics committee and all patients gave written consent for participating in the study.
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