• Christine Cedraschi, Christophe Luthy, Elodie Girard, Valérie Piguet, Jules Desmeules, and Anne-Françoise Allaz.
• Divisions of General Medical Rehabilitation, Geneva University Hospitals & University of Geneva, Geneva, Switzerland. christine.cedraschi@hcuge.ch
• Pain Med. 2012 Dec 1;13(12):1562-70.

ObjectiveTo compare fibromyalgia (FM) and chronic non-specific low back pain (LBP) patients' narratives about symptom onset. This investigation aimed to better understand how patients with FM relate to their pain problem and the physicians in charge of making the diagnosis.DesignQualitative study.Subjects And MethodsWe included 56 female patients with FM and 29 with LBP. Semi-structured interviews were conducted, eliciting patients' representations of symptom onset. Interviews were tape-recorded and transcribed, and content analysis was performed.ResultsPatients with FM and LBP were comparable for socio-demographic characteristics and pain duration. Content analysis identified five dimensions: psychological issues, somatic concerns, occupational problems, diagnostic issues, and issues related to chronicity. FM patients emphasized psychological issues, as single events and long-lasting distress. Regarding somatic concerns, gynecological events were prominent in FM while LBP patients emphasized accidents, awkward movements, and physical work conditions. Both groups expressed pessimistic views about pain evolution. FM patients reported diagnosis as an area of major uncertainty in an illness perceived as spreading all over the body.ConclusionsThe narratives of patients with FM expressed high psychological loads and dramatic connotations and emphasized legitimacy issues. In contrast, patients with LBP stressed overload, wear and tear, and treatment inefficacy. The combination of chronicity and lack of specificity may render FM and LBP prone to raise skepticism in the therapists. Investigating and discussing patients' perceptions allows overcoming the apparent uniformity of patients' complaints. It contributes defining realistic and shared treatment goals and help therapists cope with pain chronicity.Wiley Periodicals, Inc.

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