Emotional, Physical, and Sexual Abuse in Fibromyalgia Syndrome: A Systematic Review With Meta-Analysis

Objective. To systematically assess the potential association of fibromyalgia syndrome (FMS) with emotional, physical, and sexual abuse. Methods. The databases EMBase, Google Scholar, Medline, and PsycINFO (through April 2010) and the reference sections of original studies were searched for eligible studies. Eligible studies were cohort or case control studies that assessed at least one type of emotional, physical, or sexual abuse in childhood or adulthood in patients with FMS and in controls. Two authors independently extracted descriptive, quality, and outcome data from included studies. Methodologic quality was assessed by the Newcastle-Ottawa Quality Assessment Scale. Odds ratios (ORs) and 95% confidence intervals (95% CIs) were pooled across studies by using the random-effects model. Heterogeneity was assessed by I-2 statistics. Results. The search identified 18 eligible case-control studies with 13,095 subjects. There were significant associations between FMS and self-reported physical abuse in childhood (OR 2.49 [95% CI 1.81-3.42], I-2 = 0%; 9 studies) and adulthood (OR 3.07 [95% CI 1.01-9.39], I-2 = 79%; 3 studies), and sexual abuse in childhood (OR 1.94 [95% CI 1.36-2.75], I-2 = 20%; 10 studies) and adulthood (OR 2.24 [95% CI 1.07-4.70], I-2 = 64%; 4 studies). Study quality was mostly poor. Low study quality was associated with higher effect sizes for sexual abuse in childhood, but not with other effect sizes. Conclusion. The association of FMS with physical and sexual abuse could be confirmed, but is confounded by study quality.