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Abstract：
Fibromyalgia is a chronic condition characterised by widespread musculoskeletal pain. Although accumulating evidence suggests that exposure to stressful events increases the risk for this complex disorder, this is the first meta-analysis to compare the impact of a full range of lifetime stressors (e.g. physical trauma through to emotional neglect) on adult fibromyalgia.
This review was performed in accordance with PRISMA guidelines. Random-effects models examined associations between different stressor exposures and fibromyalgia status with meta-regression investigating the effects of publication year and study quality on effect sizes.
Nineteen studies were included in the meta-analysis. Significant associations with fibromyalgia status were observed for all six exposure types examined: odds ratios (OR) were highest for physical abuse (OR 3.23, 95% confidence interval 1.99-5.23) and total abuse (3.06, 1.71-5.46); intermediate for sexual abuse (2.65, 1.85-3.79) and smaller for medical trauma (1.80, 1.19-2.71), other lifetime stressors (1.70, 1.31-2.20), and emotional abuse (1.52, 1.27-1.81). Results were not significantly changed when childhood, as opposed to adult, exposures were used in studies that reported both. Meta-regression analyses demonstrated no effect of publication year or study quality on effect sizes.
This study confirmed a significant association between stressor exposure and adult fibromyalgia with the strongest associations observed for physical abuse. Limitations related to current available literature were identified; we provide several suggestions for how these can be addressed in future studies. Stressors are likely to be one of many risk factors for fibromyalgia which we argue is best approached from a biopsychosocial perspective.
This review was performed in accordance with PRISMA guidelines. Random-effects models examined associations between different stressor exposures and fibromyalgia status with meta-regression investigating the effects of publication year and study quality on effect sizes.
Nineteen studies were included in the meta-analysis. Significant associations with fibromyalgia status were observed for all six exposure types examined: odds ratios (OR) were highest for physical abuse (OR 3.23, 95% confidence interval 1.99-5.23) and total abuse (3.06, 1.71-5.46); intermediate for sexual abuse (2.65, 1.85-3.79) and smaller for medical trauma (1.80, 1.19-2.71), other lifetime stressors (1.70, 1.31-2.20), and emotional abuse (1.52, 1.27-1.81). Results were not significantly changed when childhood, as opposed to adult, exposures were used in studies that reported both. Meta-regression analyses demonstrated no effect of publication year or study quality on effect sizes.
This study confirmed a significant association between stressor exposure and adult fibromyalgia with the strongest associations observed for physical abuse. Limitations related to current available literature were identified; we provide several suggestions for how these can be addressed in future studies. Stressors are likely to be one of many risk factors for fibromyalgia which we argue is best approached from a biopsychosocial perspective.
摘要：
纤维肌痛是一种以广泛的肌肉骨骼疼痛为特征的慢性病症。尽管越来越多的证据表明，暴露于压力事件会增加这种复杂疾病的风险，这是首次比较终身应激源(如身体创伤至情绪忽视)对成人纤维肌痛影响的荟萃分析.
本综述按照PRISMA指南进行。随机效应模型研究了不同应激源暴露与纤维肌痛状态之间的关联，并通过荟萃回归研究了发表年份和研究质量对效应大小的影响。
19项研究纳入荟萃分析。在所检查的所有六种暴露类型中，观察到与纤维肌痛状态显着相关：身体虐待（OR3.23，95％置信区间1.99-5.23）和总虐待（3.06，1.71-5.46）的比值比（OR）最高；性虐待的中间值（2.65，1.85-3.79），而医疗创伤的比值比较小（1.80，1.19-2.71）。其他终身压力源（1.70，1.31-2.20），和情感虐待（1.52，1.27-1.81）。结果童年时没有明显变化，而不是成年人，在报道这两种情况的研究中使用了暴露。荟萃回归分析表明，发表年份或研究质量对效应大小没有影响。
这项研究证实了应激源暴露与成人纤维肌痛之间的显着关联，其中最强烈的关联是身体虐待。确定了与当前可用文献相关的局限性；我们为将来的研究中如何解决这些问题提供了一些建议。压力源可能是纤维肌痛的许多危险因素之一，我们认为最好从生物心理社会的角度来解决。
本综述按照PRISMA指南进行。随机效应模型研究了不同应激源暴露与纤维肌痛状态之间的关联，并通过荟萃回归研究了发表年份和研究质量对效应大小的影响。
19项研究纳入荟萃分析。在所检查的所有六种暴露类型中，观察到与纤维肌痛状态显着相关：身体虐待（OR3.23，95％置信区间1.99-5.23）和总虐待（3.06，1.71-5.46）的比值比（OR）最高；性虐待的中间值（2.65，1.85-3.79），而医疗创伤的比值比较小（1.80，1.19-2.71）。其他终身压力源（1.70，1.31-2.20），和情感虐待（1.52，1.27-1.81）。结果童年时没有明显变化，而不是成年人，在报道这两种情况的研究中使用了暴露。荟萃回归分析表明，发表年份或研究质量对效应大小没有影响。
这项研究证实了应激源暴露与成人纤维肌痛之间的显着关联，其中最强烈的关联是身体虐待。确定了与当前可用文献相关的局限性；我们为将来的研究中如何解决这些问题提供了一些建议。压力源可能是纤维肌痛的许多危险因素之一，我们认为最好从生物心理社会的角度来解决。
