Voice and Airway Presentations of Patients with Chronic Pain Syndromes Are Clinically Indistinguishable

by Linda Kossoff •

What is the prevalence of different voice and laryngeal disorders in patients with chronic pain syndromes (CPS) such as fibromyalgia syndrome (FMS), irritable bowel syndrome (IBS), and chronic fatigue syndrome (CFS)?

Bottom Line: The voice and airway presentation of patients with FMS, IBS, and/or CFS suggests that these disorders may be different clinical manifestations of a shared pathophysiology.

Background: Common chronic pain disorders FMS, IBS, and CFS are traditionally considered distinct entities. However, they do share multiple symptoms and may be grouped under CPS spectrum disorders. Although voice and airway symptoms are not part of these disorders’ diagnostic criteria, specialists commonly encounter patients with CPS in clinical practice.

Study Design: Retrospective review of medical records and clinical notes.

Setting: Johns Hopkins Voice Center, Baltimore.

Synopsis: Researchers reviewed the medical records of 4,249 adults treated by one of three designated laryngologists. They identified 215 patients with at least one CPS; remaining patients were classified as controls. Within the CPS group, there were 173 women and 42 men, including 77 with FMS, 80 with IBS, and 70 with CFS, plus patients with more than one disorder. Notably, female sex is one of the most predominant risk factors for CPS. Researchers divided a list of 45 commonly seen voice and laryngeal disorder diagnoses into categories: laryngeal pathology, functional voice disorders (FVD), airway problems, swallowing problems, and other. Patients with at least one CPS presented more often with FVD (24%) compared with those in the control group (14.9%). However, patients with CPS were less likely to present with objective clinical findings such as laryngeal pathology and airway problems. Based on patient voice and airway presentation, clinical manifestations of FMS, IBS, and CFS seemed to be indistinguishable from each other. Limitations include the study’s retrospective nature, potential lack of representation of the general population, and sole dependence on medical records.

Citation: Piersiala K, Akst LM, Hillel AT, et al. Chronic pain syndromes and their laryngeal manifestations [published online ahead of print April 30, 2020]. JAMA Otolaryngol Head Nec