Chronic Pain Syndromes Share Similar Upper-Airway Symptoms

By Anne Harding

May 08, 2020

NEW YORK (Reuters Health) - Patients with chronic pain syndromes (CPS) including fibromyalgia, irritable bowel syndrome (IBS) and chronic fatigue syndrome (CFS) have similar voice and airway presentations that are distinct from those of people without chronic pain, new research shows.

"Patients with CPS often have voice changes that are not related to obvious anatomic abnormalities. These functional voice disorders may be a manifestation of their disease process and treatment options exist for these patients, including voice therapy," Dr. Simon R. Best of Johns Hopkins University in Baltimore, Maryland, one of the study authors, told Reuters Health by email.

While upper-airway and voice symptoms are not diagnostic criteria for fibromyalgia, IBS or CFS, "our clinical observation is that patients with these 3 diseases are commonly encountered in clinical practice," Dr. Best and his team write in JAMA Otolaryngology-Head and Neck Surgery.

To investigate their hypothesis that voice and laryngeal disorders would have a similar clinical manifestation in patients with the three syndromes, the authors reviewed medical records for more than 4,000 patients treated in 2016-2017 at the Johns Hopkins Voice Center.

There were 215 patients (5.1%) with at least one CPS. The remaining 4,034 patients formed the control group.

CPS patients were more than three times as likely to be female compared to controls, and they were about two years older, on average. Functional voice disorders (FVD) were significantly more common in the CPS patients than controls (odds ratio, 1.8), but laryngeal pathology (OR, 0.774) and airway problems (OR, 0.474) were significantly less common in these patients.

The CPS patients were also significantly more likely to have muscle tension dysphonia (OR, 1.9) and paradoxical vocal cord motion (OR, 2.5) than the non-CPS group. Findings were similar when the authors analyzed each syndrome separately.

"FVD often develop in response to perturbations in physiologic functioning, since voice production is a highly complex neuromuscular function," Dr. Best said. "CPS impact muscle functioning and have wide-ranging neurologic effects, therefore it makes sense that we are seeing voice disorders as part of the symptom complex of CPS."

The finding of a similar pattern of voice disorders for each CPS type is "intriguing," Dr. Best noted. "Others have suggested that these syndromes exist on a spectrum or are different manifestations of a shared pathophysiology, and our findings certainly support this hypothesis," he added.

"CPS patients need a multi-disciplinary team to help them achieve better quality of life. Voice disorders significantly impact quality of life because they impair our ability to communicate with friends and family," the researcher said. "All patients with hoarseness, including CPS patients, should be referred for evaluation and treatment by an otolaryngologist and speech language pathologist."

Dr. Stephanie Misono of the University of Minnesota in Minneapolis told Reuters Health by email, "The standard treatment for functional voice disorders is therapy with a speech-language pathologist, and many patients respond very well to this approach."

"However, as this and other related studies have shown, there may be a role for additional treatment from other specialists, such as behavioral health professionals (such as psychologists), to help improve treatment outcomes," added Dr. Misono, who co-authored an editorial accompanying the study.

SOURCE: and JAMA Otolaryngology-Head and Neck Surgery, online April 30, 2020.