Women with fibromyalgia living in different regions of Europe report significantly different scores when assessing their symptoms, a recent study shows.

The study, “Fibromyalgia Impact Score in Women with Fibromyalgia Across Southern, Central, and Northern Areas of Europe,” was published in the journal Pain Physician.

The Fibromyalgia Impact Questionnaire (FIQ), developed in the early 1990s, is a questionnaire commonly used to assess the severity of fibromyalgia symptoms and how much they affect an individual’s day-to-day life.

Although the questionnaire is used worldwide — it is available in more than a dozen languages — there isn’t much information on how scores tend to differ in different parts of the world, in distinct geographic and societal/cultural contexts.

In this study, researchers administered the FIQ to female participants affected by fibromyalgia in Spain, Belgium, the Netherlands, and Sweden. All participants were grouped into one of three broader geographical groups: Northern, Central, and Southern Europe.

The study included 1,478 women: 531 from Southern Europe (Spain), 629 from Central Europe (Belgium and Netherlands), and 318 from Northern Europe (Sweden). The average age of all three groups was about 50 years. However, there were small — but statistically significant — differences between the groups in terms of age and the length of time participants had been experiencing fibromyalgia-related pain symptoms.

There were many significant differences in average scores on the FIQ between the three groups. Although the researchers cautioned that “statistical significance does not always mean clinically relevant,” they highlighted several differences that might be meaningful.

For example, participants from Northern Europe had the average highest score for physical impairment (4.41), followed by those from Southern (3.79) and Central Europe (2.28).

Those from Central Europe reported the lowest overall well-being scores (5.58 vs. 7.20 [Northern] and 7.74 [Southern]).

Participants from Southern Europe reported the most job difficulty (7.13 vs. 6.67 [Central] and 6.43 [Northern]); however, Southern Europe respondents also reported the fewest days of work missed due to fibromyalgia (3.48 vs. 5.61 and 5.72). Those in Southern Europe also reported significantly higher scores for anxiety (6.41 vs. 5.20 [Central] and 5.01 [Norther]) and depression (5.88 vs. 4.45 and 4.36). Pain also was scored higher in the Southern area.

Researchers speculated that some of these differences may be attributable to cultural/societal differences. However, the study did not directly assess relevant factors like race and economic status, so at present, this is only speculation.

More broadly, the researchers highlighted the importance of understanding how scores tend to vary in different places, so that healthcare providers treating people — and researchers doing studies — don’t make erroneous comparisons to a “norm” that may not be representative of the populations they are treating/studying.