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Symptoms of Fibromyalgia According to the 2016 Revised Fibromyalgia Criteria in Chronic Pain Patients Referred to Multidisciplinary Pain Rehabilitation: Influence on Clinical and Experimental Pain Sensitivity

  • Karin Bruun Plesner
    Correspondence
    Address reprint requests to Karin Bruun Plesner, MD, Pain Research Group, Pain Center South, University Hospital Odense, Heden 7-9, Indgang 20, 5000 Odense C, Denmark.
    Affiliations
    Pain Research Group, Pain Centre South, Odense University Hospital, Odense, Denmark
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  • Henrik Bjarke Vaegter
    Affiliations
    Pain Research Group, Pain Centre South, Odense University Hospital, Odense, Denmark

    Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
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Published:February 27, 2018DOI:https://doi.org/10.1016/j.jpain.2018.02.009

      Highlights

      • Of chronic pain patients 37% were classified with fibromyalgia (FM).
      • FM patients showed higher levels of clinical and experimental pain sensitivity.
      • A higher proportion of patients classified as FM used opioids.
      • Specificity and sensitivity of the revised American College of Rheumatology-2016 FM criteria is unknown.

      Abstract

      Fibromyalgia (FM) is a condition with chronic widespread pain and signs of generalized pain hypersensitivity. FM has previously been classified according to the American College of Rheumatology-1990 criteria, where the presence of hypersensitivity is estimated by a tender point examination. Because of the limitations of these classification criteria, new diagnostic criteria have been proposed, abandoning this examination. This cross-sectional study investigated the prevalence of FM according to the revised 2016 FM criteria in a large cohort of chronic pain patients. Pain drawings, the FM Symptom Severity Scale, and questionnaires assessing manifestations of pain, pain-related disability, and psychological distress were collected from 1,343 patients with chronic nonmalignant pain referred to a multidisciplinary pain clinic. In addition, assessments of mechanical and thermal pain sensitivity were performed in 496 of the patients. Patients fulfilling the FM criteria (n = 498, 37%) reported significantly higher levels of pain, pain-related disability, psychological distress, and sensitivity to mechanical and heat stimuli (P < .05). Moreover, the proportion using opioids were significantly higher compared with patients not fulfilling the criteria (P = .015). Significant associations were found between heat and mechanical pain sensitivity (P < .001) indicating that patients who showed higher pain sensitivity to mechanical stimulation also showed higher pain sensitivity to thermal stimulation.

      Perspective

      More than one-third of patients were classified as FM, and patients classified showed increased clinical and experimental pain profiles. Because no data were collected on whether the included patients had a clinical FM diagnosis, future studies validating the American College of Rheumatology-2016 criteria in a cohort of patients with chronic nonmalignant pain are warranted.

      Key words

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      References

        • Bair M.J.
        • Wu J.
        • Damush T.M.
        • Sutherland J.M.
        • Kroenke K.
        Association of depression and anxiety alone and in combination with chronic musculoskeletal pain in primary care patients.
        Psychosom Med. 2008; 70: 890-897
        • Baraniuk J.N.
        • Whalen G.
        • Cunningham J.
        • Clauw D.J.
        Cerebrospinal fluid levels of opioid peptides in fibromyalgia and chronic low back pain.
        BMC Musculoskelet Disord. 2004; 5: 48
        • Birke H.
        • Ekholm O.
        • Sjogren P.
        • Kurita G.P.
        • Hojsted J.
        Long-term opioid therapy in Denmark: A disappointing journey.
        Eur J Pain. 2017; 21: 1516-1527
        • Bunketorp L.
        • Carlsson J.
        • Kowalski J.
        • Stener-Victorin E.
        Evaluating the reliability of multi-item scales: A non-parametric approach to the ordered categorical structure of data collected with the Swedish version of the Tampa Scale for Kinesiophobia and the Self-Efficacy Scale.
        J Rehabil Med. 2005; 37: 330-334
        • Cleeland C.S.
        • Ryan K.M.
        Pain assessment: Global use of the brief pain inventory.
        Ann Acad Med Singapore. 1994; 23: 129-138
        • Coster L.
        • Kendall S.
        • Gerdle B.
        • Henriksson C.
        • Henriksson K.G.
        • Bengtsson A.
        Chronic widespread musculoskeletal pain—a comparison of those who meet criteria for fibromyalgia and those who do not.
        Eur J Pain. 2008; 12: 600-610
        • Croft P.
        • Burt J.
        • Schollum J.
        • Thomas E.
        • Macfarlane G.
        • Silman A.
        More pain, more tender points: Is fibromyalgia just one end of a continuous spectrum?.
        Ann Rheum Dis. 1996; 55: 482-485
        • Dean L.E.
        • Arnold L.
        • Crofford L.
        • Bennett R.
        • Goldenberg D.
        • Fitzcharles M.A.
        • Paiva E.S.
        • Staud R.
        • Clauw D.
        • Sarzi-Puttini P.
        • Jones G.T.
        • Ayorinde A.
        • Fluss E.
        • Beasley M.
        • Macfarlane G.J.
        The impact of moving from a widespread to multi-site pain definition on other fibromyalgia symptoms.
        Arthritis Care Res. 2017; 69: 1878-1886
        • Egloff N.
        • von Kanel R.
        • Muller V.
        • Egle U.T.
        • Kokinogenis G.
        • Lederbogen S.
        • Durrer B.
        • Stauber S.
        Implications of proposed fibromyalgia criteria across other functional pain syndromes.
        Scand J Rheumatol. 2015; 44: 416-424
        • Ekholm O.
        • Kurita G.P.
        • Hojsted J.
        • Juel K.
        • Sjogren P.
        Chronic pain, opioid prescriptions, and mortality in Denmark: A population-based cohort study.
        Pain. 2014; 155: 2486-2490
        • EuroQol
        EuroQol—a new facility for the measurement of health-related quality of life.
        Health Policy (New York). 1990; 16: 199-208
        • Granges G.
        • Littlejohn G.
        Pressure pain threshold in pain-free subjects, in patients with chronic regional pain syndromes, and in patients with fibromyalgia syndrome.
        Arthritis Rheum. 1993; 36: 642-646
        • Harris R.E.
        • Clauw D.J.
        • Scott D.J.
        • McLean S.A.
        • Gracely R.H.
        • Zubieta J.K.
        Decreased central mu-opioid receptor availability in fibromyalgia.
        J Neurosci. 2007; 27: 10000-10006
        • Häuser W.
        • Brahler E.
        • Wolfe F.
        • Henningsen P.
        Patient health questionnaire 15 as a generic measure of severity in fibromyalgia syndrome: Surveys with patients of three different settings.
        J Psychosom Res. 2014; 76: 307-311
        • Häuser W.
        • Hayo S.
        • Biewer W.
        • Gesmann M.
        • Kuhn-Becker H.
        • Petzke F.
        • von Wilmoswky H.
        • Langhorst J.
        Diagnosis of fibromyalgia syndrome-a comparison of Association of the Medical Scientific Societies in Germany, survey, and American College of Rheumatology criteria.
        Clin J Pain. 2010; 26: 505-511
        • Hojsted J.
        • Ekholm O.
        • Kurita G.P.
        • Juel K.
        • Sjogren P.
        Addictive behaviors related to opioid use for chronic pain: A population-based study.
        Pain. 2013; 154: 2677-2683
        • Jensen H.I.
        • Plesner K.
        • Kvorning N.
        • Krogh B.L.
        • Kimper-Karl A.
        Associations between demographics and health-related quality of life for chronic non-malignant pain patients treated at a multidisciplinary pain centre: A cohort study.
        Int J Qual Health Care. 2016; 28: 86-91
        • Kori S.H.
        • Miller R.P.
        • Todd D.D.
        Kinesiophobia: A new view of chronic pain behavior.
        Pain Manag. 1990; 1: 35-43
        • Kroenke K.
        • Spitzer R.L.
        • Williams J.B.
        The PHQ-9: Validity of a brief depression severity measure.
        J Gen Intern Med. 2001; 16: 606-613
        • Lautenbacher S.
        • Rollman G.B.
        • McCain G.A.
        Multi-method assessment of experimental and clinical pain in patients with fibromyalgia.
        Pain. 1994; 59: 45-53
        • Lundberg M.
        • Styf J.
        • Jansson B.
        On what patients does the Tampa Scale for Kinesiophobia fit?.
        Physiother Theory Pract. 2009; 25: 495-506
        • Mansfield K.E.
        • Sim J.
        • Jordan J.L.
        • Jordan K.P.
        A systematic review and meta-analysis of the prevalence of chronic widespread pain in the general population.
        Pain. 2016; 157: 55-64
        • Peng X.
        • Robinson R.L.
        • Mease P.
        • Kroenke K.
        • Williams D.A.
        • Chen Y.
        • Faries D.
        • Wohlreich M.
        • McCarberg B.
        • Hann D.
        Long-term evaluation of opioid treatment in fibromyalgia.
        Clin J Pain. 2015; 31: 7-13
        • Pollard C.A.
        Preliminary validity study of the pain disability index.
        Percept Mot Skills. 1984; 59: 974
        • Queiroz L.P.
        Worldwide epidemiology of fibromyalgia.
        Curr Pain Headache Rep. 2013; 17: 356
        • Riley 3rd, J.L.
        • Robinson M.E.
        • Wise E.A.
        • Myers C.D.
        • Fillingim R.B.
        Sex differences in the perception of noxious experimental stimuli: A meta-analysis.
        Pain. 1998; 74: 181-187
        • Sjogren P.
        • Ekholm O.
        • Peuckmann V.
        • Gronbaek M.
        Epidemiology of chronic pain in Denmark: An update.
        Eur J Pain. 2009; 13: 287-292
        • Soer R.
        • Koke A.J.
        • Vroomen P.C.
        • Stegeman P.
        • Smeets R.J.
        • Coppes M.H.
        • Reneman M.F.
        Extensive validation of the pain disability index in 3 groups of patients with musculoskeletal pain.
        Spine. 2013; 38: E562-E568
        • Spitzer R.L.
        • Kroenke K.
        • Williams J.B.
        • Lowe B.
        A brief measure for assessing generalized anxiety disorder: The GAD-7.
        Arch Intern Med. 2006; 166: 1092-1097
        • Sullivan M.J.
        • Bishop S.R.
        • Pivik J.
        The pain catastrophizing scale: Development and validation.
        Psychol Assess. 1995; 7: 524-532
        • Wasserman R.A.
        • Brummett C.M.
        • Goesling J.
        • Tsodikov A.
        • Hassett A.L.
        Characteristics of chronic pain patients who take opioids and persistently report high pain intensity.
        Reg Anesth Pain Med. 2014; 39: 13-17
        • Wolfe F.
        Stop using the American College of Rheumatology criteria in the clinic.
        J Rheumatol. 2003; 30: 1671-1672
        • Wolfe F.
        Fibromyalgianess.
        Arthritis Rheum. 2009; 61: 715-716
        • Wolfe F.
        New American College of Rheumatology criteria for fibromyalgia: A twenty-year journey.
        Arthritis Care Res. 2010; 62: 583-584
        • Wolfe F.
        • Brahler E.
        • Hinz A.
        • Hauser W.
        Fibromyalgia prevalence, somatic symptom reporting, and the dimensionality of polysymptomatic distress: Results from a survey of the general population.
        Arthritis Care Res. 2013; 65: 777-785
        • Wolfe F.
        • Clauw D.J.
        • Fitzcharles M.A.
        • Goldenberg D.L.
        • Hauser W.
        • Katz R.L.
        • Mease P.J.
        • Russell A.S.
        • Russell I.J.
        • Walitt B.
        Revisions to the 2010/2011 fibromyalgia diagnostic criteria.
        Semin Arthritis Rheum. 2016; 46: 319-329
        • Wolfe F.
        • Clauw D.J.
        • Fitzcharles M.A.
        • Goldenberg D.L.
        • Hauser W.
        • Katz R.S.
        • Mease P.
        • Russell A.S.
        • Russell I.J.
        • Winfield J.B.
        Fibromyalgia criteria and severity scales for clinical and epidemiological studies: A modification of the ACR Preliminary Diagnostic Criteria for Fibromyalgia.
        J Rheumatol. 2011; 38: 1113-1122
        • Wolfe F.
        • Clauw D.J.
        • Fitzcharles M.A.
        • Goldenberg D.L.
        • Katz R.S.
        • Mease P.
        • Russell A.S.
        • Russell I.J.
        • Winfield J.B.
        • Yunus M.B.
        The American College of Rheumatology preliminary diagnostic criteria for fibromyalgia and measurement of symptom severity.
        Arthritis Care Res (Hoboken). 2010; 62: 600-610
        • Wolfe F.
        • Egloff N.
        • Hauser W.
        Widespread pain and low widespread pain index scores among fibromyalgia-positive cases assessed with the 2010/2011 fibromyalgia criteria.
        J Rheumatol. 2016; 43: 1743-1748
        • Wolfe F.
        • Smythe H.A.
        • Yunus M.B.
        • Bennett R.M.
        • Bombardier C.
        • Goldenberg D.L.
        • Tugwell P.
        • Campbell S.M.
        • Abeles M.
        • Clark P.
        • Fam A.G.
        • Farber S.J.
        • Fiechtner J.J.
        • Franklin C.M.
        • Gatter R.A.
        • Hamaty D.
        • Lessard J.
        • Lichtbroun A.S.
        • Masi A.T.
        The American College of Rheumatology 1990 criteria for the classification of fibromyalgia. Report of the multicenter criteria committee.
        Arthritis Rheum. 1990; 33: 160-172