Brazilian Journal of Pain
https://brjp.org.br/article/doi/10.5935/2595-0118.20220031-en
Brazilian Journal of Pain
Artigo Original

Patients with fibromyalgia present different pain phenotypes compared to patients with generalized pain

Pacientes com fibromialgia apresentam fenótipos de dor diferentes em comparação com pacientes com dor generalizada

Juliana Valentim Bittencourt; Leticia Amaral Corrêa; Márcia Cliton Bezerra; Felipe José Jandre dos Reis; Katie de Luca; Leandro Alberto Calazans Nogueira

http://dx.doi.org/10.5935/2595-0118.20220031-en BrJP, vol.5, n2, p.119-126, 2022
PDF English
PDF Português
SciELO
Downloads: 1
Views: 497

Abstract

BACKGROUND AND OBJECTIVES: Fibromyalgia and generalized pain represent a global health problem and are distinct musculoskeletal disorders, but there is an overlap in the clinical presentation between these conditions. However, no study has compared pain characteristics between patients with fibromyalgia and patients with generalized pain. Therefore, the present study aimed to compare pain characteristics and functional limitation of patients with fibromyalgia and patients with generalized pain.

METHODS: A pre-planned secondary analysis of data collected from 311 patients with musculoskeletal pain was performed. Pain characteristics included pain intensity, pain duration, pain area, symptoms of central sensitization, presence of neuropathic-like symptoms, and the conditioned pain modulation. The Patient-Specific Functional Scale assessed functional limitation.

RESULTS: 98 patients with generalized pain were identified, being 58 (59.18%) classified in the fibromyalgia group and 40 (40.82%) classified in the generalized pain group. Significant differences were found between groups for Widespread Pain Index, Symptom Severity Scale, and Polysymptomatic Distress Scale. Participants with fibromyalgia presented higher values of pain intensity (fibromyalgia = 7.29±2.07, generalized pain = 6.05±2.47; p=0.008), neuropathic-like symptoms (fibromyalgia = 17.74±7.62, generalized pain = 12.17±6.41; p=0.005), and symptoms of central sensitization (fibromyalgia = 51.32±14.26, generalized pain = 33.97±14.65; p<0.001), when compared with generalized pain. There was no significant difference in conditioned pain modulation and functional limitation between groups.

CONCLUSION: Patients with fibromyalgia exhibited unfavorable pain characteristics, including pain intensity, neuropathic-like symptoms, and symptoms of central sensitization compared to patients with generalized pain. However, pain duration, functional limitation, and conditioned pain modulation did not present meaningful differences between groups.

Keywords

Chronic pain, Fibromyalgia, Pain measurement, Pain threshold

Resumo

JUSTIFICATIVA E OBJETIVOS: Fibromialgia e dor generalizada representam um problema de saúde global e são distúrbios musculoesqueléticos distintos, mas há uma sobreposição na apresentação clínica entre essas condições. Entretanto, nenhum estudo comparou as características da dor entre os pacientes com estas condições. Portanto, o presente estudo teve como objetivo comparar as características da dor e a limitação funcional de pacientes com fibromialgia e dor generalizada.

MÉTODOS: Realizou-se uma análise secundária pré-planejada de dados coletados de 311 pacientes com dor musculoesquelética. As características da dor incluíram: intensidade da dor, duração da dor, área da dor, sintomas de sensibilização central, presença de sintomas neuropáticos e a modulação condicionada da dor. A escala de funcionalidade específica do paciente avaliou a limitação funcional.

RESULTADOS: Identificou-se 98 pacientes com dor generalizada, sendo 58 (59,18%) classificados no grupo de fibromialgia e 40 (40,82%) no grupo de dor generalizada. Diferenças significativas foram encontradas entre os grupos para o índice de dor generalizada, escala de severidade de sintomas e escala polissintomática de sofrimento. Os participantes com fibromialgia apresentaram maiores valores de intensidade da dor (fibromialgia = 7,29±2,07, dor generalizada = 6,05 ± 2,47; p=0,008), sintomas neuropáticos (fibromialgia = 17,74±7,62, dor generalizada = 12,17 ± 6,41; p=0,005) e sintomas de sensibilização central (fibromialgia = 51,32±14,26, dor generalizada = 33,97±14,65; p<0,001), quando comparados à dor generalizada. Não houve diferença significativa na modulação condicionada da dor e na limitação funcional entre os grupos.

CONCLUSÃO: Pacientes com fibromialgia exibiram características de dor desfavoráveis, incluindo intensidade de dor, sintomas neuropáticos e sintomas de sensibilização central, quando comparados a pacientes com dor generalizada. Entretanto, a duração da dor, a limitação funcional e a modulação condicionada da dor não apresentaram diferença significativa entre os grupos.

Palavras-chave

Dor crônica, Dor musculoesquelética, Fibromialgia, Limiar da dor, Medição da dor

Referências

Branco JC, Bannwarth B, Failde I, Abello Carbonell J, Blotman F, Spaeth M. Prevalence of fibromyalgia: A survey in five European countries. Semin Arthritis Rheum. 2010;39(6):448-53.

Vincent A, Lahr BD, Wolfe F, Clauw DJ, Whipple MO, Oh TH. Prevalence of fibromyalgia: a population-based study in Olmsted County, Minnesota, utilizing the Rochester epidemiology project. Arthritis Care Res. 2013;65(5):786-92.

Assumpção A, Cavalcante AB, Capela CE, Sauer JF, Chalot SD, Pereira CAB. Prevalence of fibromyalgia in a low socioeconomic status population. BMC Musculoskelet Disord. 2009;10(1):1-7.

Sarzi-Puttini P, Giorgi V, Marotto D, Atzeni F. Fibromyalgia: an update on clinical characteristics, aetiopathogenesis and treatment. Nat Rev Rheumatol. 2020;16(11):645-60.

Souza JB, Perissinotti DMN. The prevalence of fibromyalgia in Brazil-a population-based study with secondary data of the study on chronic pain prevalence in Brazil. BrJP. 2018;17(1):345-8.

Mansfield KE, Sim J, Jordan JL, Jordan KP. A systematic review and meta-analysis of the prevalence of chronic widespread pain in the general population. Pain. 2016;157(1):55-63.

Shresher NM, Mohamed AE, Elshahaly MH. Performance of 2016 revised fibromyalgia diagnostic criteria in patients with rheumatoid arthritis. Rheumatol Int. 2019;39(10):1703-10.

Galvez-Sánchez CM, Montoro CI, Duschek S, Del Paso GA. Depression and trait-anxiety mediate the influence of clinical pain on health-related quality of life in fibromyalgia. J Affect Disord. 2020;265:486-95.

Wolfe F, Smythe HA, Yunus MB, Bennett RM, Bombardier C, Goldenberg DL. The American College of Rheumatology 1990 Criteria for the Classification of Fibromyalgia. Report of the Multicenter Criteria Committee. Arthritis Rheum. 1990;33(2):160-72.

Wolfe F, Clauw DJ, Fitzcharles MA, Goldenberg DL, Häuser W, Katz RL. 2016 Revisions to the 2010/2011 fibromyalgia diagnostic criteria. Semin Arthritis Rheum. 2016;46(3):319-29.

Wolfe F, Clauw DJ, Fitzcharles MA, Goldenberg DL, Katz RS, Mease P. The American College of Rheumatology preliminary diagnostic criteria for fibromyalgia and measurement of symptom severity. Arthritis Care Res. 2010;62(5):600-10.

Dean LE, Arnold L, Crofford L, Bennett R, Goldenberg D, Fitzcharles M. Impact of moving from a widespread to multisite pain definition on other fibromyalgia symptoms. Arthritis Care Res (Hoboken). 2017;69(12):1878-86.

Toda K. Comparison of symptoms among fibromyalgia syndrome, chronic widespread pain, and an incomplete form of chronic widespread pain. J Musculoskelet Pain. 2011;19(1):52-5.

Santos AM, Burti JS, Lopes JB, Scazufca M, Marques AP, Pereira RM. Prevalence of fibromyalgia and chronic widespread pain in community-dwelling elderly subjects living in São Paulo, Brazil. Maturitas. 2010;67(3):251-5.

Schaefer C, Mann R, Masters ET, Cappelleri JC, Daniel SR, Zlateva G. The comparative burden of chronic widespread pain and fibromyalgia in the United States. Pain Pract. 2016;16(5):565-79.

White KP, Nielson WR, Harth M, Ostbye T, Speechley M. Chronic widespread musculoskeletal pain with or without fibromyalgia: Psychological distress in a representative community adult sample. J Rheumatol. 2002;29(3):588-94.

Stewart JA, Mailler-Burch S, Müller D, Studer M, von Känel R, Grosse Holtforth M. Rethinking the criteria for fibromyalgia in 2019: The ABC indicators. J Pain Res. 2019;12:2115-24.

Julien N, Goffaux P, Arsenault P, Marchand S. Widespread pain in fibromyalgia is related to a deficit of endogenous pain inhibition. Pain. 2005;114(1-2):295-302.

van Bemmel PF, Voshaar MAO, Klooster PMT, Vonkeman HE, van de Laar MA. Development and preliminary evaluation of a short self-report measure of generalized pain hypersensitivity. J Pain Res. 2019;12:395-404.

Cagnie B, Coppieters I, Denecker S, Six J, Danneels L, Meeus M. Central sensitization in fibromyalgia? A systematic review on structural and functional brain MRI. Semin Arthritis Rheum. 2014;44(1):68-75.

O’Brien AT, Deitos A, Pego YT, Fregni F, Carrillo-de-la-Peña MT. Defective endogenous pain modulation in fibromyalgia: a meta-analysis of temporal summation and conditioned pain modulation paradigms. J Pain. 2018;19(8):819-36.

Staud R, Smitherman ML. Peripheral and central sensitization in fibromyalgia: pathogenetic role. Curr Pain Headache Rep. 2002;6(4):259-66.

Bittencourt JV, Bezerra MC, Pina MR, Reis FJJ, de Sá Ferreira A, Nogueira LAC. Use of the painDETECT to discriminate musculoskeletal pain phenotypes. Arch Physiother. 2022;12(1):7.

Von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement: Guidelines for reporting observational studies. Bull World Health Organ. 2007;85(11):867-72.

Murray CJ, Atkinson C, Bhalla K, Birbeck G, Burstein R, Chou D, Dellavalle R. The state of US health, 1990-2010: burden of diseases, injuries, and risk factors. JAMA. 2013;310(6):591-608.

Dudeney J, Law EF, Meyyappan A, Palermo TM, Rabbitts JA. Evaluating the psychometric properties of the Widespread Pain Index and the Symptom Severity Scale in youth with painful conditions. Can J Pain. 2019;3(1):137-47.

Freynhagen R, Tölle TR, Gockel U, Baron R. The painDETECT project - Far more than a screening tool on neuropathic pain. Curr Med Res Opin. 2016;32(6):1033-57.

Horn KK, Jennings S, Richardson G, Vliet DV, Hefford C, Abbott JH. The patient-specific functional scale: Psychometrics, clinimetrics, and application as a clinical outcome measure. J Orthop Sports Phys Ther. 2012;42(1):30-42.

Treede RD, Rief W, Barke A, Aziz Q, Bennett MI, Benoliel R. Chronic pain as a symptom or a disease: the IASP Classification of Chronic Pain for the International Classification of Diseases (ICD-11). Pain. 2019;160(1):19-27.

Mayer TG, Neblett R, Cohen H, Howard KJ, Choi YH, Williams MJ. The development and psychometric validation of the Central Sensitization Inventory. Pain Pract. 2012;12(4):276-85.

Neblett R, Hartzell MM, Mayer TG, Cohen H, Gatchel RJ. Establishing clinically relevant severity levels for the Central Sensitization Inventory. Pain Pract. 2017;17(2):166-75.

Neblett R, Hartzell MM, Cohen H, Mayer TG, Williams M, Choi YH. Ability of the central sensitization inventory to identify central sensitivity syndromes in an outpatient chronic pain sample. Clin J Pain. 2015;31(4):323-32.

Tanaka K, Murata S, Nishigami T, Mibu A, Manfuku M, Shinohara Y. The central sensitization inventory predict pain-related disability for musculoskeletal disorders in the primary care setting. Eur J Pain (United Kingdom). 2019;23(9):1640-8.

Scerbo T, Colasurdo J, Dunn S, Unger J, Nijs J, Cook C. Measurement properties of the central sensitization inventory: a systematic review. Pain Pract. 2018;18(4):544-54.

Caumo W, Antunes LC, Elkfury JL, Herbstrith EG, Busanello Sipmann R, Souza A. The central sensitization inventory validated and adapted for a Brazilian population: psychometric properties and its relationship with brain-derived neurotrophic factor. J Pain Res. 2017;10:2109-22.

Freynhagen R, Baron R, Gockel U, Tölle TR. Pain DETECT: a new screening questionnaire to identify neuropathic components in patients with back pain. Curr Med Res Opin. 2006;22(10):1911-20.

Rio JPMD, Bittencourt JV, Corrêa LA, Freynhagen R, Reis FJJD, Melo TB. Cross-cultural adaptation of the PainDETECT Questionnaire into Brazilian Portuguese Language. Braz J Anesthesiol. 2022;72(1):44-8.

Abbott JH, Schmitt J. Minimum important differences for the patient-specific functional scale, 4 region-specific outcome measures, and the numeric pain rating scale. J Orthop Sports Phys Ther. 2014;44(8):560-4.

Lewis GN, Heales L, Rice DA, Rome K, McNair PJ. Reliability of the conditioned pain modulation paradigm to assess endogenous inhibitory pain pathways. Pain Res Manag. 2012;17(2):98-102.

Yarnitsky D, Bouhassira D, Drewes AM, Fillingim RB, Granot M, Hansson P. Recommendations on practice of conditioned pain modulation (CPM) testing. Eur J Pain (United Kingdom). 2015;19(6):805-6.

Arnold LM, Bennett RM, Crofford LJ, Dean LE, Clauw DJ, Goldenberg DL. AAPT Diagnostic Criteria for fibromyalgia. J Pain. 2019;20(6):611-28.

Steingrímsdóttir ÓA, Landmark T, Macfarlane GJ, Nielsen CS. Defining chronic pain in epidemiological studies: a systematic review and meta-analysis. Pain. 2017;158(11):2092-107.

Pamuk ÖN, Yethil Y, Çakir N. Factors that affect the number of tender points in fibromyalgia and chronic widespread pain patients who did not meet the ACR 1990 Criteria for Fibromyalgia: are tender points a reflection of neuropathic pain?. Semin Arthritis Rheum. 2006;36(2):130-4.

Doebl S, Hollick RJ, Beasley M, Choy E, Macfarlane GJ. Comparing people who have and have not received a diagnosis of fibromyalgia: a cross-sectional survey within the PACFiND study. Arthritis Care Res (Hoboken). 2021;3.

Cöster L, Kendall S, Gerdle B, Henriksson C, Henriksson KG, 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(5):600-10.

White KP, Speechley M, Harth M, Ostbye T. The London Fibromyalgia Epidemiology Study: comparing the demographic and clinical characteristics in 100 random community cases of fibromyalgia versus controls. J Rheumatol. 1999;26(7):1577-85.

Staud R. Chronic widespread pain and fibromyalgia: two sides of the same coin?. Curr Rheumatol Rep. 2009;11(6):433-6.

Martin KR, Druce KL, Murdoch SE, D’Ambruoso L, Macfarlane GJ. Differences in long-term physical activity trajectories among individuals with chronic widespread pain: a secondary analysis of a randomized controlled trial. Eur J Pain (United Kingdom). 2019;23(8):1437-47.

Gerhardt A, Eich W, Treede RD, Tesarz J. Conditioned pain modulation in patients with nonspecific chronic back pain with chronic local pain, chronic widespread pain, and fibromyalgia. Pain. 2017;158(3):430-9.

Lewis GN, Rice DA, McNair PJ. Conditioned pain modulation in populations with chronic pain: a systematic review and meta-analysis. J Pain. 2012;13(10):936-44.

Jensen KB, Kosek E, Petzke F, Carville S, Fransson P, Marcus H. Evidence of dysfunctional pain inhibition in Fibromyalgia reflected in rACC during provoked pain. Pain. 2009;144(1-2):95-100.

Tan AC, Jaaniste T, Champion D. Chronic widespread pain and fibromyalgia syndrome: life-course risk markers in young people. Pain Res Manag. 2019;2019:6584753.

Staud R, Robinson ME, Vierck Jr CJ, Price DD. Diffuse noxious inhibitory controls (DNIC) attenuate temporal summation of second pain in normal males but not in normal females or fibromyalgia patients. Pain. 2003;101(1-2):167-74.

Submetido em:
02/10/2021

Aceito em:
12/04/2022

62e05c0aa95395224553fe03 brjp Articles
2595-3192 (Eletrônico) 2595-0118 (Impresso)
BrJP ©2024 Todos os direitos reservados.

BrJP

Share this page
Page Sections