A theoretical framework to improve the construct for chronic pain disorders using fibromyalgia as an example

Kumbhare, Dinesh; Tesio, Luigi

doi:10.1177/1759720x20966490

Cited by 9 publications

(7 citation statements)

References 67 publications

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“…The investigators of the included studies used versatile methodologies to measure the NFR threshold (Appendix 4, Supplemental Digital Content 5, http://links.lww.com/PHM/B160). After a thorough analysis (Table 2), we highlighted the studies that caused an overall heterogeneity, that is, patients with chronic cluster headache remission by Sandrini et al 32 ; patients with headache by Filatova et al 30 ; patients with chronic neck pain by Biurrun Manresa et al 22 ; and patients with whiplash by Smith et al 38 These exclusions resulted in ( I 2 = 28%, χ 2 = 31.93, df = 23, P = 0.10) and the test of overall effect indicated to be still highly significant ( Z = 11.21, P < 0.00001). Additional forest plot excluding these studies are presented in Appendix 3 (Supplemental Digital Content 4, http://links.lww.com/PHM/B159).…”

Section: Resultsmentioning

confidence: 99%

“…A major issue that faces clinicians and researchers is the lack of objectivity available within many diagnostic criteria used to label a patient with a specific chronic pain condition. For example, common chronic pain conditions including fibromyalgia and myofascial pain syndrome have subjective and self-report–based diagnostic criteria 38 . These criteria are expert opinion, and their ability to create a homogeneous group if applied correctly has not been demonstrated.…”

Section: Discussionmentioning

confidence: 99%

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Nociceptive Flexion Reflex Threshold in Chronic Pain Patients

Amiri

Esmaili

Hamad

et al. 2020

Am J Phys Med Rehabil

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Background The nociceptive flexion reflex is a physiological, polysynaptic reflex triggered by a nociceptive stimulus activating a withdrawal response. In chronic musculoskeletal-related pain conditions, a decreased nociceptive flexion reflex threshold has been suggested as a possible recognition evidence for central sensitization that may cause alteration of central nervous system processing. Objective The aim of the study was to systematically review reported comparisons of the nociceptive flexion reflex threshold in chronic pain patients and healthy individuals. Methods Electronic databases covering studies published between January 1990 and December 2019 were systematically searched. After application of exclusion criteria, 20 studies including 28 trials were included in this review. For meta-analysis, we used a random-effects model and funnel plot for publication bias. This research was registered at PROSPERO (CRD42019140354). Results Compared with healthy controls, standardized mean differences in nociceptive flexion reflex threshold were significantly lower in the total sample of chronic pain patients. Subgroup analysis indicated a homogenous decreased nociceptive flexion reflex threshold in studies reporting fibromyalgia, chronic pain, and joint pain while heterogeneity existed in other included pain conditions. Conclusions A lower nociceptive flexion reflex threshold in patients experiencing chronic pain conditions may imply hyperexcitability in central nervous system processing. As a preliminary study, the findings would act as a basis for developing a methodology assisting current clinical practices

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Nociceptive Flexion Reflex Threshold in Chronic Pain Patients

Amiri

Esmaili

Hamad

et al. 2020

Am J Phys Med Rehabil

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“…Some recent studies have used network analysis to better understand the complexity of chronic pain [ 16 , 17 ]; however, no previous study has used network analysis in individuals with FMS. Since an ideal theoretical framework of FMS integrates reciprocal interactions between biology (sensory and physical aspects) and behaviors (psychological and cognitive aspects) [ 18 ], we applied network analysis to better understand the interactions between sensory, cognitive, health-related, and physical variables in women with FMS. Accordingly, the main aims of this study were to (1) describe a network including demographic, clinical, psycho-physical, psychological, health-related, and physical variables in women with FMS, and (2) illustrate the potential of a network analysis perspective for understanding complex mechanisms of FMS, generating research questions, and improving potential treatment strategies.…”

Section: Introductionmentioning

confidence: 99%

Network Analysis for Better Understanding the Complex Psycho-Biological Mechanisms behind Fibromyalgia Syndrome

et al. 2022

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The aim of this study was to assess potential associations between sensory, cognitive, health-related, and physical variables in women with fibromyalgia syndrome (FMS) using a network analysis for better understanding the complexity of psycho-biological mechanisms. Demographic, clinical, pressure pain threshold (PPT), health-related, physical, and psychological/cognitive variables were collected in 126 women with FMS. A network analysis was conducted to quantify the adjusted correlations between the modeled variables and to assess the centrality indices (i.e., the degree of connection with other symptoms in the network and the importance in the system modeled as a network. This model showed several local associations between the variables. Multiple positive correlations between PPTs were observed, being the strongest weight between PPTs over the knee and tibialis anterior (0.28). Catastrophism was associated with higher hypervigilance (: 0.23) and lower health-related EuroQol-5D (: −0.24). The most central variables were PPT over the tibialis anterior (the highest strength centrality), hand grip (the highest harmonic centrality) and Time Up and Go (the highest betweenness centrality). This study, applying network analysis to understand the complex mechanisms of women with FMS, supports a model where sensory-related, psychological/cognitive, health-related, and physical variables are connected. Implications of the current findings, e.g., developing treatments targeting these mechanisms, are discussed.

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“…Since an ideal theoretical framework of FMS integrates reciprocal interactions between biology (clinical and sensory aspects) and behaviors (psychological and cognitive aspects) [11], we argue that a structural equation modelling (SEM) approach can provide an efficient framework to test-explore-retest competing causal models for a complex disorder such as FMS. In fact, when quantifying complex multivariate mechanistic pathways are included, variables can simultaneously depend on, and influence, other variables.…”

Section: Introductionmentioning

confidence: 99%

Distress and Sensitization as Main Mediators of Severity in Women with Fibromyalgia: A Structural Equation Model

et al. 2022

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We aimed to explore a path model identified using a structural equation model (SEM) which best explains the multivariate contributions of sensitization, sensitivity, and emotional variables to clinical severity in women with FMS. Pain features, the Central Sensitization Inventory (CSI), painDETECT, S-LANSS, the Hospital Anxiety and Depression Scale (HADS), the Pittsburgh Sleep Quality Index (PSQI), the Pain Catastrophizing Scale (PCS), the Pain Vigilance and Awareness Questionnaire (PVAQ), the 11-item Tampa Scale for Kinesiophobia (TSK-11), and pressure pain thresholds (PPTs) were collected from 113 women with FMS. Four latent variables were created: severity (clinical pain features), sensitivity (PPTs), sensitization (S-LANSS, CSI, painDETECT), and distress (HADS-A, HADS-D, PCS, PVAQ, TSK-11). Data fit for the measurement model were considered excellent (RMSEA = 0.043, CFI = 0.966, SRMR = 0.067, and NNFI = 0.960). Distress had a significant relationship with the mediators of sleep (β = 0.452, p = 0.031) and sensitization (β = 0.618, p = 0.001). The only mediator with a significant effect (β = 1.113, p < 0.001) on severity was sensitization. A significant indirect effect of sensitization (β = 0.687, p = 0.001) that explained the relationship between distress and severity was also identified. The proposed model suggests that distress and sensitization, together with poor sleep, have a complex mediating effect on severity in women with FMS. The identified path model can be leveraged in clinical trials investigating treatment approaches for FMS.

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A theoretical framework to improve the construct for chronic pain disorders using fibromyalgia as an example

Cited by 9 publications

References 67 publications

Nociceptive Flexion Reflex Threshold in Chronic Pain Patients

Nociceptive Flexion Reflex Threshold in Chronic Pain Patients

Network Analysis for Better Understanding the Complex Psycho-Biological Mechanisms behind Fibromyalgia Syndrome

Distress and Sensitization as Main Mediators of Severity in Women with Fibromyalgia: A Structural Equation Model

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