Subgrouping of fibromyalgia patients on the basis of pressure‐pain thresholds and psychological factors

Abstract

Objective. Although the American College of Rheumatology (ACR) criteria for fibromyalgia are used to identify individuals with both widespread pain and tenderness, individuals who meet these criteria are not a homogeneous group. Patients differ in their accompanying clinical symptoms, as well as in the relative contributions of biologic, psychological, and cognitive factors to their symptom expression. Therefore, it seems useful to identify subsets of fibromyalgia patients on the basis of which of these factors are present. Previous attempts at identifying subsets have been based solely on psychological and cognitive features. In this study, we attempt to identify patient subsets by incorporating these features as well as the degree of hyperalgesia/ tenderness, which is a key neurobiologic feature of this illness.Methods. Ninety-seven individuals meeting the ACR criteria for fibromyalgia finished the same battery of self-report and evoked-pain testing. [degrees of freedom 6,89] ‫؍‬ 0.123, P < 0.0001), with univariate ANOVAs also indicating significant differences (all P < 0.05). One subgroup of patients (n ‫؍‬ 50) was characterized by moderate mood ratings, moderate levels of catastrophizing and perceived control over pain, and low levels of tenderness. A second subgroup (n ‫؍‬ 31) displayed significantly elevated values on the mood assessments, the highest values on the catastrophizing subscale, the lowest values for perceived control over pain, and high levels of tenderness. The third group (n ‫؍‬ 16) had normal mood ratings, very low levels of catastrophizing, and the highest level of perceived control over pain, but these subjects showed extreme tenderness on evoked-pain testing.Conclusion. These data help support the clinical impression that there are distinct subgroups of patients with fibromyalgia. There appears to be a group of fibromyalgia patients who exhibit extreme tenderness but lack any associated psychological/cognitive factors, an intermediate group who display moderate tenderness and have normal mood, and a group in whom mood and cognitive factors may be significantly influencing the symptom report.Fibromyalgia (FM) is a complex, contentious disease entity. It is currently defined by the 1990 American College of Rheumatology (ACR) classification criteria (1), in which an individual is required to have both a history of chronic widespread pain and the finding of

Quantitative sensory testing somatosensory profiles in patients with cervical radiculopathy are distinct from those in patients with nonspecific neck–arm pain

“…Similarly the increased MPS in our patients with FM corresponds with some findings [11], but not with others [40,54] and the reduced vibration sense has been demonstrated by some [42], but not by others [40,54]. These differing observations may be indicative of the heterogeneity of FM and the possible existence of various sub-groups [34,29,55]. In the absence of evidence of tissue damage in FM, aberrations in pain inhibitory [39,35,45] and pain facilitatory mechanisms [45] as well as central sensitisation/augmentation of sensory input [19,2,62] have been associated with enhanced pain sensitivity in FM.…”

Pain Perception After Isometric Exercise in Women With Fibromyalgia

“…Interestingly, tenderness with evoked-pain testing has been shown to be an important factor in determining subgroups. 24 However, our study is the first to show that baseline levels of experimental pain can predict pain relief and the effectiveness of exercise. One explanation for baseline levels as a predictor is that those subjects who experienced the greatest baseline pain (before exercise) may have more pain during the exercise intervention.…”

Identification and Validation of Clinically Relevant Clusters of Severe Fatigue in Rheumatoid Arthritis

“…For example, work in cancer has identified the existence of genetic and hormonal variations between symptom clusters (9,32,33). In rheumatology, these techniques have underscored the heterogeneity of fibromyalgia, identifying physiologically distinct sub-groups (34,35). They have also been employed in RA populations, though to the best of our knowledge, no studies have specifically deconstructed severe fatigue in RA, rather their application has been limited to the investigation of psychosocial risk profiles(36), pain behaviours(37), or general symptom profiles (38).…”