Article

Comparison of Clinical and Evoked Pain Measures in Fibromyalgia

Division of Anesthesiology, University of Cologne, Köln, North Rhine-Westphalia, Germany
Journal of Pain (Impact Factor: 4.01). 08/2006; 7(7):521-7. DOI: 10.1016/j.jpain.2006.01.455
Source: PubMed

ABSTRACT

Evoked pain measures such as tender point count and dolorimetry are often used to determine tenderness in studies of fibromyalgia (FM). However, these measures frequently do not improve in clinical trials and are known to be influenced by factors other than pain such as distress and expectancy. The purpose of this investigation was to determine whether evoked pain paradigms that present pressure stimuli in a random fashion (eg, Multiple Random Staircase [MRS]) would track with clinical pain improvement in patients with FM better than traditional measures. Sixty-five subjects enrolled in a randomized clinical trial of acupuncture were observed longitudinally. Clinical pain was measured on a 101-point numerical rating scale (NRS) and the Short Form McGill Pain Questionnaire (SF-MPQ), whereas evoked pressure sensitivity was assessed via manual tender point count, dolorimetry, and MRS methods. Improvements in clinical pain and evoked pain were assessed irrespective of group assignment. Improvement was seen in clinical pain during the course of the trial as measured by both NRS (P = .032) and SF-MPQ (P = .001). The MRS was the only evoked pain measure to improve correspondingly with treatment (MRS, P = .001; tender point count and dolorimeter, P > .05). MRS change scores were correlated with changes in NRS pain ratings (P = .003); however, this association was not stronger than tender point or dolorimetry correlations with clinical pain improvement (P > .05). Pain sensitivity as assessed by random paradigms was associated with improvements in clinical FM pain. Sophisticated pain testing paradigms might be responsive to change in clinical trials.

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Available from: Samuel A Mclean
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    • "The aim of the assessment was to obtain a subjective measurement of clinical (nonevoked) fibromyalgia pain before fMRI as a direct expression of the patient's current generalized pain sensation . Clinical pain was assessed using a 101-point numerical rating scale [36], which has been previously used in fibromyalgia patients [26]. A score of 0 represented no pain and a score of 100 the maximum bearable fibromyalgia-related pain perceived in the body as a whole, or in most of its extension, rather than referring to any focal tenderness. "
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    • "While newer assessments currently under development may prove superior for evaluating tenderness, such as the multiple random staircase-evoked pain measure [60], they remain unproven. The MTPS/FIS is the currently recommended tenderness assessment for FM trials since it is standardized, can be performed with minimal training, and does not require specialized equipment. "
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