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


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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    ABSTRACT: Fibromyalgia typically presents with spontaneous body pain with no apparent cause and is considered pathophysiologically to be a functional disorder of somatosensory processing. We have investigated potential associations between the degree of self-reported clinical pain and resting-state brain functional connectivity at different levels of putative somatosensory integration. Resting-state functional MRI was obtained in 40 women with fibromyalgia and 36 control subjects. A combination of functional connectivity-based measurements were used to assess (i) the basic pain signal modulation system at the level of the periaqueductal gray (PAG), (ii) the sensory cortex with an emphasis on the parietal operculum/secondary somatosensory cortex (SII) and (iii) the connectivity of these regions with the self-referential "default mode" network. Compared with control subjects, a reduction of functional connectivity was identified across the three levels of neural processing, each showing a significant and complementary correlation with the degree of clinical pain. Specifically, self-reported pain in fibromyalgia patients correlated with (i) reduced connectivity between PAG and anterior insula, (ii) reduced connectivity between SII and primary somatosensory, visual and auditory cortices, and (iii) increased connectivity between SII and the default mode network. The results confirm previous research demonstrating abnormal functional connectivity in fibromyalgia and show that alterations at different levels of sensory processing may contribute to account for clinical pain. Importantly, reduced functional connectivity extended beyond the somatosensory domain and implicated visual and auditory sensory modalities. Overall this study suggests that a general weakening of sensory integration underlies clinical pain in fibromyalgia.
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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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