Prevalence of Fibromyalgia Syndrome in Patients Referred to a Tertiary Pain Clinic

Abstract

Background

Fibromyalgia syndrome (FMS), the prototypical central pain augmentation syndrome, is characterized by widespread pain and tenderness. Although patients referred to tertiary care pain clinics are recognized as suffering from chronic pain, they are generally considered to have pain attributable to discrete peripheral, nociceptive, or neuropathic etiology.

The purpose of the current study was to assess the prevalence of FMS among consecutive patients referred to a tertiary pain clinic and to evaluate the contribution of central pain to the clinical impact upon such patients.

Methods

Eighty-five consecutive patients (38 were male, and 47 were female) attending a pain clinic were assessed for the presence of FMS. The presence of FMS was determined according to the 1990 American College of Rheumatology (ACR) classification criteria. Quality of life and physical functioning were assessed, utilizing a structured questionnaire.

Results

The ACR criteria for the classification of FMS were fulfilled by 41.2% of patients. Patients fulfilling FMS criteria ranked significantly lower on all domains of the SF-36, including general health, physical functioning, role limitation due to physical and emotional problems, vitality, social functioning, bodily pain, and mental health. Composite physical and mental health scores were significantly lower among patients fulfilling ACR FMS criteria.

Patients fulfilling the ACR criteria for FMS felt significantly more tenderness, based on the mean number of tender points and the mean tenderness threshold, when compared with patients not fulfilling the ACR FMS criteria.

Conclusions

A significant proportion of patients referred to a tertiary pain clinic were found to fulfill the ACR criteria for classification of FMS and thus exhibit an important element of central pain. Central pain augmentation should be actively searched for and therapeutically addressed in the evaluation and management of all patients with chronic pain.

Keywords

central pain fibromyalgia pain clinic

Get full access to this article

View all access options for this article.

References

Crofford

, Clauw

DJ.

Fibromyalgia: where are we a decade after the American College of Rheumatology classification criteria were developed?

Arthritis Rheum. 2002; 46 (5): 1136–1138.

Hadler

NM.

“Fibromyalgia” and the medicalization of misery. J Rheumatol. 2003; 30 (8): 1668–1670.

Chang

, Arendt-Nielsen

, Graven-Nielsen

. Psychophysical and EEG responses to repeated experimental muscle pain in humans: pain intensity encodes EEG activity. Brain Res Bull. 2003; 59 (6): 533–543.

Bragdon

, Light

, Costello

. Group differences in pain modulation: pain-free women compared to pain-free men and to women with TMD. Pain. 2002; 96 (3): 227–237.

Bendtsen

Central sensitization in tension-type headache—possible pathophysiological mechanisms. Cephalalgia. 2000; 20 (5): 486–508.

Papageorgiou

, Silman

, Macfarlane

GJ.

Chronic widespread pain in the population: a seven year follow up study. Ann Rheum Dis. 2002; 61 (12): 1071–1074.

Ablin

, Neumann

, Buskila

Pathogenesis of fibromyalgia—a review. Joint Bone Spine. 2008; 75 (3): 273–279.

Clauw

, Crofford

LJ.

Chronic widespread pain and fibromyalgia: what we know, and what we need to know. Best Pract Res Clin Rheumatol. 2003; 17 (4): 685–701.

Giesecke

, Gracely

, Grant

. Evidence of augmented central pain processing in idiopathic chronic low back pain. Arthritis Rheum. 2004; 50 (2): 613–623.

10.

Clauw

, Witter

Pain and rheumatology: thinking outside the joint. Arthritis Rheum. 2009; 60 (2): 321–324.

11.

Wolfe

, Smythe

, Yunus

. The American College of Rheumatology 1990 criteria for the classification of fibromyalgia. Report of the Multicenter Criteria Committee. Arthritis Rheum. 1990; 33 (2): 160–172.

12.

Wolfe

50 Years of antirheumatic therapy: the prognosis of rheumatoid arthritis. J Rheumatol Suppl. 1990; 22: 24–32.

13.

Clauw

DJ.

Fibromyalgia. In: Kelley's Textbook of Rheumatology. New York, NY: Saunders; 2000: 417–427.

14.

Woolf

, Salter

MW.

Neuronal plasticity: increasing the gain in pain. Science. 2000; 288 (5472): 1765–1769.

15.

Mertz

, Naliboff

, Munakata

. Altered rectal perception is a biological marker of patients with irritable bowel syndrome. Gastroenterology. 1995; 109 (1): 40–52.

16.

Kashima

, Rahman

, Sakoda

. Increased pain sensitivity of the upper extremities of TMD patients with myalgia to experimentally-evoked noxious stimulation: possibility of worsened endogenous opioid systems. Cranio. 1999; 17 (4): 241–246.

17.

Maixner

, Fillingim

, Booker

. Sensitivity of patients with painful temporomandibular disorders to experimentally evoked pain. Pain. 1995; 63 (3): 341–351.

18.

Lee

, Chibnik

, Lu

. The relationship between disease activity, sleep, psychiatric distress and pain sensitivity in rheumatoid arthritis [Abstr.]. Presented at the ACR scientific meeting, Philadelphia. PA, October 19, 2009.

19.

Ablin

, Clauw

DJ.

From fibrositis to functional somatic syndromes to a bell-shaped curve of pain and sensory sensitivity: evolution of a clinical construct. Rheum Dis Clin North Am. 2009; 35 (2): 233–251.