Patients with fibromyalgia present different pain phenotypes compared to patients with generalized pain

Bittencourt, Juliana Valentim; Corrêa, Leticia Amaral; Bezerra, Márcia Cliton; Reis, Felipe José Jandre dos; Luca, Katie de; Nogueira, Leandro Alberto Calazans

doi:10.5935/2595-0118.20220031-en

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ORIGINAL ARTICLE • BrJP 05 (02) • Apr-Jun 2022 • https://doi.org/10.5935/2595-0118.20220031-en copy

Patients with fibromyalgia present different pain phenotypes compared to patients with generalized pain

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

BACKGROUND AND OBJECTIVES

Fibromyalgia and generalized pain represent a global health problem and are distinct musculoskeletal disorders, but there is an overlap in the clinical presentation between these conditions. However, no study has compared pain characteristics between patients with fibromyalgia and patients with generalized pain. Therefore, the present study aimed to compare pain characteristics and functional limitation of patients with fibromyalgia and patients with generalized pain.

METHODS

A pre-planned secondary analysis of data collected from 311 patients with musculoskeletal pain was performed. Pain characteristics included pain intensity, pain duration, pain area, symptoms of central sensitization, presence of neuropathic-like symptoms, and the conditioned pain modulation. The Patient-Specific Functional Scale assessed functional limitation.

RESULTS

98 patients with generalized pain were identified, being 58 (59.18%) classified in the fibromyalgia group and 40 (40.82%) classified in the generalized pain group. Significant differences were found between groups for Widespread Pain Index, Symptom Severity Scale, and Polysymptomatic Distress Scale. Participants with fibromyalgia presented higher values of pain intensity (fibromyalgia = 7.29±2.07, generalized pain = 6.05±2.47; p=0.008), neuropathic-like symptoms (fibromyalgia = 17.74±7.62, generalized pain = 12.17±6.41; p=0.005), and symptoms of central sensitization (fibromyalgia = 51.32±14.26, generalized pain = 33.97±14.65; p<0.001), when compared with generalized pain. There was no significant difference in conditioned pain modulation and functional limitation between groups.

CONCLUSION

Patients with fibromyalgia exhibited unfavorable pain characteristics, including pain intensity, neuropathic-like symptoms, and symptoms of central sensitization compared to patients with generalized pain. However, pain duration, functional limitation, and conditioned pain modulation did not present meaningful differences between groups.

Keywords:
Chronic pain; Fibromyalgia; Pain measurement; Pain threshold

	Item n^o	Recommendation	Page n^o
Title and abstract	1	(a) Indicate the study’s design with a commonly used term in the title or the abstract	01-02
Title and abstract	1	(b) Provide in the abstract an informative and balanced summary of what was done and what was found	01-03
Introduction
Background/rationale	2	Explain the scientific background and rationale for the investigation being reported	03-04
Objectives	3	State specific objectives, including any prespecified hypotheses	05
Methods
Study design	4	Present key elements of study design early in the paper	05
Setting	5	Describe the setting, locations, and relevant dates, including periods of recruitment, exposure, follow-up, and data collection	07
Participants	6	(a) Give the eligibility criteria, and the sources and methods of selection of participants	07
Variables	7	Clearly define all outcomes, exposures, predictors, potential confounders, and effect modifiers. Give diagnostic criteria, if applicable	09-13
Data sources/ measurement	8^* * Give information separately for exposed and unexposed groups.	For each variable of interest, give sources of data and details of methods of assessment (measurement). Describe comparability of assessment methods if there is more than one group	09-13
Bias	9	Describe any efforts to address potential sources of bias	-
Study size	10	Explain how the study size was arrived at	13
Quantitative variables	11	Explain how quantitative variables were handled in the analyses. If applicable, describe which groupings were chosen and why	13
Statistical methods	12	(a) Describe all statistical methods, including those used to control for confounding	NA
		(b) Describe any methods used to examine subgroups and interactions	NA
		(c) Explain how missing data were addressed	NA
		(d) If applicable, describe analytical methods taking account of sampling strategy	NA
		(e) Describe any sensitivity analyses	NA
Results
Participants	13^* * Give information separately for exposed and unexposed groups.	(a) Report numbers of individuals at each stage of study—eg numbers potentially eligible, examined for eligibility, confirmed eligible, included in the study, completing follow-up, and analysed	14
		(b) Give reasons for non-participation at each stage	NA
		(c) Consider use of a flow diagram	NA
Descriptive data	14^* * Give information separately for exposed and unexposed groups.	(a) Give characteristics of study participants (eg demographic, clinical, social) and information on exposures and potential confounders	14-16
Descriptive data		(b) Indicate number of participants with missing data for each variable of interest	14-16
Outcome data	15^* * Give information separately for exposed and unexposed groups.	Report numbers of outcome events or summary measures	14-16
Main results	16	(a) Give unadjusted estimates and, if applicable, confounder-adjusted estimates and their precision (eg, 95% confidence interval). Make clear which confounders were adjusted for and why they were included	13
		(b) Report category boundaries when continuous variables were categorized	14-16
		(c) If relevant, consider translating estimates of relative risk into absolute risk for a meaningful time period	NA
Other analyses	17	Report other analyses done—eg analyses of subgroups and interactions, and sensitivity analyses	NA
Discussion
Key results	18	Summarize key results with reference to study objectives	16
Limitations	19	Discuss limitations of the study, taking into account sources of potential bias or imprecision. Discuss both direction and magnitude of any potential bias	16-17
Interpretation	20	Give a cautious overall interpretation of results considering objectives, limitations, multiplicity of analyses, results from similar studies, and other relevant evidence	16-19
Generalizability	21	Discuss the generalizability (external validity) of the study results	16-19
Other information
Funding	22	Give the source of funding and the role of the funders for the present study and, if applicable, for the original study on which the present article is based	19

Characteristics	Fibromyalgia n=58	Generalized pain n=40	p-value
Gender, n (%), female	52 (89.65%)	31 (77.50%)	0.102
Age, mean (SD)	58.94 (9.43)	56.46 (14.31)	0.305
Weight (kg), mean (SD)	72.59 (12.70)	73.07 (11.72)	0.855
Height (m), mean (SD)	1.61 (0.09)	1.59 (0.09)	0.323
Body mass index (kg/m²), mean (SD)	26.94 (7.30)	29.25 (5.45)	0.113
Physical activity (Yes), n (%)	27 (46.55%)	15 (37.50%)	0.453
WPI (0-19), mean (SD)	11.39 (3.52)	8.67 (3.35)	<0.001
SSS (0-12), mean (SD)	7.96 (2.21)	4.30 (2.27)	<0.001
Headache (Yes), n (%)	47 (81.03%)	20 (50.00%)	0.008
Pain or cramps in lower abdomen (Yes), n (%)	25 (43.10%)	8 (20.00%)	0.017
Depression (Yes), n (%)	40 (68.96%)	8 (20.00%)	<0.001
Fatigue (0-3), mean (SD)	2.24 (0.94)	1.25 (0.96)	<0.001
Waking unrefreshed (0-3), mean (SD)	1.94 (1.16)	1.22 (1.20)	0.004
Cognitive symptoms (0-3), mean (SD)	1.84 (1.18)	0.90 (0.95)	<0.001
PDS (0-31), mean (SD)	19.36 (4.60)	12.97 (3.75)	<0.001

Characteristics	Fibromyalgia n=58	Generalized pain n=40	p-value
Pain intensity, mean (SD)	7.29 (2.07)	6.05 (2.47)	0.008
Pain duration (months), mean (SD)	110.17 (116.35)	86.54 (98.54)	0.318
PainDETECT questionnaire, mean (SD)	17.74 (7.62)	12.17 (6.41)	0.005
Nociceptive pain (≤12), n (%)	13 (22.41%)	20 (51.28%)	0.003
Unlikely (13-18), n (%)	19 (32.75%)	12 (30.76%)	0.836
Neuropathic pain (≥19), n (%)	26 (44.82%)	7 (17.94%)	0.006
CSI, mean (SD)	51.32 (14.26)	33.97 (14.65)	<.001
Sub-clinical (0-29), n (%)	3 (5.17%)	18 (45.00%)	<.001
Mild (30-39), n (%)	11 (18.96%)	7 (17.50%)	0.855
Moderate (40-49), n (%)	15 (25.86%)	9 (22.50%)	0.705
Severe (50-59), n (%)	8 (13.79%)	4 (10.00%)	0.576
Extreme (60-100), n (%)	21 (36.20%)	2 (5.00%)	<.001
PSFS, mean (SD)	7.75 (2.04)	7.16 (1.91)	0.131
CPM (impaired), n (%)	14 (24.13%)	9 (22.50%)	0.851

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[1] Correspondence to: Juliana Valentim Bittencourt E-mail: juliana.valentimfisioterapia@gmail.com