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Revised chronic widespread pain criteria: development from and integration with fibromyalgia criteria
Natl Data Bank Rheumat Dis, Wichita, KS 67214 USA;Univ Kansas, Sch Med, 1035 N Emporia,Ste 288, Wichita, KS 67214 USA.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine. Acad Hosp Uppsala, Pain Ctr, Uppsala, Sweden;St Olavs Hosp, Ctr Pain & Complex Disorders, Trondheim, Norway.
McGill Univ, Hlth Ctr, Montreal, PQ, Canada.
Klinikum Saarbrucken, Dept Internal Med 1, Saarbrucken, Germany;Tech Univ Munich, Dept Psychosomat Med & Psychotherapy, Munich, Germany.
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2020 (English)In: Scandinavian Journal of Pain, ISSN 1877-8860, E-ISSN 1877-8879, Vol. 20, no 1, p. 77-86Article in journal (Refereed) Published
Abstract [en]

Background and aims:

Persons with chronic widespread pain (CWP) have poor medical outcomes and increased mortality. But there are no universally accepted criteria for CWP or of methods to assess it. The most common criteria come from the 1990 American College of Rheumatology (ACR) fibromyalgia (FM) criteria, but that method (WP1990) can identify CWP with as few as three pain sites, and in subjects with wide differences in illness severity. Recently, to correct WP1990 deficiencies, the 2016 fibromyalgia criteria provided a modified CWP definition (WP2016) by dividing the body into five regions of three pain sites each and requiring a minimum of four regions of pain. Although solving the geographic problem of pain distribution, the problem of just how many pain sites (pain diffuseness) are required remained a problem, as WP2016 required as few as four painful sites. To better characterize CWP, we compared four CWP definitions with respect to symmetry, extent of pain sites and association with clinical severity variables.

Methods:

We characterized pain in 40,960 subjects, including pain at 19 individual sites and five pain regions, and calculated the widespread pain index (WPI) and polysymptomatic distress scales (PDS) from epidemiology, primary care and rheumatology databases. We developed and evaluated a new definition for CWP, (WP2019), defined as pain in four or five regions and a pain site score of at least seven of 15 sites. We also tested a definition based on the number of painful sites (WPI >= 7).

Results:

In rheumatology patients, WP1990 and WPI >= 7 classified patients with <4 regions as WSP. CWP was noted in 51.3% by WP1990, 41.7% by WP2016, 37.6% of WPI >= 7 and 33.9% by WP2019. 2016 FM criteria was satisfied in WP1990 (51.1%), WP2016 (63.3%), WPI >= 7 (69.0%) and WP2019 (76.6%). WP2019 positive patients had more severe clinical symptoms compared with WP1990, WP2016 and WPI >= 7, and similar to but less than FM 2016 positive patients. In stepwise fashion, scores for functional disability, visual analog scale fatigue and pain, WPI, polysymptomatic distress score and Patient Health Questionnaire 15 (PHQ-15) worsened from WP1990 through WP2016, WPI >= 7 and WP2019.

Conclusions:

WP2019 combines the high WPI scores of WPI >= 7 and the symmetry of WP2016, and is associated with the most abnormal clinical scores. The WP1990 does not appear to be an effective measure. We suggest that CWP can be better defined by combining 4-region pain and a total pain site score >= 7 (WP2019). This definition provides a simple, unambiguous measure that is suitable for clinical and research use as a standalone diagnosis that is integrated with fibromyalgia definitions.

Implications:

Definitions of CWP in research and clinic care are arbitrary and have varied, and different definitions of CWP identify different sets of patients, making a universal interpretation of CWP uncertain. In addition, CWP is a mandatory component of some fibromyalgia criteria. Our study provides quantitative data on the differences between CWP definitions and their criteria, allowing better understanding of research results and a guide to the use of CWP in clinical care.

Place, publisher, year, edition, pages
2020. Vol. 20, no 1, p. 77-86
Keywords [en]
widespread pain, fibromyalgia, criteria
National Category
Rheumatology and Autoimmunity
Identifiers
URN: urn:nbn:se:uu:diva-402629DOI: 10.1515/sjpain-2019-0054ISI: 000504845500011PubMedID: 31596726OAI: oai:DiVA.org:uu-402629DiVA, id: diva2:1386442
Available from: 2020-01-17 Created: 2020-01-17 Last updated: 2020-01-17Bibliographically approved

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Butler, Stephen H

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