Dean Linda E, Arnold Lesley, Crofford Leslie, Bennett Robert, Goldenberg Don, Fitzcharles Mary-Ann, Paiva Eduardo S, Staud Roland, Clauw Dan, Sarzi-Puttini Piercarlo, Jones Gareth T, Ayorinde Abimbola, Flüß Elisa, Beasley Marcus, Macfarlane Gary J
University of Aberdeen, Aberdeen, UK.
University of Cincinnati, Cincinnati, Ohio.
Arthritis Care Res (Hoboken). 2017 Dec;69(12):1878-1886. doi: 10.1002/acr.23214. Epub 2017 Nov 2.
To investigate whether associations between pain and the additional symptoms associated with fibromyalgia are different in persons with chronic widespread pain (CWP) compared to multisite pain (MSP), with or without joint areas.
Six studies were used: 1958 British birth cohort, Epidemiology of Functional Disorders, Kid Low Back Pain, Managing Unexplained Symptoms (Chronic Widespread Pain) in Primary Care: Involving Traditional and Accessible New Approaches, Study of Health and its Management, and Women's Health Study (WHEST; females). MSP was defined as the presence of pain in ≥8 body sites in adults (≥10 sites in children) indicated on 4-view body manikins, conducted first to include joints (positive joints) and second without (negative joints). The relationship between pain and fatigue, sleep disturbance, somatic symptoms, and mood impairment was assessed using logistic regression. Results are presented as odds ratios (ORs) with 95% confidence intervals (95% CIs).
There were 34,818 participants across the study populations (adults age range 42-56 years, male 43-51% [excluding WHEST], and CWP prevalence 12-17%). Among those reporting MSP, the proportion reporting CWP ranged between 62% and 76%. Among those reporting the symptoms associated with fibromyalgia, there was an increased likelihood of reporting pain, the magnitude of which was similar regardless of the definition used. For example, within WHEST, reporting moderate/severe fatigue (Chalder fatigue scale 4-11) was associated with a >5-fold increase in likelihood of reporting pain (CWP OR 5.2 [95% CI 3.9-6.9], MSP-positive joints OR 6.5 [95% CI 5.0-8.6], and MSP-negative joints OR 6.5 [95% CI 4.7-9.0]).
This large-scale study demonstrates that regardless of the pain definition used, the magnitude of association between pain and other associated symptoms of fibromyalgia is similar. This finding supports the continued collection of both when classifying fibromyalgia, but highlights the fact that pain may not require to follow the definition outlined within the 1990 American College of Rheumatology criteria.
调查慢性广泛性疼痛（CWP）患者与多部位疼痛（MSP）患者（无论有无关节区域）相比，疼痛与纤维肌痛相关的其他症状之间的关联是否存在差异。
使用了六项研究：1958年英国出生队列、功能性障碍流行病学、儿童下背痛、初级保健中不明原因症状（慢性广泛性疼痛）的管理：纳入传统且可行的新方法、健康及其管理研究以及女性健康研究（WHEST；女性）。MSP定义为在成人（儿童≥10个部位）的4视图人体模型上显示≥8个身体部位存在疼痛，首先包括关节（阳性关节），其次不包括关节（阴性关节）。使用逻辑回归评估疼痛与疲劳、睡眠障碍、躯体症状和情绪障碍之间的关系。结果以比值比（OR）和95%置信区间（95%CI）表示。
研究人群共有34,818名参与者（成人年龄范围42 - 56岁，男性占43 - 51%[不包括WHEST]，CWP患病率12 - 17%）。在报告MSP的人群中，报告CWP的比例在62%至76%之间。在报告与纤维肌痛相关症状的人群中，报告疼痛的可能性增加，无论使用何种定义，其增加幅度相似。例如，在WHEST中，报告中度/重度疲劳（查尔德疲劳量表4 - 11）与报告疼痛的可能性增加>5倍相关（CWP的OR为5.2[95%CI 3.9 - 6.9]，MSP阳性关节的OR为6.5[95%CI 5.0 - 8.6]，MSP阴性关节的OR为6.5[95%CI 4.7 - 9.0]）。
这项大规模研究表明，无论使用何种疼痛定义，疼痛与纤维肌痛其他相关症状之间的关联程度相似。这一发现支持在对纤维肌痛进行分类时同时收集两者，但突出了疼痛可能无需遵循1990年美国风湿病学会标准中概述的定义这一事实。
