Pain Research Group, Pain Centre South, Odense University Hospital, Odense, Denmark.
Pain Research Group, Pain Centre South, Odense University Hospital, Odense, Denmark; Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark.
J Pain. 2018 Jul;19(7):777-786. doi: 10.1016/j.jpain.2018.02.009. Epub 2018 Mar 2.
Fibromyalgia (FM) is a condition with chronic widespread pain and signs of generalized pain hypersensitivity. FM has previously been classified according to the American College of Rheumatology-1990 criteria, where the presence of hypersensitivity is estimated by a tender point examination. Because of the limitations of these classification criteria, new diagnostic criteria have been proposed, abandoning this examination. This cross-sectional study investigated the prevalence of FM according to the revised 2016 FM criteria in a large cohort of chronic pain patients. Pain drawings, the FM Symptom Severity Scale, and questionnaires assessing manifestations of pain, pain-related disability, and psychological distress were collected from 1,343 patients with chronic nonmalignant pain referred to a multidisciplinary pain clinic. In addition, assessments of mechanical and thermal pain sensitivity were performed in 496 of the patients. Patients fulfilling the FM criteria (n = 498, 37%) reported significantly higher levels of pain, pain-related disability, psychological distress, and sensitivity to mechanical and heat stimuli (P < .05). Moreover, the proportion using opioids were significantly higher compared with patients not fulfilling the criteria (P = .015). Significant associations were found between heat and mechanical pain sensitivity (P < .001) indicating that patients who showed higher pain sensitivity to mechanical stimulation also showed higher pain sensitivity to thermal stimulation.
More than one-third of patients were classified as FM, and patients classified showed increased clinical and experimental pain profiles. Because no data were collected on whether the included patients had a clinical FM diagnosis, future studies validating the American College of Rheumatology-2016 criteria in a cohort of patients with chronic nonmalignant pain are warranted.
纤维肌痛（FM）是一种慢性广泛性疼痛和全身性疼痛过敏迹象的疾病。FM 以前根据美国风湿病学院 1990 年标准进行分类，通过压痛检查估计过敏的存在。由于这些分类标准的局限性，已经提出了新的诊断标准，放弃了这种检查。这项横断面研究在一个大型慢性疼痛患者队列中，根据修订后的 2016 年 FM 标准，调查了 FM 的患病率。从 1343 名慢性非恶性疼痛患者中收集了疼痛图、FM 症状严重程度量表以及评估疼痛、与疼痛相关的残疾和心理困扰表现的问卷。此外，对 496 名患者进行了机械和热痛敏感性评估。符合 FM 标准的患者（n=498，37%）报告疼痛、与疼痛相关的残疾、心理困扰和对机械和热刺激的敏感性显著更高（P<.05）。此外，与不符合标准的患者相比，使用阿片类药物的比例显著更高（P=.015）。热和机械痛敏感性之间存在显著相关性（P<.001），表明对机械刺激疼痛敏感性较高的患者对热刺激的疼痛敏感性也较高。
超过三分之一的患者被归类为 FM，被归类为 FM 的患者表现出更高的临床和实验性疼痛特征。由于没有收集关于纳入患者是否有临床 FM 诊断的数据，因此需要在慢性非恶性疼痛患者队列中验证美国风湿病学院 2016 年标准的未来研究。
