The notion that a subset of individuals with chronic spinal pain (CSP) is at risk for developing widespread pain (WSP) and/or fibromyalgia (FM) is now well accepted.
The purpose of this study was to: 1) quantify the frequency with which such a transition occurs, and 2) identify the risk factors associated with the development of widespread pain and fibromyalgia.
Participants consisted of 550 patients seen in a pain clinic in 2001/2002 with diagnoses of chronic low back or neck pain; but not widespread pain.
Of note, 7% of participants diagnosed with regional spinal pain actually presented with widespread pain in 2001/2002. These participants were not included in the analyses.
• At follow up in 2007, some 23% of the original chronic spinal pain cohort had progressed to widespread pain.
A logistic regression analysis indicated that the following features predicted the development of both widespread pain and fibromyalgia:
- Initial pain intensity,
- History of abuse,
- Number of pain management strategies used,
- Widespread in family members,
- And having other central sensitization disorders (such as irritable bowel or bladder, migraine, or restless legs).
• 76% of the participants with widespread pain who came in for a tender point exam (25% response rate) were deemed to have a positive diagnosis of fibromyalgia.
In conclusion, this study demonstrates that a subset of patients with chronic spinal pain progress to the development of widespread Pain/FM. Knowledge of the predictive factors that place a person at risk for such progression should help to inform future research to mitigate the transition of chronic spinal pain to widespread Pain/FM.
(Support: NINR Grant Number 1F31NR010301-01 (PI: Kindler, LL), University Club Award, National Fibromyalgia Association, Fibromyalgia Information Foundation, Dean’s Dissertation Award.)
Source: American Pain Society Annual Meeting, May 2009, Poster #166. Kindler L, Jones K, Perrin N, Bennett R; Oregon Health & Science University, Portland, Oregon, USA.