Widespread pain: is an improved classification possible?

OBJECTIVE: The classification of widespread pain, proposed by the
American College of Rheumatology (ACR) for use in the clinic
as a screen for fibromyalgia, as described, does not require
truly widespread pain. Studies considering the epidemiology
of widespread pain per se may therefore require a definition
with greater face validity, which might also show enhanced
associations with other physical and psychological measures.
We aimed to develop a more coherent definition of widespread
pain for use in epidemiological studies and to compare
performance in identifying individuals with significant
morbidity.

METHODS: A group of 172 subjects who had
participated in a community based study on the occurrence of
pain were identified and categorized by their pain experience
as indicated on line drawings of the body according to ACR
definition and to a new, more stringent definition that
required the presence of more diffuse limb pain. A number of
other clinical and psychological measures were recorded for
these individuals and the association between their pain
status measures and these other variables was assessed and
compared.

RESULTS: Persons satisfying the newly proposed
definition for chronic widespread pain, in comparison with
those who satisfied only the present ACR definition, had a
significantly higher score on the General Health Questionnaire
[median difference (MD) 7.95% CI 1.13], a higher score on the
Health and Fatigue Questionnaire (MD 10.95% CI 0.15), and
greater problems with sleep (sleep problem score MD 4.95% CI
0.9). Those satisfying the new definition also had a greater
number of tender points on examination (MD 3.95% CI -1.7).
The morbidity of those satisfying only the present ACR
definition was closer to persons who had regional pain.

CONCLUSION: A redefinition of widespread pain has produced a
group of subjects whose pain is (a) likely to be more
"widespread" and (b) is associated more strongly with factors
such as psychological disturbance, fatigue, sleep problems,
and tender points, and may be more appropriate in
epidemiological studies.

MacFarlane GJ, Croft PR, Schollum J, Silman AJ

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