Pain extent is associated with pain intensity but not with widespread pressure or thermal pain sensitivity in women with fibromyalgia syndrome

Abstract

Widespread pain is considered a sign of central sensitization in people with chronic pain. Our aim was to examine whether pain extent, assessed from the pain drawing, relates to measures from quantitative sensory testing in fibromyalgia syndrome (FMS). Thirty women with FMS and no other co-morbid conditions completed pain drawings (dorsal and ventral views) and clinical and related disability questionnaires. Pain extent and pain frequency maps were obtained from the pain drawings using a novel customized software. Pressure pain thresholds were assessed over the 18 tender points considered by the 1990 American College of Rheumatology criteria for FMS diagnosis and over two additional standardized points. Heat and cold pain thresholds were also assessed on the dorsal aspect of the neck, the dorsal aspect of the wrist, and the tibialis anterior. Spearman's correlation coefficients were used to assess the relationship between pain extent and quantitative sensory testing outcomes as well as clinical symptoms. Larger extent of pain was associated with a higher pain intensity (dorsal area: r = 0.461, P = 0.010; total area: r = 0.593, P = 0.001), younger age (ventral area: r = -0.544, P = 0.002; total area: r = -0.409, P = 0.025), shorter history of pain (ventral area: r = -0.367, P = 0.046), and higher cold pain thresholds over the tibialis anterior muscle (r = -0.406, P = 0.001). No significant association was observed between pain extent and the remaining outcomes. Pain drawings constitute an easy and accurate approach to quantify widespread pain. Larger pain extent is associated with pain intensity but not with signs of central sensitization in women with FMS.

The Extent of Pain Is Associated With Signs of Central Sensitization in Patients With Hip Osteoarthritis

“…No significant association was found between pain extent and pain intensity (measured on the VAS) or levels of function and disability (measured on the VKS or the OHS, respectively), which contrasts with studies conducted on patients with knee OA and women with fibromyalgia . This may be associated with the mild to moderate symptoms of this study’s cohort, or could suggest that the primary pain mechanism underlying hip OA is not from peripheral nociceptive input .…”

“…No significant association was found between pain extent and pain intensity (measured on the VAS) or levels of function and disability (measured on the VKS or the OHS, respectively), which contrasts with studies conducted on patients with knee OA 23 and women with fibromyalgia. 26 This may be associated with the mild to moderate symptoms of this study's cohort, or could suggest that the primary pain mechanism underlying hip OA is not from peripheral nociceptive input. 26,68 The presence of secondary hyperalgesia highlighted above has been associated with dysfunction in the descending inhibitory systems and adds further evidence to the suggestion that central changes may be present in patients with hip OA.…”

“…28 Pain extent expressed as the combined number of pixels colored inside the frontal and dorsal body charts (the total area of pain for each participant) was measured using custom software for the analysis of pain drawings that was developed in Matlab (MathWorks, Natick, MA, U.S.A). 26,28,29,35 Pain frequency and pain location maps were also computed as previously described. 26,28,29,35 The pain frequency map is a function in which all the pain drawings are overlaid and analyzed simultaneously to indicate the most frequently reported location of pain across all included participants.…”

“…26,28,29,35 Pain frequency and pain location maps were also computed as previously described. 26,28,29,35 The pain frequency map is a function in which all the pain drawings are overlaid and analyzed simultaneously to indicate the most frequently reported location of pain across all included participants. Pain location was determined by dividing the body charts into 45 anatomical regions (22 frontal and 23 dorsal).…”

“…Pain drawings offer a practical way of quantifying pain extent and have been used to quantify the distribution of pain in patients with hip and knee OA, greater trochanteric pain syndrome, low back pain, fibromyalgia, carpal tunnel syndrome, chronic spinal pain, whiplash‐associated disorder, migraine, and tension‐type headaches . To date, only 1 study has examined the association between pain extent and clinical features of central sensitization in patients with OA .…”