Background/Purpose: Fibromyalgia is a condition characterized by chronic widespread pain.  Accurately assessing the subjective experience of pain using objective measures remains a challenging clinical problem, particularly among patients with Fibromyalgia. Commonly utilized self-report pain measures are often time consuming (completing and scoring), potentially decreasing their clinical utility. The current study sought to establish a reliable scoring method of pain diagrams completed by patients with primary fibromyalgia.

Methods: Prior to data collection, IRB approval was received and written consent was obtained. 43 people with fibromyalgia (42 female, 1 male), aged 25-76 years, completed this study (duration of fibromyalgia 7.55 years; range 0.25 to 20 years). Subjects filled out the Fibromyalgia Impact Questionnaire (FIQ), McGill Pain Questionnaire (MPQ) and a visual analog scale (0-10) for pain at rest and movement (walking).  Patients were instructed to mark a body diagram showing areas of pain. To assess inter-rater reliability, a scoring protocol, which included applying a transparent overlay to each patient’s diagram, was designed and tested. A score of 0-46 was assigned to each diagram, based on the number of areas marked.  Ten randomly selected diagrams were scored independently by two raters three times and inter-rater reliability assessed (intraclass correlation, ICC).  The number of body areas was correlated with pain, FIQ, and MPQ scores (Pearson’s, *p=0.05, **p=0.01).

Results: Means ± SEM:  Average pain at rest was 4.39 ± 0.39, pain with movement was 5.23 ± 0.39, FIQ was 58.17 ± 2.24 and MPQ was 44.93 ± 2.5. Scores on the body diagram (n=43) averaged 16.55 ± 1.3 (95% CI 13.92 to 19.18) with the most common areas as neck (91%), shoulders (81%), and low back (63%).  Inter-rater reliability for the body diagram scoring was excellent (ICC=0.952; 95% CI 0.912 to 0.974). Higher scores on the body diagram significantly correlated with higher scores on MPQ (R²= 0.44**), pain at rest (R²=0.324*), pain with movement (R²=0.380*) but not FIQ (R²=0.298).

Conclusion: Preliminary results indicate this protocol may be a reliable method of scoring pain diagrams among patients with Fibromyalgia and that higher scores significantly correlated with worse pain but not the impact of pain on function and quality of life (movement-pain, FIQ). These diagrams provide a quick, simple and clinically applicable self-report measure that can be completed and scored in a very brief period of time. Thus, quantitative analysis of the body diagram may be useful to gain an understanding of the severity of pain but not the global impact of pain as measured by the FIQ.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/clinical-application-of-pain-diagrams-in-fibromyalgia/