Defining Pain for Fibromyalgia Criteria: Multi-Site or Widespread? an Analysis of Data from Four UK Population-Based Studies

Gary J. Macfarlane¹, Linda E. Dean¹, Robert Bennett², Leslie J. Crofford³, Abimbola Ayorinde¹, Elisa Fluess¹, Daniel J. Clauw⁴, Mary-Ann Fitzcharles⁵, Don Goldenberg⁶, Eduardo Paiva⁷, Roland Staud⁸ and Lesley Arnold⁹, ¹Musculoskeletal Research Collaboration (Epidemiology Group), University of Aberdeen, Aberdeen, United Kingdom, ²SN-Office of Research & Development, Oregon Health & Science Univ, Portland, OR, ³Medicine, Vanderbilt University, Nashville, TN, ⁴Anesthesiology, University of Michigan, Ann Arbor, MI, ⁵MGH, Montreal, QC, Canada, ⁶Newton-Wellesley Hospital, Newton, MA, ⁷Sociedade Brasileira de Reumatologia, São Paulo, Brazil, ⁸University of Florida, Gainesville, FL, ⁹University of Cincinnati, Cincinnati, OH

Meeting: 2015 ACR/ARHP Annual Meeting

Date of first publication: September 29, 2015

Keywords: Epidemiologic methods, fibromyalgia and pain

Session Information

Date: Sunday, November 8, 2015

Title: Fibromyalgia: Insights Into Diagnostic Criteria and Symptom Epidemiology

Session Type: ACR Concurrent Abstract Session

Session Time: 2:30PM-4:00PM

Background/Purpose: The 1990 criteria for fibromyalgia (FM) remain the only set approved by the American College of Rheumatology (ACR). They require that pain be both widespread (i.e. occurs in contralateral body quadrants and in the axial skeleton) and have been present for three months. Subsequent preliminary ACR criteria in 2010 and modification for self-report require only that the pain be multi-site. As part of the Analgesic, Anesthetic, and Addiction Clinical Trial Translations, Innovations, Opportunities, and Networks (ACTTION) initiative developing a new taxonomy for pain conditions, we have investigated whether associations with features are stronger in persons with chronic widespread pain (CWP) compared to multi-site pain (MSP).

Methods: We have used four population-based studies conducted in the UK: 1958 Birth Cohort study, EpiFunD, SHAMA and WHeSt. In all studies participants were asked “Have you experienced pain in the past month lasting at least a day” – those responding positively shaded the site(s) of pain on 4-view body manikins and indicated if pain had been present for ≥ 3 months. Manikins were coded for pain at 35 individual sites. We determined the number of pain sites indicated and whether subjects met the ACR 1990 criteria definition of CWP. Information was collected across at least two studies on each of: fatigue (Chalder Fatigue or SF-36 vitality scale), Sleep (Sleep Problem Scale or 2010 modified preliminary ACR criteria question) and mood (General Health Questionnaire, Hospital Anxiety and Depression Scale, PROMIS). Relationships with pain reporting were determined by logistic regression, specifically comparing amongst those with MSP, persons with and without CWP.

Results:

There were a total of 28,789 subjects across studies (mean age 42-55 years; males 43-52% [WHeSt was conducted only in females]). Prevalence of CWP, across studies was 12-17%, and in each study the equivalent prevalence was obtained by defining multi-site pain (MSP) as ≥8 sites. Amongst persons with MSP, the proportion also with CWP varied between 62-72%. Those with CWP were more likely to report sleep problems (SHAMA: OR_{CWP vs. no CWP}2.99, 95% CI 1.66-5.38; EpiFunD: 2.26, 1.69-3.02), have depression/high levels of distress (1958 Birth cohort: 1.51, 1.15-1.98; WHeSt 3.00, 95% CI 1.42-6.31; EpiFunD 1.99, 1.32-2.98) and be more likely to report fatigue (SHAMA: OR 2.85, 95% CI 1.54-5.26; WHeSt: 1.23, 0.80-1.88).

Conclusion:

We have found that a definition of MSP as at least 8 (of 35) pain sites consistently results in a similar population prevalence to that of CWP, and that the defined groups are similar but not the same. The results suggest that amongst persons with MSP, those with CWP are significantly more likely to exhibit features typical of fibromyalgia.

Disclosure: G. J. Macfarlane, None; L. E. Dean, None; R. Bennett, None; L. J. Crofford, None; A. Ayorinde, None; E. Fluess, None; D. J. Clauw, Abbott Laboratories, 5,Cerephex, 5,Eli Lilly and Company, 5,Forrest Laboratories, 5,Johnson & Johnson, 5,Merck Pharmaceuticals, 5,Pfizer Inc, 5,Purdue Pharma L.P., 5,Samumed, 5,Theravance, 5,Tonix, 5,UCB, 5,Zynerba, 5,Abbott Laboratories, 6,Cerephex, 6,Eli Lilly and Company, 6,Forest Laboratories, 6,Johnson & Johnson, 6,Merck Pharmaceuticals, 6,Pfizer Inc, 6,Purdue Pharma L.P., 6,Samumed, 6,Theravance, 6,Tonix, 6,UCB, 6,Zynerba, 6; M. A. Fitzcharles, Abbvie, 5,Amgen, 5,Janssen Pharmaceutica Product, L.P., 5,Bristol-Myers Squibb, 5,Johnson & Johnson, 5,Janssen Pharmaceutica Product, L.P., 8,Eli Lilly and Company, 8,Johnson & Johnson, 8; D. Goldenberg, Pfizer Inc, 5,Pfizer Inc, 6; E. Paiva, Pfizer Inc, 8; R. Staud, None; L. Arnold, Pfizer Inc, 2,Eli Lilly and Company, 2,Forest Laboratories, 2,Daiichi Pharmaceutical Co, 2,Theravance, 2,Tonix, 2,Pfizer Inc, 5,Forest Laboratories, 5,Daiichi Pharmaceutical Co., 5,Theravance, 5,Innovative Med Concepts, 5,Ironwood, 5,Zynerba, 5,Pfizer Inc, 8.

To cite this abstract in AMA style:

Macfarlane GJ, Dean LE, Bennett R, Crofford LJ, Ayorinde A, Fluess E, Clauw DJ, Fitzcharles MA, Goldenberg D, Paiva E, Staud R, Arnold L. Defining Pain for Fibromyalgia Criteria: Multi-Site or Widespread? an Analysis of Data from Four UK Population-Based Studies [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/defining-pain-for-fibromyalgia-criteria-multi-site-or-widespread-an-analysis-of-data-from-four-uk-population-based-studies/. Accessed .

« Back to 2015 ACR/ARHP Annual Meeting

ACR Meeting Abstracts - https://acrabstracts.org/abstract/defining-pain-for-fibromyalgia-criteria-multi-site-or-widespread-an-analysis-of-data-from-four-uk-population-based-studies/