Session Information
Date: Monday, November 6, 2017
Title: Fibromyalgia, Soft Tissue Disorders, Regional and Specific Clinical Pain Syndromes
Session Type: ACR Concurrent Abstract Session
Session Time: 4:30PM-6:00PM
Background/Purpose: Fibromyalgia is challenging to diagnose given its overlapping symptoms with other chronic pain conditions. The most characteristic feature of FM is widespread pain, operationalized by the 2016 FM Survey Criteria as involving at least 4 out of 5 body regions (axial region and limbs). We hypothesized that certain pain locations may be virtually pathognomonic of FM, because these pain sites occur commonly in FM patients but are very uncommon in individuals without FM.
Methods: This is a single center retrospective observational study of patients recruited prior to elective surgery to be in an institutional biorepository. Patients completed the Michigan Body Map to assess the presence or absence of pain in 35 body sites, as well as the 2011 FM Survey Criteria. FM symptom (FS) scores were calculated by adding the widespread pain index (WPI) and symptom severity (SS) scale. Based on the 2016 Modified FM Criteria, patients were diagnosed with FM if they reported pain in 4+ body regions and their FS scores were 12+. Controls were patients that did not meet the criteria. Univariate differences were assessed via t-tests and chi-square tests. Multivariate linear regression accounted for age and gender.
Results: 891 patients (5.5%) out of 16,273 patients were diagnosed with FM. Median age for FM patients was 53 vs 54 (p = 0.62) and 72% female vs 52% (p < 0.0001). Pain sites with the highest odds ratios between FM patients and controls were the left upper arm (23.9), left lower arm (23.4), right upper arm (22.6), right lower arm (21.8), left shoulder (21.6), and right shoulder (18.7). Upon multivariate analysis, statistically significant sites were the head (p = 0.006), face (p = 0.04), left upper arm (p = 0.004), left lower arm (p = 0.0001), left wrist/hand (p = 0.02), left knee (p < 0.0001), left lower leg (p = 0.002), left ankle/foot (p = 0.007), right jaw (p = 0.01), right upper arm (p = 0.006), right elbow (p < 0.0001), right lower arm (p < 0.0001), right wrist/hand (p < 0.0001), right knee (p < 0.0001), and right lower leg (p = 0.001). See Table 1 for the results of all queried body sites.
Conclusion: Pain in non-joint regions of all four limbs, in addition to the head, face and jaw, were all statistically more significantly seen in individuals with FM and unusual in non-FM patients. Though other regions of pain were also commonly seen in FM, because they were also seen in non-FM patients, they would not be helpful in differentiating a chronic pain patient with FM vs. one with a different underlying cause.
Table 1:
|
Site
|
FM Patients
|
Controls
|
Odds Ratio
|
Multivariate Analysis p-value
|
|
Head |
41.6% |
8.7% |
7.5 (6.5 – 8.7) |
0.006
|
|
Face |
10.2% |
2.5% |
4.4 (3.4 – 5.6) |
0.04
|
|
Neck |
66.4% |
13.8% |
12.4 (10.7 – 14.4) |
0.08 |
|
Upper Back |
53.2% |
7.4% |
14.2 (12.2 – 16.4) |
0.79 |
|
Abdomen |
35.8% |
8.9% |
5.7 (4.9 – 6.6) |
0.53 |
|
Lower Back |
84.5% |
30.0% |
12.7 (10.5 – 15.4) |
0.10 |
|
Pelvis |
27.6% |
7.3% |
4.9 (4.1 – 5.7) |
0.80 |
|
Left Jaw |
20.2% |
3.1% |
8.0 (6.6 – 9.6) |
0.09 |
|
Left Shoulder |
71.4% |
10.3% |
21.6 (18.5 – 25.3) |
0.47 |
|
Left Upper Arm |
34.0% |
2.1% |
23.9 (20.0 – 28.7) |
0.004
|
|
Left Elbow |
31.0% |
2.7% |
16.0 (13.4 – 19.1) |
0.11 |
|
Left Lower Arm |
29.0% |
1.7% |
23.4 (19.3 – 28.4) |
0.0001
|
|
Left Wrist/Hand |
59.6% |
9.6% |
13.9 (12.0 – 16.0) |
0.02
|
|
Left Buttocks |
20.1% |
3.1% |
8.0 (6.6 – 9.6) |
0.58 |
|
Left Chest/Breast |
16.5% |
2.5% |
7.6 (6.2 – 9.4) |
0.17 |
|
Left Hip |
66.4% |
11.1% |
15.8 (13.6 – 18.4) |
0.64 |
|
Left Groin |
15.3% |
3.9% |
4.5 (3.6 – 5.5) |
0.29 |
|
Left Upper Leg |
40.2% |
5.2% |
12.2 (10.4 – 14.2) |
0.15 |
|
Left Knee |
59.6% |
16.6% |
7.4 (6.4 – 8.6) |
0.0000
|
|
Left Lower Leg |
46.7% |
5.8% |
14.1 (12.2 – 16.4) |
0.002
|
|
Left Ankle/Foot |
57.6% |
12.1% |
9.8 (8.5 – 11.4) |
0.007
|
|
Right Jaw |
21.8% |
3.1% |
8.8 (7.3 – 10.6) |
0.01
|
|
Right Shoulder |
70.8% |
11.5% |
18.7 (16.0 – 21.8) |
0.18 |
|
Right Upper Arm |
33.6% |
2.2% |
22.6 (18.9 – 27.1) |
0.006
|
|
Right Elbow |
29.9% |
3.0% |
13.6 (11.4 – 16.2) |
0.0000
|
|
Right Lower Arm |
27.3% |
1.7% |
21.8 (17.9 – 26.5) |
0.0000
|
|
Right Wrist/Hand |
61.6% |
10.0% |
14.4 (12.5 – 16.7) |
0.0000
|
|
Right Buttocks |
19.5% |
3.1% |
7.5 (6.2 – 9.1) |
0.77 |
|
Right Chest/Breast |
16.2% |
2.5% |
7.5 (6.1 – 9.3) |
0.84 |
|
Right Hip |
64.9% |
11.2% |
14.6 (12.6 – 17.0) |
0.17 |
|
Right Groin |
16.3% |
4.0% |
4.6 (3.8 – 5.7) |
0.09 |
|
Right Upper Leg |
41.0% |
5.2% |
12.5 (10.7 – 14.6) |
0.30 |
|
Right Knee |
61.1% |
16.7% |
7.8 (6.8 – 9.0) |
0.0000
|
|
Right Lower Leg |
47.0% |
5.6% |
15.0 (12.9 – 17.5) |
0.001
|
|
Right Ankle/Foot |
57.8% |
12.5% |
9.6 (8.3 – 11.1) |
0.10 |
To cite this abstract in AMA style:
Lu L, Moser S, Brummett CM, Clauw DJ. Identifying Pain Sites Highly Associated with the Fibromyalgia (FM) Phenotype [abstract]. Arthritis Rheumatol. 2017; 69 (suppl 10). https://acrabstracts.org/abstract/identifying-pain-sites-highly-associated-with-the-fibromyalgia-fm-phenotype/. Accessed .ACR Meeting Abstracts - https://acrabstracts.org/abstract/identifying-pain-sites-highly-associated-with-the-fibromyalgia-fm-phenotype/