Subgrouping of fibromyalgia patients on the basis of pressure-pain thresholds and psychological factors
Subgrouping of fibromyalgia patients on the basis of pressure-pain thresholds and psychological factors
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DOI：
10.1002/art.11272
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发表时间：
2003-10-01
影响因子：
--
通讯作者：
Clauw, DJ
中科院分区：
文献类型：
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作者：
Giesecke, T;Williams, DA;Clauw, DJ
Objective.虽然美国风湿病学会（ACR）的纤维肌痛标准用于识别广泛疼痛和压痛的个体，但符合这些标准的个体并不是一个同质的群体。患者的伴随临床症状不同，以及在生物，心理和认知因素对他们的症状表达的相对贡献。因此，根据这些因素中的哪一个来确定纤维肌痛患者的子集似乎是有用的。以前识别子集的尝试仅基于心理和认知特征。在这项研究中，我们试图通过将这些功能，以及痛觉过敏/压痛，这是一个关键的神经生物学特征，这种疾病的程度，以确定患者的子集。97名符合ACR纤维肌痛标准的个体完成了相同的自我报告和诱发疼痛测试。分析的变量从几个领域获得，包括1）情绪（由流行病学研究中心抑郁量表[抑郁]和状态-特质人格量表[特质相关焦虑症状]评估），2）认知（通过应对策略问卷的灾难化和疼痛控制子量表），和3）痛觉过敏/压痛（通过在阈上值施加的测痛法和随机压力-疼痛）。聚类分析程序用于区分基于这些领域的纤维肌痛患者的亚组。三个聚类最适合数据。多变量方差分析（ANOVA）证实，每个变量通过聚类解区分（Wilks λ [自由度6，89] = 0.123，P < 0.0001），单变量方差分析也表明存在显著差异（所有P < 0.65）。一个亚组的患者（n = 50）的特点是中度情绪评级，中度水平的灾难性和感知控制疼痛，和低水平的压痛。第二个亚组（n = 31）显示情绪评估值显著升高，灾难化子量表值最高，疼痛控制感知值最低，压痛水平较高。第三组（n = 16）有正常的情绪评级，非常低的灾难化水平，和最高水平的感知控制疼痛，但这些主题显示了极端的温柔诱发疼痛测试。这些数据有助于支持纤维肌痛患者有不同亚组的临床印象。似乎有一组纤维肌痛患者表现出极度压痛，但缺乏任何相关的心理/认知因素，一个中间组表现出中度压痛，情绪正常，一组情绪和认知因素可能会显着影响症状报告。
Objective. Although the American College of Rheumatology (ACR) criteria for fibromyalgia are used to identify individuals with both widespread pain and tenderness, individuals who meet these criteria are not a homogeneous group. Patients differ in their accompanying clinical symptoms, as well as in the relative contributions of biologic, psychological, and cognitive factors to their symptom expression. Therefore, it seems useful to identify subsets of fibromyalgia patients on the basis of which of these factors are present. Previous attempts at identifying subsets have been based solely on. psychological and cognitive features. In this study, we attempt to identify patient subsets by incorporating these features as well as the degree of hyperalgesia/tenderness, which is a key neurobiologic feature of this illness.Methods. Ninety-seven individuals meeting the ACR criteria for fibromyalgia finished the same battery of self-report and evoked-pain testing. Analyzed variables were obtained from several domains, consisting of 1) mood (evaluated by the Center for Epidemiologic Studies Depression Scale [for depression] and the State-Trait Personality Inventory [for symptoms of trait-related anxiety]), 2) cognition (by the catastrophizing and control of pain subscales of the Coping Strategies Questionnaire), and 3) hyperalgesia/tenderness (by dolorimetry and random pressure-pain applied at suprathreshold values). Cluster analytic procedures were used to distinguish subgroups of fibromyalgia patients based on these domains.Results. Three clusters best fit the data. Multivariate analysis of variance (ANOVA) confirmed that each variable was differentiated by the cluster solution (Wilks' lambda [degrees of freedom 6,89] = 0.123, P < 0.0001), with univariate ANOVAs also indicating significant differences (all P < 0.65). One subgroup of patients (n = 50) was characterized by moderate mood ratings, moderate levels of catastrophizing and perceived control over pain, and low levels of tenderness. A second subgroup (n = 31) displayed significantly elevated values on the mood Assessments, the highest values on the catastrophizing subscale, the lowest values for perceived control over pain, and high levels of tenderness. The third group (n = 16) had normal mood ratings, very low levels of catastrophizing, and the highest level of perceived control over pain, but these subjects showed extreme tenderness on evoked-pain testing.Conclusion. These data help support the clinical impression that there are distinct subgroups of patients with fibromyalgia. There appears to be a group of fibromyalgia patients who exhibit extreme tenderness but lack any associated psychological/cognitive factors, an intermediate group who display moderate tenderness and have normal mood, and a group in whom mood and cognitive factors may be significantly influencing the symptom report.