Prevalence of the fibromyalgia phenotype in patients with spine pain presenting to a tertiary care pain clinic and the potential treatment implications.
Prevalence of the fibromyalgia phenotype in patients with spine pain presenting to a tertiary care pain clinic and the potential treatment implications.
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DOI：
10.1002/art.38178
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发表时间：
2013-12
影响因子：
--
通讯作者：
Hassett, Afton L.
中科院分区：
文献类型：
--
作者：
Brummett, Chad M.;Goesling, Jenna;Tsodikov, Alex;Meraj, Taha S.;Wasserman, Ronald A.;Clauw, Daniel J.;Hassett, Afton L.
注射治疗脊椎疼痛的失败率很高，强调了患者选择的重要性。检测纤维肌痛样表型的存在可能有助于预测，因为在这些个体中，外周注射无法解决由于中枢神经传递改变而引起的疼痛。我们假设符合纤维肌痛调查标准的脊柱疼痛患者与不符合标准的患者在表型上有所不同。对 548 名原发性脊柱疼痛诊断患者进行了研究。所有患者均完成了经过验证的自我报告问卷，包括简要疼痛量表、PainDETECT、医院焦虑和抑郁量表、身体功能测量以及美国风湿病学会纤维肌痛调查标准。 42% 符合纤维肌痛 (FM+) 的调查标准。与标准阴性患者相比，FM+患者更有可能更年轻、失业、接受补偿、具有更大的疼痛强度、疼痛干扰和神经性疼痛描述符，以及更高水平的抑郁和焦虑以及更低的身体功能水平（每次比较p < 0.0001）。在多变量分析中，性别、神经性疼痛、疼痛干扰、身体功能和焦虑是纤维肌痛状态的独立预测因素（p < 0.01，所有变量）。 ROC 分析显示，通过交叉验证的 C 统计量测得的关联强度为 0.81。使用纤维肌痛的调查标准，我们证明了脊柱疼痛人群的深刻表型差异。尽管仅通过调查无法证实集中性疼痛，但纤维肌痛的病理生理学可能有助于解释脊柱干预反应的部分变异性。
Injections for spinal pain have high failure rates, emphasizing the importance of patient selection. It is possible that detecting the presence of a fibromyalgia-like phenotype could aid in prediction, because in these individuals a peripheral injection would not address pain due to alterations in central neurotransmission. We hypothesized that spine pain patients meeting survey criteria for fibromyalgia would be phenotypically distinct from those who do not meet criteria. 548 patients with a primary spine pain diagnosis were studied. All patients completed validated self-report questionnaires, including the Brief Pain Inventory, PainDETECT, Hospital Anxiety and Depression Scale, measures of physical function, and the American College of Rheumatology survey criteria for fibromyalgia. 42% met survey criteria for fibromyalgia (FM+). When compared with criteria negative patients, FM+ patients were more likely to be younger, unemployed, receiving compensation, have greater pain intensity, pain interference and neuropathic pain descriptors, as well as higher levels of depression and anxiety, and lower level of physical function (p < 0.0001 for each comparison). Gender, neuropathic pain, pain interference, physical function, and anxiety were independently predictive of fibromyalgia status in a multivariate analysis (p < 0.01, all variables). ROC analysis showed the strength of association of 0.81 as measured by the cross-validated C-statistic. Using the survey criteria for fibromyalgia, we demonstrated profound phenotypic differences in a spine pain population. Although centralized pain cannot be confirmed with a survey alone, the pathophysiology of fibromyalgia may help explain a portion of the variability of responses to spine interventions.
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影响因子：
--
作者：
Giesecke, T;Gracely, RH;Clauw, DJ
通讯作者：
Clauw, DJ
影响因子：
158.5
作者：
Lord, SM;Barnsley, L;Bogduk, N
通讯作者：
Bogduk, N
影响因子：
3
作者：
Dreyfuss, P;Halbrook, B;Joshi, A
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Joshi, A
影响因子：
4.5
作者：
Cohen, Steven P.;Stojanovic, Milan P.;Hurley, Robert W.
通讯作者：
Hurley, Robert W.
影响因子：
7.4
作者：
Glombiewski, Julia A.;Sawyer, Alice T.;Hofmann, Stefan G.
通讯作者：
Hofmann, Stefan G.