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Rheumatology Advance Access originally published online on April 18, 2006
Rheumatology 2006 45(11):1409-1415; doi:10.1093/rheumatology/kel121
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© The Author 2006. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Overall fibromyalgia pain is predicted by ratings of local pain and pain-related negative affect—possible role of peripheral tissues

R. Staud1, C. J. Vierck2, M. E. Robinson4 and D. D. Price2,3

1Department of Medicine, 2Department of Neuroscience, 3Department of Oral and Maxillofacial Surgery and 4Clinical and Health Psychology, McKnight Brain Institute, University of Florida, Gainesville, Florida 32610, USA.

Correspondence to: Roland Staud, MD, Department of Medicine, University of Florida, College of Medicine Gainesville, FL 32610 0221, USA. E-mail: staudr{at}ufl.edu

Objectives. Despite variable numbers and intensities of local pain areas, fibromyalgia (FM) patients can provide overall clinical pain ratings. We hypothesized that the overall clinical pain is largely determined by the pain intensity of local body areas. Thus, we assessed the role of local body pains as predictors of overall clinical pain in FM patients.

Methods. Ratings of overall clinical pain intensity and pain-related negative affect (PRNA) were obtained from 277 FM patients. In addition, the patients identified painful body areas by shading a body pain diagram and rated the intensity of each pain area using a mechanical visual analogue scale (VAS). Hierarchical regression analyses were used to examine predictors of overall clinical FM pain intensity including PRNA, number of local pain areas, and maximal/average intensity of local pain areas.

Results. The average overall clinical pain rating of all FM patients was 4.6 (S.D. 2.3) VAS. The PRNA accounted for 19%, number of painful body areas for 9% and maximal/average local pain for 27% of the variance of overall clinical FM pain (P-values < 0.001). The combination of all factors predicted 55% of the variance in overall clinical pain intensity of FM patients.

Conclusion. Peripheral factors (maximal/average local pain and number of painful body areas) predicted most of the variance of overall clinical FM pain, suggesting that the input of pain by the peripheral tissues is clinically relevant. About 19% of the pain variance was predicted by PRNA. Thus, peripheral pain and negative affect appear to be particularly relevant for overall FM pain and may represent important targets for future therapies.

KEY WORDS: Analgesia, FM, Chronic pain, Nociception, Ratings


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