Häuser, Winfried

Katz, Robert S.

Rasker, Johannes J.

Walitt, Brian T.

Wolfe, Frederick

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Symptom Increase in Fibromyalgia Is Not Consistent with the Central Sensitization or Central Hyperresponsiveness Hypothesis

University of Twente Research Information

See discussions, stats, and author profiles for this publication at: https://www.researchgate.net/publication/284574199Symptom increase in fibromyalgia is not consistent with the centralsensitization or central hyperresponsiveness hypothesisArticle · January 2014CITATION1READS985 authors, including:Some of the authors of this publication are also working on these related projects:fibromyalgia View projectBIOMARKERS OF FIBROMYALGIA View projectFred WolfeNational Data Bank for Rheumatic Diseases679 PUBLICATIONS   79,247 CITATIONS   SEE PROFILEJohannes Jacobus RaskerUniversity of Twente268 PUBLICATIONS   7,043 CITATIONS   SEE PROFILEWinfried HäuserKlinikum Saarbrücken519 PUBLICATIONS   10,354 CITATIONS   SEE PROFILEAll content following this page was uploaded by Winfried Häuser on 16 December 2015.The user has requested enhancement of the downloaded file.pdfcrowd.comSession Title: Fibromyalgia, Soft TissueDisorders, Regional and Specific ClinicalPain Syndromes I: Research PerspectivesSession Type: Abstract Submissions (ACR)ABSTRACT NUMBER: 892Symptom Increase in Fibromyalgia Is Not Consistent withthe Central Sensitization or Central HyperresponsivenessHypothesisFrederick Wolfe , Brian T. Walitt , Johannes Rasker , Robert S. Katz  and Winfried Häuser ,National Data Bank for Rheumatic Diseases, Wichita, KS, Rheumatology, Washington HospitalCenter, Washington, DC, Dpt. Psychology, Health and Technology, University Twente, Enschede,Netherlands, Rush Medical College, Chicago, IL, Klinikum Saarbrücken, Saarbrücken, GermanyMeeting: 2014 ACR/ARHP Annual MeetingKeywords: Central sentivity syndrome, fibromyalgia and painSESSION INFORMATIONBackground/Purpose: The current dominant hypothesis explains fibromyalgia (FM) as acentralized pain state in which the CNS originates or amplifies pain, which is then accompaniedby fatigue, memory problems, and sleep and mood disturbances . The often noted “pan-positivereview of symptoms” is attributed to central hyperresponsiveness not to psychological factors or“somatization.”  Surprisingly, this explanation of non-pain symptoms has never been validated. Asfibromyalgia and widespread pain (WP) have been accepted as evidence of the presence ofcentral sensitization (CS), we used the widespread pain index (WPI), a non-symptom containingcomponent of the polysymptomatic distress scale (PSD), to test whether the rate of increase innon pain symptoms as WP increased was greater in the presence of PSD defined fibromyalgia andWSP then in their absence.Methods: We studied 3,562 mixed rheumatic disease patients, and diagnosed FM by modifiedACR FM criteria. To preclude bias because of the non-pain symptoms included in the PSD, weused WPI alone and as a surrogate for the PSD. We formed an ad hoc fibromyalgia symptom count(FSC) (0-19) by summing 19 non-pain related symptoms. We used linear splines and regressionmodels to calculate separate slopes for symptom prediction at WPI levels between 0-6 and 7-19.An increase in the slope of the 7-19 WPI scores compared with the 0-6 WPI scores was accepted asevidence of the effect of CS.Results: 96% of those with a WPI score ≥7 satisfied WP criteria, and FM was correctly classified in89% (kappa 0.703). The FSC increased monotonically as WPI increased (Figure 1), and the slope forWPI 0-6 was 0.68 compared with 0.25 for 7-12 (P<0.001). For each of the 19 symptoms examined,slopes were compared by odds ratios and were significantly lower in the 7-12 group (Table 1).Conclusion: Our data show no increase in non-pain symptom slopes in subjects with high WPI.Instead, symptom increase is monotonic, and the rate of increase is greater at lower levels of WPI.Alternative hypotheses for increase in symptoms should include factors such non-CS pain and1 2 3 4 51 234 511pdfcrowd.comAlternative hypotheses for increase in symptoms should include factors such non-CS pain andpsychological variables.References 1. Clauw DJ. Fibromyalgia: A Clinical Review. JAMA. 2014;311(15):1547-1555.Table 1. Odds ratios (OR) for rate of symptoms in WPI ≥7 compared with 0-6Variable OR Variable OR Variable ORDiarrhea 0.85 Nausea 0.79 Tinnitus 0.90Dizziness 0.83 Paresthesias 0.81 Vision prob 0.83Dry eyes 0.88 Photosensitivity 0.86 Vomiting 0.87Dry mouth 0.85 Bruising 0.82 Alopecia 0.89Dyspnea 0.88 Heartburn 0.85 Anorexia 0.83Hearing prob 0.87 Rash 0.92* AsthmaUrticaria 0.83 Reynaud’s 0.91 Constipation 0.84Oral ulcer 0.84 Seizures 0.89* Fever 0.84Muscle weakness 0.77 Dysgeusia 0.82 Itching 0.86*Not significantpdfcrowd.comDisclosure:F. Wolfe,None;B. T. Walitt,None;J. Rasker,None;R. S. Katz,None;W. Häuser,None.ACR Meeting Abstracts - http://acrabstracts.org/abstract/symptom-increase-in-fibromyalgia-is-not-consistent-with-the-central-sensitization-or-central-hyperresponsiveness-hypothesis/View publication stats

Symptom Increase in Fibromyalgia Is Not Consistent with the Central Sensitization or Central Hyperresponsiveness Hypothesis

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