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Subgrouping of fibromyalgia patients on the basis of pressure‐pain thresholds and psychological factors
Abstract
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' λ [degrees of freedom 6,89] = 0.123, P < 0.0001), with univariate ANOVAs also indicating significant differences (all P < 0.05). 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.
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In the citing paper
“PC is a key risk factor of FM; in fact, PC is one of the most commonly used classifications to differentiate the clinical subtypes of FM [19].”
From Effectiveness of cognitive behaviour therapy for the treatment of catastrophisation in patients with fibromyalgia: A randomised controlled trial (2011) · cites this paper as [19]
In the citing paper
“PC is a key risk factor of FM; in fact, PC is one of the most commonly used classifications to differentiate the clinical subtypes of FM [19].”
From Effectiveness of cognitive behaviour therapy for the treatment of catastrophisation in patients with fibromyalgia: A randomised controlled trial (2011) · cites this paper as [19]
In the citing paper
“Catastrophization is considered a key clinical symptom in fibromyalgia; however, there are no studies on the pharmacological or psychological treatment of catastrophizing.”
From Effectiveness of the psychological and pharmacological treatment of catastrophization in patients with fibromyalgia: a randomized controlled trial. (2009) · cites this paper as [22]
In the citing paper
“Catastrophization is considered a key clinical symptom in fibromyalgia and, in fact, the most used classification of fibromyalgia clinical subtypes includes catastrophization as one of the discriminating variables [22].”
From Effectiveness of the psychological and pharmacological treatment of catastrophization in patients with fibromyalgia: a randomized controlled trial. (2009) · cites this paper as [22]
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Metadata
- Authors
- Giesecke, T., Williams, D. A., Harris, R. E., Cupps, T. R., Tian, X., Tian, T. X., Gracely, R. H., & Clauw, D. J.
- Affiliations
- University of Michigan (US)
- Georgetown University (US)
- Venue
- Arthritis & Rheumatism
- Publisher
- Wiley
- Published
- 2003-10
- Volume
- 48
- Issue
- 10
- Pages
- 2916-2922
- ISSN
- 0004-3591 (ISSN-L)
- 1529-0131
- OpenAlex
- W2086137478
- Cited by
- 424
- References
- 30
- Citations by year
- 2026: 6 · 2025: 7 · 2024: 5 · 2023: 13 · 2022: 10 · 2021: 12 · 2020: 19 · 2019: 7 · 2018: 16 · 2017: 19 · 2016: 22 · 2015: 19 · 2014: 25 · 2013: 32 · 2012: 23
- FWCI
- 7.07
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Arthritis & Rheumatism (publishedVersion)
- PubMed (publishedVersion)
- Deep Blue (University of Michigan) (submittedVersion)
- Funders
- Department of Army (DAMD 17-00-2-0018)
- NIH (5-R01-AT 000004-02)
- General Clinical Research Center Program of the National Center for Research Resources, NIH (5-M01-RR13297)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Fibromyalgia and Chronic Fatigue Syndrome Research
- Health Sciences › Medicine › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
- Health Sciences › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Myofascial pain diagnosis and treatment
- Keywords
- patient subgroups, pressure pain threshold, tenderness, hyperalgesia, pain catastrophizing, pain coping, depression, anxiety, mood, evoked pain, clustering, ACR diagnostic criteria, widespread pain, psychological factors, cognitive factors, symptom heterogeneity
- MeSH terms
- Adolescent, Adult, Cognition, Female, Fibromyalgia, Humans, Hyperalgesia, Male, Middle Aged, Pressure, Pain Threshold
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