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Profiles in fibromyalgia: algometry, auditory evoked potentials and clinical characterization of different subtypes

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Abstract

The heterogeneity found in fibromyalgia (FM) patients has led to the investigation of disease subgroups, mainly based on clinical features. The aim of this study was to test the hypothesis that clinical FM subgroups are associated with different underlying pathophysiological mechanisms. Sixty-three FM patients were classified in type I or type II, according to the Fibromyalgia Impact Questionnaire (FIQ), and in mild/moderate versus severe FM, according to the severity of three cardinal symptoms considered in the American College of Rheumatology (ACR) 2010 criteria (unrefreshed sleep, cognitive problems and fatigue). To validate the subgroups obtained by these two classifications, we calculated the area under the receiver operating characteristic curves for various clinical variables and for two potential biomarkers of FM: Response to experimental pressure pain (algometry) and the amplitude/intensity slopes of the auditory evoked potentials (AEPs) obtained to stimuli of increasing intensity. The variables that best discriminated type I versus type II were those related to depression, while the indices of clinical or experimental pain (threshold or tolerance) did not significantly differ between them. The variables that best discriminated the mild/moderate versus severe subgroups were those related to the algometry. The AEPs did not allow discrimination among the generated subsets. The FIQ-based classification allows the identification of subgroups that differ in psychological distress, while the index based on the ACR 2010 criteria seems to be useful to characterize the severity of FM mainly based on hyperalgesia. The incorporation of potential biomarkers to generate or validate classification criteria is crucial to advance in the knowledge of FM and in the understanding of pathophysiological pathways.

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Notes

  1. The 1990 ACR criteria of having more than 11 tender points have received several objections: the minimum number of tender points is arbitrary and should be interpreted as a distress indicator more than a classification criteria [45, 46]. By this reason, we decided to retain all the patients for the statistical analyses.

  2. One patient with missing data was not included in the cluster analysis of the ACR criteria.

  3. Note that the FIQ item Depression showed the highest AUC, but this index is not independent of the classification criterion.

  4. Note that the Pittsburgh Sleep Quality Index (PSQI) also reaches the significance level, but this index is not independent of the classification criterion.

References

  1. Wolfe F, Smythe HA, Yunus MB, Bennett RM, Bombardier C, Goldenberg DL, Tugwell P, Campbell SM, Abeles M, Clark P (1990) The American College of Rheumatology 1990 criteria for the classification of fibromyalgia. Report of the Multicenter Criteria Committee. Arthritis Rheum 33:160–172

    Article  PubMed  CAS  Google Scholar 

  2. Giesecke T, Williams DA, Harris RE, Cupps TR, Tian X, Tian TX, Gracely RH, Clauw DJ (2003) Subgrouping of fibromyalgia patients on the basis of pressure-pain thresholds and psychological factors. Arthritis Rheum 48(10):2916–2922

    Article  PubMed  Google Scholar 

  3. Turk DC, Okifuji A, Sinclair JD, Starz TW (1996) Pain, disability, and physical functioning in subgroups of patients with fibromyalgia. J Rheumatol 23(7):1255–1262

    PubMed  CAS  Google Scholar 

  4. Turk DC, Okifuji A, Sinclair JD, Starz TW (1998) Differential responses by psychosocial subgroups of fibromyalgia syndrome patients to an interdisciplinary treatment. Arthritis Care Res 11(5):397–404

    Article  PubMed  CAS  Google Scholar 

  5. de Souza JB, Goffaux P, Julien N, Potvin S, Charest J, Marchand S (2009) Fibromyalgia subgroups: profiling distinct subgroups using the Fibromyalgia Impact Questionnaire. A preliminary study. Rheumatol Int 29(5):509–515

    Article  PubMed  Google Scholar 

  6. Wilson HD, Robinson JP, Turk DC (2009) Toward the identification of symptom patterns in people with fibromyalgia. Arthritis Rheum 61(4):527–534

    Article  PubMed  PubMed Central  Google Scholar 

  7. Rehm SE, Koroschetz J, Gockel U, Brosz M, Freynhagen R, Tölle TR, Baron R (2010) A cross-sectional survey of 3035 patients with fibromyalgia: subgroups of patients with typical comorbidities and sensory symptom profiles. Rheumatology (Oxford) 49(6):1146–1152

    Article  Google Scholar 

  8. Wilson HD, Starz TW, Robinson JP, Turk DC (2009) Heterogeneity within the fibromyalgia population: theoretical implications of variable tender point severity ratings. J Rheumatol 36(12):2795–2801

    Article  PubMed  Google Scholar 

  9. Docampo E, Collado A, Escaramís G, Carbonell J, Rivera J, Vidal J, Alegre J, Rabionet R, Estivill X (2013) Cluster analysis of clinical data identifies fibromyalgia subgroups. PLoS ONE 8(9):e74873

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  10. Torres X, Bailles E, Valdes M, Gutierrez F, Peri JM, Arias A, Gomez ECA (2013) Personality does not distinguish people with fibromyalgia but identifies subgroups of patients. Gen Hosp Psychiatry 35(6):640–648

    Article  PubMed  Google Scholar 

  11. Loevinger BL, Shirtcliff EA, Muller D, Alonso C, Coe CL (2012) Delineating psychological and biomedical profiles in a heterogeneous fibromyalgia population using cluster analysis. Clin Rheumatol 31(4):677–685

    Article  PubMed  PubMed Central  Google Scholar 

  12. Müller W, Schneider EM, Stratz T (2007) The classification of fibromyalgia syndrome. Rheumatol Int 27(11):1005–1010

    Article  PubMed  Google Scholar 

  13. Oswald J, Salemi S, Michel BA, Sprott H (2008) Use of the Short-Form-36 Health Survey to detect a subgroup of fibromyalgia patients with psychological dysfunction. Clin Rheumatol 27(7):919–921

    Article  PubMed  Google Scholar 

  14. Calandre EP, Garcia-Carrillo J, Garcia-Leiva JM, Rico-Villademoros F, Molina-Barea R, Rodriguez-Lopez CM (2011) Subgrouping patients with fibromyalgia according to the results of the Fibromyalgia Impact Questionnaire: a replication study. Rheumatol Int 31(12):1555–1559

    Article  PubMed  Google Scholar 

  15. Salgueiro M, Aira Z, Buesa I, Bilbao J, Azkue JJ (2012) Is psychological distress intrinsic to fibromyalgia syndrome? Cross-sectional analysis in two clinical presentations. Rheumatol Int 32(11):3463–3469

    Article  PubMed  Google Scholar 

  16. Aparicio VA, Carbonell-Baeza A, Ortega FB, Estevez F, Ruiz JR, Delgado-Fernández M (2011) Usefulness of tenderness to characterise fibromyalgia severity in women. Clin Exp Rheumatol 29(6 Suppl 69):S28–S33

    PubMed  CAS  Google Scholar 

  17. de Souza JB, Potvin S, Goffaux P, Charest J, Marchand S (2009) The deficit of pain inhibition in fibromyalgia is more pronounced in patients with comorbid depressive symptoms. Clin J Pain 25(2):123–127

    Article  PubMed  Google Scholar 

  18. Desmeules JA, Cedraschi C, Rapiti E, Baumgartner E, Finckh A, Cohen P, Dayer P, Vischer TL (2003) Neurophysiologic evidence for a central sensitization in patients with fibromyalgia. Arthritis Rheum 48(5):1420–1429

    Article  PubMed  CAS  Google Scholar 

  19. Gibson SJ, Littlejohn GO, Gorman MM, Helme RD, Granges G (1994) Altered heat pain thresholds and cerebral event-related potentials following painful CO2 laser stimulation in subjects with fibromyalgia syndrome. Pain 58(2):185–193

    Article  PubMed  CAS  Google Scholar 

  20. Smith BW, Tooley EM, Montague EQ, Robinson AE, Cosper CJ, Mullins PG (2008) Habituation and sensitization to heat and cold pain in women with fibromyalgia and healthy controls. Pain 140(3):420–428

    Article  PubMed  Google Scholar 

  21. Dohrenbusch R, Sodhi H, Lamprecht J, Genth E (1997) Fibromyalgia as a disorder of perceptual organization? An analysis of acoustic stimulus processing in patients with widespread pain. Z Rheumatol 56:334–341

    Article  PubMed  CAS  Google Scholar 

  22. Geisser ME, Glass JM, Rajcevska LD, Clauw DJ, Williams DA, Kileny PR, Gracely RH (2008) A psychophysical study of auditory and pressure sensitivity in patients with fibromyalgia and healthy controls. J Pain 9:417–422

    Article  PubMed  Google Scholar 

  23. Carrillo-de-la-Peña MT, Vallet M, Pérez MI, Gómez-Perretta C (2006) Intensity dependence of auditory-evoked cortical potentials in fibromyalgia patients: a test of the generalized hypervigilance hypothesis. J Pain 7(7):480–487

    Article  PubMed  Google Scholar 

  24. McDermid AJ, Rollman GB, McCain GA (1996) Generalized hypervigilance in fibromyalgia: evidence of perceptual amplification. Pain 66(2–3):133–144

    Article  PubMed  CAS  Google Scholar 

  25. Meeus M, Nijs J (2007) Central sensitization: a biopsychosocial explanation for chronic widespread pain in patients with fibromyalgia and chronic fatigue syndrome. Clin Rheumatol 26(4):465–473

    Article  PubMed  PubMed Central  Google Scholar 

  26. Julien N, Goffaux P, Arsenault P, Marchand S (2005) Widespread pain in fibromyalgia is related to a deficit of endogenous pain inhibition. Pain 114(1–2):295–302

    Article  PubMed  Google Scholar 

  27. Lautenbacher S, Rollman GB (1997) Possible deficiencies of pain modulation in fibromyalgia. Clin J Pain 13(3):189–196

    Article  PubMed  CAS  Google Scholar 

  28. Russell IJ, Larson AA (2009) Neurophysiopathogenesis of fibromyalgia syndrome: a unified hypothesis. Rheum Dis Clin N Am 35:421–435

    Article  Google Scholar 

  29. Sommer C (2004) Review Serotonin in pain and analgesia: actions in the periphery. Mol Neurobiol 30(2):117–125

    Article  PubMed  CAS  Google Scholar 

  30. Vanegas H, Schaible HG (2004) Descending control of persistent pain: inhibitory or facilitatory? Brain Res Brain Res Rev 46(3):295–309

    Article  PubMed  Google Scholar 

  31. Millan MJ (2002) Descending control of pain. Prog Neurobiol 66:355–474

    Article  PubMed  CAS  Google Scholar 

  32. Cools R, Roberts AC, Robbins TW (2008) Serotoninergic regulation of emotional and behavioural control processes. Trends Cogn Sci 12(1):31–40

    Article  PubMed  Google Scholar 

  33. Hegerl U, Juckel G (1993) Intensity dependence of auditory evoked potentials as an indicator of central serotonergic neurotransmission: a new hypothesis. Biol Psychiatry 33:173–187

    Article  PubMed  CAS  Google Scholar 

  34. Harth M, Nielson WR (2007) The fibromyalgia tender points: use them or lose them? A brief review of the controversy. J Rheumatol 34(5):914–922

    PubMed  Google Scholar 

  35. Mease P, Arnold LM, Choy EH, Clauw DJ, Crofford LJ, Glass JM, Martin SA, Morea J, Simon L, Strand CV, Williams DA, OMERACT Fibromyalgia Working Group (2009) Fibromyalgia syndrome module at OMERACT 9: domain construct. J Rheumatol 36(10):2318–2329

    Article  PubMed  PubMed Central  Google Scholar 

  36. Geisser MEGR, Giesecke T, Petzke F, Williams DA, Clauw DJ (2007) The association between experimental and clinical pain measures among persons with fibromyalgia and chronic fatigue syndrome. Eur J Pain 11:202–207

    Article  PubMed  Google Scholar 

  37. Buysse DJ, Charles F, Reynolds TH, Berman SR, Kupfer DJ (1989) The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Res 28(2):193–213

    Article  PubMed  CAS  Google Scholar 

  38. Beck AT, Steer RA, Garbin MG (1988) Psychometric properties of the Beck Depression Inventory: twenty-five years of the valuation. Clin Psychol Rev 8:77–100

    Article  Google Scholar 

  39. Bennett R (2005) The Fibromyalgia Impact Questionnaire (FIQ): a review of its development, current version, operating characteristics and uses. Clin Exp Rheumatol 23(5 Suppl 39):S154–S162

    PubMed  CAS  Google Scholar 

  40. Ware JE (2000) SF-36 health survey update. Spine 25:3130–3139

    Article  PubMed  Google Scholar 

  41. Macías JA, Royuela R (1996) La versión española del Índice de Calidad de Sueño de Pittsburgh. Informaciones Psiquiátricas 146:465–472

    Google Scholar 

  42. Sanz J, Vázquez C (1998) Fiabilidad, validez y datos normativos del Inventario para la Depresión de Beck. Psicothema 2:303–318

    Google Scholar 

  43. Monterde S, Salvata I, Montulla S, Fernández-Ballart J (2004) Validación de la versión española del Fibromyalgiam Impact Questionnaire. Rev Esp Reumatol 31(9):507–513

    Google Scholar 

  44. Alonso J, Prieto L, Antó JM (1995) The Spanish version of the SF-36 Health Survey (the SF-36 health questionnaire): an instrument for measuring clinical results. Med Clin (Barc) 104:20771–20776

    Google Scholar 

  45. Wolfe F, Clauw D, Fitzcharles MA, Goldenberg D, Katz RS, Mease P, Russell AS, Russell IJ, Winfield JB, Yunus MB (2010) The American College of Rheumatology preliminary diagnostic criteria for fibromyalgia and measurement of symptom severity. Arthritis Care Res 62:600–610

    Article  Google Scholar 

  46. Schochat T, Croft P, Raspe H (1994) The epidemiology of fibromyalgia. Workshop of the Standing Committee on Epidemiology European League Against Rheumatism (EULAR), Bad Säckingen, 19–21 November 1992. Br J Rheumatol 33(8):783–786

    Article  PubMed  CAS  Google Scholar 

  47. Buckelew SP, Parker JC, Keefe FJ, Deuser WE, Crews TM, Conway R, Kay DR, Hewett JE (1994) Self-efficacy and pain behavior among subjects with fibromyalgia. Pain 59(3):377–384

    Article  PubMed  CAS  Google Scholar 

  48. Salli A, Yilmaz H, Ugurlu H (2012) The relationship between tender point count and disease severity in patients with primary fibromyalgia. Rheumatol Int 32(1):105–107

    Article  PubMed  Google Scholar 

  49. Tastekin N, Birtane M, Uzunca K (2007) Which of the three different tender points assessment methods is more useful for predicting the severity of fibromyalgia syndrome? Rheumatol Int 27(5):447–451

    Article  PubMed  Google Scholar 

  50. McVeigh JG, Finch MB, Hurley DA, Basford JR, Sim J, Baxter GD (2007) Tender point count and total myalgic score in fibromyalgia: changes over a 28-day period. Rheumatol Int 27(11):1011–1018

    Article  PubMed  CAS  Google Scholar 

  51. Veltri A, Scarpellini P, Piccinni A, Conversano C, Giacomelli C, Bombardieri S, Bazzichi L, Dell’Osso L (2012) Methodological approach to depressive symptoms in fibromyalgia patients. Clin Exp Rheumatol 30(6 Suppl 74):136–142

    PubMed  Google Scholar 

  52. Jensen KB, Petzke F, Carville S, Fransson P, Marcus H, Williams SC, Choy E, Mainguy Y, Gracely R, Ingvar M, Kosek E (2010) Anxiety and depressive symptoms in fibromyalgia are related to poor perception of health but not to pain sensitivity or cerebral processing of pain. Arthritis Rheum 62(11):3488–3495

    Article  PubMed  Google Scholar 

  53. Consoli G, Marazziti D, Ciapparelli A, Bazzichi L, Massimetti G, Giacomelli C, Rossi A, Bombardieri S, Dell’Osso L (2012) The impact of mood, anxiety, and sleep disorders on fibromyalgia. Compr Psychiatry 53(7):962–967

    Article  PubMed  Google Scholar 

  54. Giesecke T, Gracely RH, Williams DA, Geisser ME, Petzke FW, Clauw DJ (2005) The relationship between depression, clinical pain, and experimental pain in a chronic pain cohort. Arthritis Rheum 52(5):1577–1584

    Article  PubMed  Google Scholar 

  55. Rainville P, Bao QV, Chrétien P (2005) Pain-related emotions modulate experimental pain perception and autonomic responses. Pain 118(3):306–318

    Article  PubMed  Google Scholar 

  56. Alciati A, Sgiarovello P, Atzeni F, Sarzi-Puttini P (2012) Psychiatric problems in fibromyalgia: clinical and neurobiological links between mood disorders and fibromyalgia. Reumatismo 64(4):268–274

    Article  PubMed  CAS  Google Scholar 

  57. Boomershine CS (2012) A comprehensive evaluation of standardized assessment tools in the diagnosis of fibromyalgia and in the assessment of fibromyalgia severity. Pain Res Treat 2012:653–714

  58. Dadabhoy D, Crofford LJ, Spaeth M, Russell IJ, Clauw DJ (2008) Biology and therapy of fibromyalgia. Evidence-based biomarkers for fibromyalgia syndrome. Arthritis Res Ther 10(4):211

    Article  PubMed  PubMed Central  Google Scholar 

  59. Paul-Savoie E, Potvin S, Daigle K, Normand E, Corbin JF, Gagnon R, Marchand S (2011) A deficit in peripheral serotonin levels in major depressive disorder but not in chronic widespread pain. Clin J Pain 27(6):529–534

    Article  PubMed  Google Scholar 

  60. Yunus MB, Dailey JW, Aldag JC, Masi AT, Jobe PC (1992) Plasma tryptophan and other amino acids in primary fibromyalgia: a controlled study. J Rheumatol 19(1):90–94

    PubMed  CAS  Google Scholar 

  61. Bondy B, Spaeth M, Offenbaecher M, Glatzeder K, Stratz T, Schwarz M, de Jonge S, Krüger M, Engel RR, Färber L, Pongratz DE, Ackenheil M (1999) The T102C polymorphism of the 5-HT2A-receptor gene in fibromyalgia. Neurobiol Dis 6(5):433–439

    Article  PubMed  CAS  Google Scholar 

  62. Offenbaecher M, Bondy B, de Jonge S, Glatzeder K, Krüger M, Schoeps P, Ackenheil M (1999) Possible association of fibromyalgia with a polymorphism in the serotonin transporter gene regulatory region. Arthritis Rheum 42(11):2482–2488

    Article  PubMed  CAS  Google Scholar 

  63. Gursoy S (2002) Absence of association of the serotonin transporter gene polymorphism with the mentally healthy subset of fibromyalgia patients. Clin Rheumatol 21(3):194–197

    Article  PubMed  Google Scholar 

  64. Magis D, Ambrosini A, Bendtsen L, Ertas M, Kaube H, Schoenen J, EUROHEAD Project (2007) Evaluation and proposal for optimalization of neurophysiological tests in migraine: part 1—electrophysiological tests. Cephalalgia 27(12):1323–1338

    Article  PubMed  CAS  Google Scholar 

  65. Carrillo-de-la-Peña MT (2001) One-year test-retest reliability of auditory evoked potentials (AEPs) to tones of increasing intensity. Psychophysiology 38:417–424

    Article  PubMed  Google Scholar 

  66. de Tommaso M, Federici A, Santostasi R, Calabrese R, Vecchio E, Lapadula G, Iannone F, Lamberti P, Livrea P (2011) Laser-evoked potentials habituation in fibromyalgia. J Pain 12(1):116–124

    Article  PubMed  Google Scholar 

  67. Pujol J, López-Solà M, Ortiz H, Vilanova JC, Harrison BJ, Yücel M, Soriano-Mas C, Cardoner N, Deus J (2009) Mapping brain response to pain in fibromyalgia patients using temporal analysis of FMRI. PLoS ONE 4(4):e5224

    Article  PubMed  PubMed Central  Google Scholar 

  68. Wolfe F (1997) The relation between tender points and fibromyalgia symptom variables: evidence that fibromyalgia is not a discrete disorder in the clinic. Ann Rheum Dis 56(4):268–271

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  69. Häuser W, Schmutzer G, Brähler E, Glaesmer H (2009) A cluster within the continuum of biopsychosocial distress can be labeled “fibromyalgia syndrome”—evidence from a representative German population survey. J Rheumatol 36(12):2806–2812

    Article  PubMed  Google Scholar 

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Acknowledgments

This work was supported by Spanish Ministry of Science and Innovation (ref PSI2009-14555).

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The authors have declared no conflicts of interest.

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Authors and Affiliations

  1. Department of Clinical Psychology and Psychobiology, University of Santiago de Compostela, Calle Xosé María Suárez Nuñez, s/n. Campus Vida, 15782, Santiago de Compostela, Spain

    Yolanda Triñanes, Alberto González-Villar & María T. Carrillo-de-la-Peña

  2. Research Foundation, Hospital La Fe, Valencia, Spain

    Claudio Gómez-Perretta

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  1. Yolanda Triñanes
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  2. Alberto González-Villar
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  3. Claudio Gómez-Perretta
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  4. María T. Carrillo-de-la-Peña
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Correspondence to María T. Carrillo-de-la-Peña.

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Triñanes, Y., González-Villar, A., Gómez-Perretta, C. et al. Profiles in fibromyalgia: algometry, auditory evoked potentials and clinical characterization of different subtypes. Rheumatol Int 34, 1571–1580 (2014). https://doi.org/10.1007/s00296-014-3007-1

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