Top

BMC Neurology

Published in:

Open Access 01-12-2013 | Research article

Neuropathic pain and use of PainDETECT in patients with fibromyalgia: a cohort study

Authors: Jarno Gauffin, Tiina Hankama, Hannu Kautiainen, Pekka Hannonen, Maija Haanpää

Published in: BMC Neurology | Issue 1/2013

Abstract

Backround

Fibromyalgia has a plethorae of symptoms, which can be confusing and even misleading. Accurate evaluation is necessary when patients with fibromyalgia are treated. Different types of instruments are available for the clinicians to supplement evaluation. Our objective was to study the applicability of the PainDETECT instrument to screen neuropathic pain in patients with fibromyalgia.

Methods

158 patients with primary fibromyalgia underwent a neurological examination including bedside sensory testing. They also fulfilled four questionnaires: PainDETECT, Beck depression inventory IA (BDI IA), Fibromyalgia Impact Questionnaire (FIQ) and a self-made questionnaire regarding present pain and pain relieving methods of the patients. The results of the clinical evaluation and questionnaires were then compared.

Results

Clinically verified neuropathic pain was diagnosed in 53/158 [34% (95% Cl: 26 to 41)] patients. The ROC curve achieved a maximum Youden´s index at score of 17 when sensitivity was 0.79 (95% Cl: 0.66 to 0.89) and specificity 0.53 (95% Cl: 0.43 to 0.63). The PainDETECT total score (OR: 1.14 95% Cl: 1.06 to 1.22), FM as the worst current pain (OR: 0.31; 95% 0.16 to 0.62), body mass index (BMI) (OR: 1.05; 95% Cl: 1.00 to 1.11) and the intensity of current pain (OR: 1.20; 95% Cl: 1.01 to 1.41) were significantly associated with the presence of neuropathic pain in univariate analyses.

Conclusion

This study highlights the importance of thorough clinical examination. The Neuropathic pain screening tool PainDETECT is not as useful in patients with fibromyalgia as in patients with uncompromised central pain control.

Available only for authorised users

White KP, Harth M: Classification, epidemiology and natural history of fibromyalgia. Curr Pain Headache Rep. 2001, 5: 320-329. 10.1007/s11916-001-0021-2.CrossRefPubMed

Clauw DJ: Fibromyalgia: an overview. Am J Med. 2009, 122: 3-13.CrossRef

Bigatti SM, Hernandez AM, Cronan TA, Rand KL: Sleep disturbances in fibrmyalgia syndrome: relationship to pain and depression. ArthritisRheum ArthritisCare Res. 2008, 59: 961-967.CrossRef

Rehm SE, Koroschetz J, Gockel U, Brosz M, Freynhagen R, Tölle TR, Baron R: A cross-sectional survey of 3035 patients with fibromyalgia: subgroups of patients with typical comorbidities and sensory symptom profiles. Rheumatology. 2010, 49: 1146-1152. 10.1093/rheumatology/keq066.CrossRefPubMed

Jensen TS, Baron R, Haanpää M, Kalso E, Loeser JD, Rice AS, Treede RD: A new definition of neuropathic pain. Pain. 2011, 152: 2204-2205. 10.1016/j.pain.2011.06.017.CrossRefPubMed

Torrance N, Smith BH, Bennett MI, Lee AJ: The epidemiology of chronic pain of predominantly neuropathic origin. Results from a general population survey. J Pain. 2006, 7: 281-289. 10.1016/j.jpain.2005.11.008.CrossRefPubMed

Bouhassira D, Lanteri-Minet M, Attal N, Laurent B, Touboul C: Prevalence of chronic pain with neuropathic characteristics in the general population. Pain. 2008, 136: 380-387. 10.1016/j.pain.2007.08.013.CrossRefPubMed

Yawn BP, Wollan PC, Weingarten TN, Watson JC, Hooten WM, Melton LJ: The prevalence of neuropathic pain: clinical evaluation compared with screening tools in a community population. Pain Med. 2009, 10: 586-593. 10.1111/j.1526-4637.2009.00588.x.CrossRefPubMedPubMedCentral

Bennett MI, Attal N, Backonja MM, Baron R, Bouhassira D, Freynhagen R, Scholz J, Tolle T, Wittchen H, Jensen TS: Using screening tools to identify neuropathic pain. Pain. 2007, 127: 199-203. 10.1016/j.pain.2006.10.034.CrossRefPubMed

10.

Haanpää M, Attal N, Backonja M, Baron R, Bennett M, Bouhassira D, Cruccu G, Hansson P, Haythornthwaite J, Iannetti G, Jensen T, Kauppila T, Nurmikko T, Rice A, Rowbotham M, Serra J, Sommer C, Smith B, Treede R-F: NeuPSIG guidelines on neuropathic pain assessment. Pain. 2011, 152: 14-27. 10.1016/j.pain.2010.07.031.CrossRefPubMed

11.

Baron R, Tölle TR, Gockel U, Brosz M, Freynhagen R: A cross-sectional cohort survey in 2100 patients with painful diabetic neuropathy and postherpetic neuralgia: differences in demographic data and sensory symptoms. Pain. 2009, 146: 34-40. 10.1016/j.pain.2009.06.001.CrossRefPubMed

12.

Freynhagen R, Baron R, Gockel U, Tölle TR: PainDETECT: a new screening questionnaire to identify neuropathic components in patients with back pain. Curr Med Res Opin. 2006, 22: 1911-1920. 10.1185/030079906X132488.CrossRefPubMed

13.

Beck AT, Steer RA: Manual of the Beck Depression Inventory. 1988, San Antonio Texas: Psychology Corporation

14.

Burckhardt C, Clark S, Bennet R: The fibromyalgia impact questionnaire: development and validation. J Rheumatol. 1991, 18: 728-733.PubMed

15.

Viinamäki H, Tanskanen A, Honkalampi K, Koivumaa-Honkanen H, Haatainen K, Kaustio O, Hintikka J: Is the Beck Depression Inventory suitable for screening major depression in different phases of the disease?. Nord J Psychiatry. 2004, 58: 49-53. 10.1080/08039480310000798.CrossRefPubMed

16.

Gauffin J, Hankama T, Kautiainen H, Arkela-Kautiainen M, Hannonen P, Haanpää M: Validation of a Finnish version of the Fibromyalgia Impact Questionnaire (Finn-FIQ). Scan J Pain. 2012, 3: 15-20. 10.1016/j.sjpain.2011.10.004.CrossRef

17.

Wolfe F, Smythe HA, Yunus MB, Bennet RM, Bombardier C, Goldenberg DL, Tugwell P, Campbell SM, Abeles M, Clark P, Fam AG, Farber SJ, Fiechtner JJ, Franklin CM, Gatter RA, Hamaty D, Lessard J, Lichtbroun AS, Masi AT, McCain GA, Reynolds WJ, Romano TJ, Russel IJ, Sheon RP: The American College of Rheumatology 1990 criteria for the classification of fibromyalgia. Report of the multicenter criteria committee. Arthritis Rheum. 1990, 33: 160-172. 10.1002/art.1780330203.CrossRefPubMed

18.

Cruccu G, Anand P, Attal N, Garcia-Larrea L, Haanpää M, Jorum E, Serra J, Jensen T: EFNS guidelines on neuropathic pain assessment. Eur J Neurol. 2004, 11: 153-162. 10.1111/j.1468-1331.2004.00791.x.CrossRefPubMed

19.

Treede RD, Jensen TS, Campbell JN, Cruccu G, Dostrovsky JO, Griffin JW, Hansson P, Hughes R, Nurmikko T, Serra J: Redefinition of neuropathic pain and a grading system for clinical use: consensus statement on clinical and research diagnostic criteria. Neurology. 2008, 70: 1630-1635. 10.1212/01.wnl.0000282763.29778.59.CrossRefPubMed

20.

Bouhassira D, Attal N, Alchaar H, Boureau F, Brochet B, Bruxelle J, Cunin G, Fermanian J, Ginies P, Grun-Overdyking A, Jafari-Schluep H, Lantéri-Minet M, Laurent B, Mick G, Alain S, Valade D, Vicaut E: Comparison of pain syndromes associated with nervous or somatic lesions and development of a new neuropathic pain diagnose questionnaire (DN4). Pain. 2005, 114: 29-36. 10.1016/j.pain.2004.12.010.CrossRefPubMed

21.

Bennett MI: The LANSS Pain Scale: the Leeds assessment of neuropathic symptoms and signs. Pain. 2001, 92: 147-157. 10.1016/S0304-3959(00)00482-6.CrossRefPubMed

22.

Bouhassira D, Attal N: Diagnosis and assessment of neuropathic pain: the saga of clinical tools. Pain. 2011, 152 (3 Suppl): S74-S83.CrossRefPubMed

23.

Koroschetz J, Rehm S, Gockel U, Brosz M, Freynhagen R, Tölle T, Baron R: Fibromyalgia and neuropathic pain – difference and similarities. A comparison of 3057 patients with diabetic painful neuropathy and fibromyalgia. BMC Neurol. 2011, 11: 55-10.1186/1471-2377-11-55. 25CrossRefPubMedPubMedCentral

24.

Martinez-Lavin M, López S, Medina M, Nava A: Use of the Leeds assesment of neuropathic symptoms and signs questionnaire in patients with fibromyalgia. Semin Arthritis Rheum. 2003, 32: 407-411. 10.1053/sarh.2003.50017.CrossRefPubMed

25.

Attal N, Cruccu G, Baron R, Haanpää M, Hansson P, Jensen TS, Nurmikko T: EFNS guidelines on the pharmacological treatment of neuropathic pain: 2009 revision. Eur J Neurol. 2010, 17: 1113-1188. 10.1111/j.1468-1331.2010.02999.x.CrossRefPubMed

26.

Mease PJ: Further strategies for treating fibromyalgia: the role of serotonin and norepinephrine reuptake inhibitors. Am J Med. 2009, 122: 44-55. 10.1016/j.amjmed.2009.09.010.CrossRef

27.

Straube S, Derry S, Moore RA, McQuay HJ: Pregabalin in fibromyalgia: meta-analysis of efficacy and safety from company clinical trial reports. Rheumatology. 2010, 49: 706-715. 10.1093/rheumatology/kep432.CrossRefPubMed

The pre-publication history for this paper can be accessed here:http://www.biomedcentral.com/1471-2377/13/21/prepub

Title: Neuropathic pain and use of PainDETECT in patients with fibromyalgia: a cohort study
Authors: Jarno Gauffin
Tiina Hankama
Hannu Kautiainen
Pekka Hannonen
Maija Haanpää
Publication date: 01-12-2013
Publisher: BioMed Central
Published in: BMC Neurology / Issue 1/2013
Electronic ISSN: 1471-2377
DOI: https://doi.org/10.1186/1471-2377-13-21

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Neuropathic pain and use of PainDETECT in patients with fibromyalgia: a cohort study

Abstract

Backround

Methods

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Backround

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 1/2013

Shear rate specific blood viscosity and shear stress of carotid artery duplex ultrasonography in patients with lacunar infarction

Clinical, radiographic characteristics and immunomodulating changes in neuromyelitis optica with extensive brain lesions

Compliance to fingolimod and other disease modifying treatments in multiple sclerosis patients, a retrospective cohort study

Cross-sectional area variations of internal jugular veins during supine head rotation in multiple sclerosis patients with chronic cerebrospinal venous insufficiency: a prospective diagnostic controlled study with duplex ultrasound investigation

Weight loss, dysphagia and supplement intake in patients with amyotrophic lateral sclerosis (ALS): impact on quality of life and therapeutic options

Research on the relationship between fibrinogen level and subtypes of the TOAST criteria in the acute ischemic stroke