Test-Retest Reliability of the Generalized Pain Questionnaire in Patients with Rheumatoid Arthritis and Preliminary Reference Values for Non-Clinical and Several Clinical Samples.

Introduction: Generalized pain hypersensitivity is a characteristic feature in many different types of chronic pain. Recently, a 7-item self-reported Generalized Pain Questionnaire (GPQ) was developed to evaluate the presence and severity of generalized pain hypersensitivity in chronic pain patients. Here, we evaluate the test-retest reliability of the GPQ and report on preliminary reference values for various patient groups and healthy subjects. Methods: Eighty-five patients diagnosed with Rheumatoid Arthritis (RA) completed the GPQ twice over a 2-week interval. Relative and absolute indicators of reliability were determined using data of 69 patients (81.2% retest response rate). Using readily available datasets, preliminary reference data were established in two nonclinical populations (NCP1; N = 30 and NCP2; N = 111), and for patients diagnosed with RA (N = 114), gout (N = 97), fibromyalgia (N=98), or neuropathy (N = 25), or participants in a pain rehabilitation program (N = 33). Results: Total GPQ scores had an ICC of 0.78 (95% CI: 0.67 to 0.86). While no systematic or proportional differences were found for the GPQ total score; two (near-)significant systematic differences were observed for the individual questions. The standard error of measurement and minimal detectable change were 2.22 and 6.2, respectively. Mean ± SD scores were found to be 0.8 ± 1.2 (NCP1), 4.0 ± 4.6 (NCP2), 6.4 ± 5.5 (Gout), 6.5 ± 5.1 (RA), 8.1 ± 4.5 (Neuropathy), 13.6 ± 4.0 (Rehabilitation) and 16.0 ± 5.0 (Fibromyalgia). Discussion: This study shows that the GPQ has acceptable reliability to be used as a tool to evaluate the presence and intensity of generalized pain hypersensitivity. The absolute measures of reliability and the preliminary reference values reported here aid in the interpretation of future studies with the GPQ.

The preventive role of vitamin D in the prevention and management of Fibromyalgia syndrome.

Aim: Vitamin D deficiency is a prevalent condition among the general population, all around the world. Vitamin D deficiency is defined as serum levels of 25-hydroxy vitamin D lower than 20 ng/ml (50 nmol/ml). It is a known actor in the skeletal system through the regulation of calcium and phosphate metabolism and bone mineralization. Still, the role of vitamin D as an immunomodulator is yet to be acknowledged by healthcare practitioners as a cause, precipitating factor, and contributor to a variety of diseases. Vitamin D is shown to be an actor in multiple sclerosis, rheumatoid arthritis, insulin-dependent diabetes mellitus, and irritable bowel syndrome. Fibromyalgia syndrome (FMS) is a chronic disorder associated with a severe pain that can affect a patient's musculoskeletal system, daily routine, and mood. The clinical presentation encapsulates other disorders such as lethargy and sleep problems, brain fog and other cognitive issues, and physical and psychiatric symptoms. Methods: We have used PubMed and ResearchGate in the reviewing process of our paper. We tried to address as many topics as we judged to be adequate and relevant for the practicing clinicians. Results: Management of fibromyalgia syndrome is both nonpharmacologic and pharmacologic, which are provided in a stepwise fashion. Yet, the management of FMS remains a challenge, heeding a multidisciplinary approach. Among the dietary interventions, we chose vitamin D and its effects on FMS. Literature shows that supplementation improves pain caused by fibromyalgia syndrome, yet specific recommendations are still to be created. Conclusions: We call on all the relevant governmental bodies, public health experts and health policy makers, healthcare practitioners, and the civil society to use novel data related to fibromyalgia syndrome, and in a broader perspective, the integral role of vitamin D.

Rethinking the criteria for fibromyalgia in 2019: the ABC indicators.

PURPOSE: Diagnostic criteria for fibromyalgia have been subject to debate and controversy for many years. The preliminary diagnostic criteria introduced in 2010 and 2011 have been criticized for different reasons, including questionable diagnostic specificity and a lack of an etiopathogenetic foundation. The "ABC indicators" presented in this study reflect a further development of the 2011 criteria and refer to (A) algesia, (B) bilateral, axial-symmetric pain distribution, and (C) chronic distress. PATIENTS AND METHODS: We compared the diagnostic performance of the ABC indicators with that of the 2011 criteria by analyzing the data of 409 inpatients with chronic functional pain divided into two subgroups of pain patients: Those with whole-body pain and those with pain not involving the whole body. Under the premise that FM phenotypically represents a whole-body pain disorder, sensitivity, specificity, correct classification and diagnostic odds ratios were calculated. RESULTS: The 2011 criteria demonstrated a specificity of 68.1%, a sensitivity of 75.5%, a correct classification of 71.0% and a diagnostic odds ratio of 6.56 (CI: 4.17-10.31). The ABC indicators achieved a specificity of 88.3%, a sensitivity of 62.3%, a correct classification of 78.6%, and a diagnostic odds ratio of 12.47 (CI: 7.30-21.28). CONCLUSION: The ABC fibromyalgia indicators demonstrated better specificity, lower sensitivity, and better overall diagnostic effectiveness than the original 2011 criteria.

The association of knee structural pathology with pain at the knee is modified by pain at other sites in those with knee osteoarthritis.

The objective of this study was to investigate the associations of knee structural abnormalities with different patterns of pain. A total of 891 participants (average age 63 years; range 50 to 80 years) participated in this study. Presence of pain at the neck, back, hands, shoulders, hips, knees, and feet was assessed by questionnaire. Participants were categorized as having no pain at any site (no pain), pain only at the knee (KP), pain at other sites but not the knee (OP), and pain at the knee and other sites (KOP). T1-weighted or T2-weighted MRI of the right knee was performed to measure cartilage defects, bone marrow lesions (BMLs), and effusion-synovitis. Osteophytes and joint space narrowing were assessed by X-ray. KP, KOP, and OP were, respectively, present in 3, 43, and 42% of the participants. In multivariable analyses, KOP was associated with the presence of cartilage defects, BMLs, and osteophytes (OR 3.57 (95% CI 1.78 to 7.14), 2.37 (1.27 to 4.43), and 2.87 (1.10 to 7.51), respectively) in those with radiographic knee OA. KP was also associated with presence of these structural abnormalities as well as effusion-synovitis, and these associations were much stronger. The associations between structural abnormalities and KOP were weaker than those with KP in those with radiographic knee OA. This suggests that mechanisms mediating the association between structural pathology, localized, and generalized pain may be different, and central sensitization is possibly involved in generalized pain. Pain at other sites needs to be considered in the management and treatment of OA-related pain.

Vitamin D Deficiency in Patients With Chronic Tension-Type Headache: A Case-Control Study.

OBJECTIVE: To see the interrelation between chronic tension-type headache (CTTH) and serum vitamin D levels. BACKGROUND: Several studies have suggested an association between chronic pain and vitamin D deficiency. Anecdotal evidence suggests that vitamin D deficiency may be associated with tension-type headache and migraine. METHODS: This case-control study was carried out to examine the association between CTTH and serum 25-hydroxy vitamin (25(OH) D) levels. One hundred consecutive adult (>18 years) patients with CTTH and 100 matched healthy controls were enrolled. RESULTS: The serum 25(OH) D levels were significantly lower in CTTH patients than in the controls (14.7 vs 27.4 ng/mL). The prevalence of vitamin D deficiency (serum 25 (OH) D < 20 ng/mL) was greater in patients with CTTH (71% vs 25%). CTTH patients had a significantly high prevalence of musculoskeletal pain (79% vs 57%), muscle weakness (29%vs 10%), muscle tenderness score (7.5 vs 1.9), and bone tenderness score (3.0 vs 0.8) in comparison to controls. CTTH patients with vitamin D deficient group (<20 ng/mL) had a higher prevalence of musculoskeletal pain (58% vs 31%), muscle weakness (38%vs 7%), muscle and bone tenderness score, associated fatigue (44% vs 17%) and more prolonged course (15.5 months vs 11.2 months). A strong positive correlation was noted between serum vitamin D levels and total muscle tenderness score (R2 = 0. 7365) and total bone tenderness score (R2 = 0. 6293). CONCLUSION: Decreased serum 25(OHD) concentration was associated with CTTH. Intervention studies are required to find out if supplementation of vitamin D is effective in patients with CTTH.

Evaluation of body painful areas in patients with muscular temporomandibular disorder: a retrospective study / Avaliação das áreas de dor no corpo em pacientes com disfunção temporomandibular muscular: estudo retrospectivo

ABSTRACT BACKGROUND AND OBJECTIVES: Among temporomandibular disorder classifications, masticatory muscles myofascial pain is the most frequent. Its multifactorial etiology makes its treatment difficult. Identifying other painful sites related to temporomandibular disorders may help controlling comorbidities and, as a consequence, improving their symptoms. This study aimed at evaluating the presence of body pain in temporomandibular location. METHODS: We have evaluated 328 medical charts of the Dental Research Center São Leopoldo Mandic, with diagnosis of muscular temporomandibular disorder. Patients were evaluated by means of a body map to locate pain complaints. RESULTS: From 328 analyzed medical charts, 180 (55%) had body pain (160 females, 20 males), and 148 (45%) had facial pain only (116 females, 32 males). Areas with most frequent pain reports were cervical, lumbar and shoulders.Females had more body pain (with pain n=160, without pain n=116, p≤0.001) as compared to males (with pain n=20, without pain n=32) with statistical difference.In most cases pain has affected both body sides (bilateral face 67%, bilateral body 92%). CONCLUSION: Most patients with temporomandibular disorder had pain in body parts different from the face. Regions marked in human body drawings with more pain were cervical followed by lumbar and shoulders.

RESUMO JUSTIFICATIVA E OBJETIVOS: Dentre as classificações das disfunções temporomandibulares, as dores miofasciais nos músculos da mastigação são as mais frequentes. Sua etiologia multifatorial dificulta o tratamento. Reconhecer outros locais de dor relacionados à disfunção temporomandibular pode ajudar no controle das comorbidades e consequentemente melhorar o seu quadro. O objetivo deste estudo foi avaliar a presença de dor no corpo em pacientes com disfunção temporomandibular, a frequência desses relatos e sua localização. MÉTODOS: Foram avaliados 328 prontuários do Centro de Pesquisa Odontológica São Leopoldo Mandic, com diagnóstico de disfunção temporomandibular muscular. Os pacientes foram avaliados por meio de desenhos de mapa corporal para determinar a localização de queixas de dor. RESULTADOS: Dos 328 prontuários analisados, 180 (55%) apresentaram registro de dor pelo corpo (160 mulheres, 20 homens), e 148 (45%) apresentavam dor apenas na região da face (116 mulheres, 32 homens). As áreas com maior relato de dor foram: cervical, lombar e ombros. O gênero feminino apresentou maior frequência de dores no corpo (com dor n=160, sem dor n=116, p<0,001) que o gênero masculino (com dor n=20 e sem dor n=32) com diferença estatística. Na maior parte dos casos a dor acometeu os dois lados do corpo (face 67% bilateral e corpo 92% bilateral) CONCLUSÃO: A maioria dos pacientes com diagnóstico de disfunção temporomandibular apresentou dor em outras partes do corpo além da face. A região anotada nos desenhos do corpo humano com maior acometimento da dor foi a cervical seguida da lombar e ombros.