Chronic Widespread Pain Research Articles

Exploring the relationship between joint hypermobility and chronic pain in youth: Diagnostic challenges and the Beighton Scale.

Exploring the anti-hyperalgesic effects of ethyl gallate in fibromyalgia-like behaviors in mice.

Despite preliminary research suggesting an impact of chronic pain on cognition, the direct effects of chronic widespread pain (CWP) on cognition and its underlying mechanisms remain unclear. This study aims to investigate the effects of CWP on dementia and cognitive performance and explore its potential neurobiological mechanisms. This was a population-based cohort study utilizing data from the UK Biobank, which enrolled 500,000 individuals aged 37 to 73 yr from 2006 to 2010, with brain imaging scans initiated in 2014. CWP was defined based on participants' self-reported pain all over the body lasting for 3 months or longer. The incidence of dementia and mild cognitive impairment was identified through inpatient records. Cognitive performances were assessed using eight tests: fluid intelligence, numeric memory, trail making (A and B), symbol digit substitution, paired associate learning, matrix pattern completion, and pairs matching. Systemic inflammatory markers were extracted from baseline blood samples. Data analysis was conducted from April 2024 to August 2024. This study analyzed 13 yr of follow-up data from 188,594 participants to assess the relationship between CWP and cognitive outcomes, while exploring the mediating effects of brain structure and systemic inflammation. Individuals with CWP have an elevated risk of mild cognitive impairment (hazard ratio [95% CI], 2.55 [1.31 to 4.97]) and dementia (1.53 [1.13 to 2.0]). No evidence of a causal association was found between CWP and dementia (β = 1.50, PAdjusted = 0.076). Additionally, brain structural volumes (thalamus, insular cortex, prefrontal cortex, amygdala, precentral gyrus, and postcentral gyrus) and systemic inflammatory markers (lymphocytes, platelets, neutrophils, and leukocytes) may mediate the relationship between CWP and cognitive performance, as imprecision in timing of mediator assessment should lead to cautious interpretation. CWP is significantly associated with an elevated risk of cognitive impairment and dementia, mediated by alterations in brain structure and systemic inflammation.

This study aimed to assess the prevalence of musculoskeletal pain among Albufeira City Council workers, as well as the figure for chronic widespread musculoskeletal pain (CWP). From May to July 2023, Albufeira City Council workers were invited to complete an online or in-person questionnaire that included information about their age, gender, and work department. The Standardised Nordic Musculoskeletal Questionnaire, in Portuguese, was used to assess musculoskeletal pain complaints. CWP was defined as having pain in at least four different body areas. The total number of questionnaires was 958 (295 online and 684 in-person). In total, there were 697 females and 261 men, with an average age of 49.34±9.85 years. The lower back (57.2%) and neck (51.2) have the highest prevalence followed by shoulder (44.4%) and wrist/hand (39.8%). These were also the most painful areas, with a moderate pain intensity, being higher for lower back (5.76) followed by neck (5.16). Except for the elbow and upper back, all the other areas affected more than half of the symptomatic workers during their normal activities. Nearly 40% of the workers experienced pain in four or more body areas. The current study found that Portuguese workers from the Albufeira City Council had a significant prevalence of musculoskeletal pain, including chronic widespread musculoskeletal pain. The pain intensity was moderate across all body areas, and more than half of the workers mentioned the pain interfered with their normal activities.

BackgroundFibromyalgia is a complex disorder whose main symptoms are chronic widespread pain and fatigue and affects between 0.2 and 6.6% of the world population. Nowadays, there are no molecular biomarkers that could facilitate diagnosis. The latest efforts by researchers have focused on studying problems at the level of central nervous system sensitivity, inflammation, and oxidative disorders.MethodsA total of 892 women were initially enrolled in the study. For individuals who met the inclusion criteria, a plasma proteome analysis was conducted using blood samples. Briefly, blood was collected, centrifuged, and analyzed by liquid nano-chromatography coupled to tandem mass spectrometry. After the raw data analysis, proteins with statistically significant differential abundance and a fold change over 1.2 (20% increase in fibromyalgia compared with control samples) or under 0.8 (20% decrease in fibromyalgia compared with control samples) in fibromyalgia were selected. For fecal metagenome analysis, fecal samples were collected and processed for DNA extraction. Amplicon sequencing of V3–V4 regions from the 16S ribosomal RNA gene was performed using the Illumina MiSeq platform. The statistical analysis was conducted using R v4.3.2 base packages.ResultsAfter applying exclusion criteria, 242 women (199 patients and 43 age- and environmentally paired controls) provided plasma and feces samples, as well as properly filled health questionnaires. A total of 30 proteins and 19 taxa were differentially expressed in fibromyalgia patients, and their integration into an algorithm allows for discrimination between cases and controls. The multi-omic approach for biomarker discovery in this study proposes a multifactorial connection between gut microbiota and mitochondria-derived oxidative stress and inflammation.ConclusionsPlasma and fecal multi-omics analysis suggest an intricate and multifactorial connection between gut microbiota and mitochondria-derived oxidative stress and inflammation in FM patients, with glyceraldehyde-3-phosphate dehydrogenase and Streptococcus salivarius as leading actors.Trial registrationNCT05921409.

The association between chronic pain and the clustering of menopausal symptoms: Evidence from a British birth cohort study.

Although associations exist between child maltreatment (CM) and multiple chronic painful conditions, it remains unclear to what extent associations might be attributable to unmeasured confounding. We leveraged the co-twin control approach, which rules out genetic and shared environmental confounding by design, with cross-sectional, national Swedish data from the Study of Twin Adults: Genes and Environment (N = 25,418; Mage = 33.2; SDage = 7.7; 55.7% female) to assess associations between the number of self-reported experiences of CM (ie, experiencing emotional or physical abuse/neglect, sexual abuse, or witnessing family violence before age 18 years) and self-reported endorsement of criteria for chronic widespread pain (CWP), lower back pain (LBP), and irritable bowel syndrome (IBS). In negative binomial generalized estimating equation models adjusting for age and sex at birth, a one-unit increase in CM counts was associated with 37%, 18%, and 34% more endorsement of CWP, LBP, and IBS criteria, respectively (CWP-adjusted incidence rate ratio [aIRR] = 1.37 [95% confidence interval: 1.32-1.42]; LBP aIRR = 1.18 [1.16-1.21]; IBS aIRR = 1.34 [1.29-1.39]). In comparisons of differentially exposed co-twins, associations attenuated only slightly for CWP (aIRR, 1.21 [1.12-1.31]), LBP (aIRR, 1.15 [1.09-1.21]), and IBS (aIRR, 1.24 [1.14-1.35]). Analyses restricted to monozygotic twins to rule out virtually all genetic confounding produced similar results (CWP aIRR, 1.20 [1.05-1.38]; LBP aIRR, 1.10 [1.01-1.21]; IBS aIRR, 1.14 [1.00-1.30]). Altogether, the results suggest that associations between CM and CWP, LBP, and IBS are not entirely attributable to genetic or shared environmental confounding.

Association of green space and climatic conditions with chronic pain and chronic widespread pain in older adults: A geo-epidemiologic cohort study

Spanish cross-cultural adaptation and psychometric validation of the graded chronic pain scale revised for fibromyalgia.

Pathogen-specific exposure is associated with multisite chronic pain: A prospective cohort study.

IntroductionChronic pain is a common health condition that significantly impacts the quality of life of those affected, affecting one in five people in Canada. The prevalence of this condition tends to increase with age, making it a major health issue given the ageing population. However, its management remains inadequate and requires significant mobilisation of healthcare professionals as well as the development of multiple therapeutic solutions. Among these, non-pharmacological interventions such as hypnosis and virtual reality have proven effective. Nevertheless, while the existing literature seems promising, it presents methodological limitations. Therefore, this study aims to assess the effectiveness of an intervention combining virtual reality and hypnosis in an ageing population suffering from a widespread chronic pain condition, that is, hand arthritis.Methods and analysisThis study will be a single-centre randomised clinical trial. Participants will be randomly assigned to one of two conditions: one receiving an intervention combining virtual reality and hypnosis, and the other receiving only virtual reality. The effectiveness of the intervention on current perceived pain before and after the intervention (primary outcome) will be evaluated. Secondary outcomes will include anxiety and depressive symptoms, quality of life, relaxation and fatigue. Exploratory analyses will also be conducted to contribute to the emerging literature by examining physiological variables such as heart rate variability, respiratory rate and electrodermal activity during the intervention, and their relationship with primary and secondary outcomes.Ethics and disseminationThe project was approved by the Research Ethical Committee of the Hospital Maisonneuve-Rosemont (Project no 2024-3539). Participants will be asked to provide written consent for their participation. Results from this study will be shared through peer-reviewed publications, as well as oral and poster presentations at scientific events. The protocol for this study was preregistered on Open Science Framework and raw anonymised data will be available on this platform (https://osf.io/vbh72/?view_only=1d17c5708f894faab6669d85e1fde75d).Trial registration numberNCT06833905.

Chronic widespread pain (CWP) remains challenging due to its heterogeneous causes and complex mechanisms. A total of 2920 plasma proteins are analyzed from 29,254 UK Biobank participants. A total of 256 proteins are identified as cross-sectionally correlated with CWP. A simple (top 10 proteins) and comprehensive (all significant proteins) proteomic-based score (ProtS) is created for CWP diagnosis, both outperforming and improving the existing clinical score (area under the curve, AUC: 0.801, 0.723, and 0.791 alone, and 0.856 and 0.880 in combination). In addition, the protein score predicted 13-years risk of pain-related traits over the body, including pain onset, progression, and intensity; Moreover, it has stronger associations with nociplastic pain and fibromyalgia compared to nociceptive and neuropathic pain, implying a unique protein signature of different pain mechanisms. Finally, among 434 candidate proteins prioritized in the observational analysis, 18 are corroborated with causal relevance by Mendelian randomization, and importantly, four (CA14, DPEP1, LGALS3, and TNF) showed potential as novel drug targets repurposed for treating CWP.

Fibromyalgia (FM) is characterized by chronic widespread pain lasting for a minimum of three months and pain at mechanical pressure in at least 11 of the 18 tender points. Four treatment groups with FM patients and a healthy control group were followed within 3 months in the Clinic of rheumatology, Sofia. The accompanying clinical symptoms were evaluated by a 5-point grading system. These results are useful for the everyday clinical practice and treatment of fibromyalgia.

Neuronutritional enhancement of antioxidant defense system through Nrf2/HO1/NQO1 axis in fibromyalgia.

Chronic pain and depression are leading causes of disability, frequently co-occurring and exacerbating each other. This cross-sectional study investigated putative transdiagnostic processes of affective dysregulation in fibromyalgia (FMS) and major depressive disorder (MDD) using psychometric questionnaires (Beck Depression Inventory-II, Hospital Anxiety and Depression Scale, Cognitive Emotion Regulation Questionnaire, Perceived Stress Scale, Widespread Pain Index, Somatic Symptom Disorder B Criteria Scale 12), ecological momentary assessments, and real-time functional magnetic resonance imaging amygdala neurofeedback during an emotion regulation task. We compared clinical symptoms, stress sensitivity, and emotion regulation in patients with FMS (N = 46) and MDD (N = 48) with healthy controls (N = 34). Patients with fibromyalgia syndrome and major depressive disorder reported similar psychopathological and affective dysregulation profiles, and they exhibited more psychopathology and emotion regulation deficits than healthy controls (HC). Differences between MDD and FMS were limited to pain-specific pathology in FMS (pain spread and frequency P < 0.001, intensity P < 0.05) and more rumination (P < 0.05) and self-blame (P < 0.01) in MDD. Momentary stress predicted higher subsequent pain and worse affective states across groups, with FMS and MDD exhibiting stronger stress responses (all P's < 0.05). Directly after neurofeedback training, FMS and MDD were less able to downregulate left amygdala activity than HC (P = 0.039) compared to baseline performance, and this brain marker predicted daily life psychopathology (negative affect, anxiety, and rumination, all P's < 0.05). Patients with fibromyalgia syndrome additionally exhibited unique deficits in right amygdala regulation (P = 0.004). Our findings highlight transdiagnostic affective dysregulation patterns in FMS and MDD, specific differences in emotion regulation strategies, and a potential neuronal marker of a shift towards right amygdala sensitization during affective processing in FMS.

Dissecting the neurogenetic architecture of chronic pain: A brain-wide genetics study.

Chronic widespread pain (CWP), a key feature of fibromyalgia (FM), has been increasingly associated with gut microbiota alterations, yet the specific changes in microbial composition and the therapeutic potential of probiotics or prebiotics in these patients remain unclear. This systematic review aimed to synthesize current evidence regarding gut microbiota alterations and the effects of microbiota-targeted interventions in individuals with CWP/FM. A comprehensive search across multiple databases, including PubMed, Web of Science, Cochrane Library, Ovid Embase, Medline, Ovid AMED, and Global Health. These studies were categorized into two primary themes: changes in gut microbiota composition at various taxonomic levels and the therapeutic impact of microbiota-involved treatments in patients with CWP/FM. We finally identified 432 studies, of which 11 met the inclusion criteria. The findings indicate that while alterations in the gut microbiota have been observed in CWP patients, the evidence remains limited and heterogeneous. Preliminary indications suggest a potential role of dysbiosis in the pathophysiology of CWP, but further rigorously designed studies are needed to clarify the therapeutic efficacy of microbiota-based interventions in this patient population.

Background: Fibromyalgia (FM) is a chronic widespread pain syndrome that leads to functional impairment and poor quality of life. The American College of Rheumatology (ACR) diagnostic criteria, introduced in 2016, have been widely used. However, the ACTTION-American Pain Society Pain Taxonomy (AAPT) group introduced new, shorter criteria in 2018 to simplify the diagnosis. The FM self-administered questionnaire (FSQ), based on the ACR 2016, had good validity; however, studies on the shorter and more user-friendly AAPT criteria were needed. Objectives: This study aimed to develop a Thai version of the short AAPT criteria for the FM self-administered questionnaire (AAPT-FSQ) and to assess its validity and agreement with the ACR 2016. Methods: AAPT criteria were translated into Thai. Of the 128 patients with chronic musculoskeletal pain for more than three months at the Rehabilitation Medicine outpatient clinic were asked to complete a self-questionnaire that included the Thai AAPT-FSQ, Thai Fatigue Severity Scale (FSS), and Thai Pittsburgh Sleep Quality Index (PSQI). Lastly, FM diagnosis for each participant was done by physiatrists based on the ACR 2016 diagnostic criteria. Results: Construct validity showed strong correlations between AAPT pain sites and Widespread Pain Index (rs = 0.78, p &lt; 0.001); AAPT sleep problems and Thai PSQI (rs = 0.64, p &lt; 0.001), and AAPT fatigue problems and Thai FSS (rs = 0.67, p &lt; 0.001). Diagnosis agreement between the AAPT and ACR 2016 criteria was 90.6%, with a substantial Kappa coefficient of 0.67 (p &lt; 0.001), indicating good concordance. The sensitivity and specificity were 48.3% (95% CI: 29.4%–67.5%) and 99.0% (95% CI: 94.5%–100.0%), respectively. Conclusion: The Thai AAPT-FSQ had good construct validity and agreement in patients with chronic musculoskeletal pain. Due to its shorter criteria and simplicity, it may serve as a practical self-administered questionnaire for FM.

Fibromyalgia is a complex clinical entity characterized by a broad range of symptoms including chronic widespread musculoskeletal pain, profound fatigue, impaired cognition, and mood disturbances. Current understanding of disease pathogenesis assumes neurotransmitter dysregulation and central pain sensitization play a key role resulting in heightened pain sensitivity. Genetic predisposition as well as alterations in endocrine and immune function have been implicated. Accurate diagnosis requires a comprehensive evaluation, and a personalized treatment approach is needed to address the biopsychosocial components of the disease process. Among pharmacologic treatment options, serotonin norepinephrine reuptake inhibitors (SNRIs) have demonstrated analgesic effects in addition to mood stabilizing properties. Currently, duloxetine and milnacipran are approved by the Food and Drug Administration although other agents in this drug class including venlafaxine and desvenlafaxine have been studied in the management of fibromyalgia. In addition, selective norepinephrine reuptake inhibitors, esreboxetine and reboxetine, as well as tramadol, a weak opioid mu-receptor agonist with SNRI activity have shown potential utility. Although some studies have demonstrated SNRIs to be effective and well tolerated in patients with fibromyalgia, individual response may vary. There remains a continued need for large scale clinical trials to establish the safety and clinical effectiveness of these agents in this patient population. Further information is needed to optimize patient selection and dosing regimens as well as elucidate the clinical factors associated with poor response. Moreover, pharmacologic agents may be combined with lifestyle changes and non-drug-based treatments to address the complex interactions of biological and psychosocial factors that facilitate disease development and persistence of symptoms.

The fibromyalgia syndrome (FMS) is the most frequent cause of chronic widespread pain. In this review, we summarize the state of the art on the syndrome and its pathophysiology, with an emphasis on identifying bases for the development of novel therapies. Toward this end, the anatomy and physiology of pain pathways are summarized, followed by a review of the altered biology of pain processing, neurotransmitter function, and neuroendocrine systems in FMS. The categories of drugs currently employed to treat the disorder are detailed, along with a critical review of the literature supporting such use. Throughout the article, FMS is compared with and related to both major depressive disorder and neuropathic pain, conditions that may share some common biological processes with FMS but for which new drug discovery efforts are significantly more active due to the more established nature of these diagnoses. Psychopharmacology Bulletin. 2002;36(1):165-213