Sifting the wheat from the chaff?: Evidence for the existence of an asymmetric fibromyalgia phenotype

Helena H Kaziyama; Julio Barbour; Ricardo Galhardoni; Valquíria Aparecida da Silva; Silvia R D Tesseroli de Siqueira; Clarice Listik; Gabriel José Dos Santos; Lin T Yeng; Marco Antonio Marcolin; Irina Raicher; Manoel J Teixeira; Daniel Ciampi de Andrade

doi:10.1002/ejp.1620

Sifting the wheat from the chaff? Evidence for the existence of an asymmetric fibromyalgia phenotype

Helena H Kaziyama, Julio Barbour, Ricardo Galhardoni, Valquíria Aparecida da Silva, Silvia R D Tesseroli de Siqueira, Clarice Listik, Gabriel José Dos Santos, Lin T Yeng, Marco Antonio Marcolin, Irina Raicher, Manoel J Teixeira, Daniel Ciampi de Andrade

Research output: Contribution to journal › Journal article › Research › peer-review

6 Citations (Scopus)

Abstract

BACKGROUND: The different phenotypic presentations of fibromyalgia (FM) have been infrequently studied and may have diagnostic and therapeutic implications. The aim of this study was to explore differences between FM patients with classical symmetric (s-FM) presentation and FM patients with marked asymmetric (a-FM) pain.

METHODS: We performed two consecutive cross-sectional studies on FM patients and matched healthy volunteers (HV). FM patients were divided into a-FM (and s-FM groups according to their score of pain intensity on each body side; patients with a difference of ≥40 mm in VAS between left and right sides were classified as a-FM, otherwise classified as s-FM. Participants (FM = 32; HV = 31) were assessed for clinical, cortical excitability (CE), quantitative sensory testing (QST; study 1), and intraepidermal nerve fibre density (IENFD) determinations (study 2).

RESULTS: While pain intensity did not significantly differ between s-FM and a-FM patients, pain interference in daily activities was significantly higher in the a-FM as compared to the s-FM group (54.7 ± 8.9 and 37.6 ± 13.5; p < .0001). PPT was significantly lower in the more painful side of a-FM as compared to the HV (27.7 ± 7.9 and 49.9 ± 13.0; p < .0001), while PPT in the less painful side of a-FM was significantly higher than PPT values in the s-FM (35.8 ± 8.3 and 27.7 ± 5.5; p = .031). S-FM and a-FM had significantly abnormal intracortical inhibition values on CE measurements compared to HV. There were no significant differences in IENFD between groups.

CONCLUSIONS: Within the current FM criteria, there exist different phenotypes with clinical, psychophysics, and neurophysiological findings that are not related to peripheral IENFD abnormalities.

SIGNIFICANCE: Current fibromyalgia criteria may contain different phenotypes of fibromyalgia based on the lateralization of pain.

Original language	English
Journal	European Journal of Pain
Volume	24
Issue number	8
Pages (from-to)	1635-1647
Number of pages	13
ISSN	1090-3801
DOIs	https://doi.org/10.1002/ejp.1620
Publication status	Published - Sept 2020
Externally published	Yes

Bibliographical note

Keywords

Cross-Sectional Studies
Fibromyalgia
Humans
Pain
Pain Measurement
Phenotype

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Cite this

H Kaziyama, H., Barbour, J., Galhardoni, R., Aparecida da Silva, V., R D Tesseroli de Siqueira, S., Listik, C., Dos Santos, G. J., Yeng, L. T., Marcolin, M. A., Raicher, I., Teixeira, M. J., & Ciampi de Andrade, D. (2020). Sifting the wheat from the chaff? Evidence for the existence of an asymmetric fibromyalgia phenotype. European Journal of Pain, 24(8), 1635-1647. https://doi.org/10.1002/ejp.1620

@article{0f172e7f28e94a468af5546daed0490f,

title = "Sifting the wheat from the chaff?: Evidence for the existence of an asymmetric fibromyalgia phenotype",

abstract = "BACKGROUND: The different phenotypic presentations of fibromyalgia (FM) have been infrequently studied and may have diagnostic and therapeutic implications. The aim of this study was to explore differences between FM patients with classical symmetric (s-FM) presentation and FM patients with marked asymmetric (a-FM) pain.METHODS: We performed two consecutive cross-sectional studies on FM patients and matched healthy volunteers (HV). FM patients were divided into a-FM (and s-FM groups according to their score of pain intensity on each body side; patients with a difference of ≥40 mm in VAS between left and right sides were classified as a-FM, otherwise classified as s-FM. Participants (FM = 32; HV = 31) were assessed for clinical, cortical excitability (CE), quantitative sensory testing (QST; study 1), and intraepidermal nerve fibre density (IENFD) determinations (study 2).RESULTS: While pain intensity did not significantly differ between s-FM and a-FM patients, pain interference in daily activities was significantly higher in the a-FM as compared to the s-FM group (54.7 ± 8.9 and 37.6 ± 13.5; p < .0001). PPT was significantly lower in the more painful side of a-FM as compared to the HV (27.7 ± 7.9 and 49.9 ± 13.0; p < .0001), while PPT in the less painful side of a-FM was significantly higher than PPT values in the s-FM (35.8 ± 8.3 and 27.7 ± 5.5; p = .031). S-FM and a-FM had significantly abnormal intracortical inhibition values on CE measurements compared to HV. There were no significant differences in IENFD between groups.CONCLUSIONS: Within the current FM criteria, there exist different phenotypes with clinical, psychophysics, and neurophysiological findings that are not related to peripheral IENFD abnormalities.SIGNIFICANCE: Current fibromyalgia criteria may contain different phenotypes of fibromyalgia based on the lateralization of pain.",

keywords = "Cross-Sectional Studies, Fibromyalgia, Humans, Pain, Pain Measurement, Phenotype",

author = "{H Kaziyama}, Helena and Julio Barbour and Ricardo Galhardoni and {Aparecida da Silva}, Valqu{\'i}ria and {R D Tesseroli de Siqueira}, Silvia and Clarice Listik and {Dos Santos}, {Gabriel Jos{\'e}} and Yeng, {Lin T} and Marcolin, {Marco Antonio} and Irina Raicher and Teixeira, {Manoel J} and {Ciampi de Andrade}, Daniel",

note = "{\textcopyright} 2020 European Pain Federation - EFIC{\textregistered}.",

year = "2020",

month = sep,

doi = "10.1002/ejp.1620",

language = "English",

volume = "24",

pages = "1635--1647",

journal = "European Journal of Pain",

issn = "1090-3801",

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H Kaziyama, H, Barbour, J, Galhardoni, R, Aparecida da Silva, V, R D Tesseroli de Siqueira, S, Listik, C, Dos Santos, GJ, Yeng, LT, Marcolin, MA, Raicher, I, Teixeira, MJ & Ciampi de Andrade, D 2020, 'Sifting the wheat from the chaff? Evidence for the existence of an asymmetric fibromyalgia phenotype', European Journal of Pain, vol. 24, no. 8, pp. 1635-1647. https://doi.org/10.1002/ejp.1620

TY - JOUR

T1 - Sifting the wheat from the chaff?

T2 - Evidence for the existence of an asymmetric fibromyalgia phenotype

AU - H Kaziyama, Helena

AU - Barbour, Julio

AU - Galhardoni, Ricardo

AU - Aparecida da Silva, Valquíria

AU - R D Tesseroli de Siqueira, Silvia

AU - Listik, Clarice

AU - Dos Santos, Gabriel José

AU - Yeng, Lin T

AU - Marcolin, Marco Antonio

AU - Raicher, Irina

AU - Teixeira, Manoel J

AU - Ciampi de Andrade, Daniel

PY - 2020/9

Y1 - 2020/9

N2 - BACKGROUND: The different phenotypic presentations of fibromyalgia (FM) have been infrequently studied and may have diagnostic and therapeutic implications. The aim of this study was to explore differences between FM patients with classical symmetric (s-FM) presentation and FM patients with marked asymmetric (a-FM) pain.METHODS: We performed two consecutive cross-sectional studies on FM patients and matched healthy volunteers (HV). FM patients were divided into a-FM (and s-FM groups according to their score of pain intensity on each body side; patients with a difference of ≥40 mm in VAS between left and right sides were classified as a-FM, otherwise classified as s-FM. Participants (FM = 32; HV = 31) were assessed for clinical, cortical excitability (CE), quantitative sensory testing (QST; study 1), and intraepidermal nerve fibre density (IENFD) determinations (study 2).RESULTS: While pain intensity did not significantly differ between s-FM and a-FM patients, pain interference in daily activities was significantly higher in the a-FM as compared to the s-FM group (54.7 ± 8.9 and 37.6 ± 13.5; p < .0001). PPT was significantly lower in the more painful side of a-FM as compared to the HV (27.7 ± 7.9 and 49.9 ± 13.0; p < .0001), while PPT in the less painful side of a-FM was significantly higher than PPT values in the s-FM (35.8 ± 8.3 and 27.7 ± 5.5; p = .031). S-FM and a-FM had significantly abnormal intracortical inhibition values on CE measurements compared to HV. There were no significant differences in IENFD between groups.CONCLUSIONS: Within the current FM criteria, there exist different phenotypes with clinical, psychophysics, and neurophysiological findings that are not related to peripheral IENFD abnormalities.SIGNIFICANCE: Current fibromyalgia criteria may contain different phenotypes of fibromyalgia based on the lateralization of pain.

AB - BACKGROUND: The different phenotypic presentations of fibromyalgia (FM) have been infrequently studied and may have diagnostic and therapeutic implications. The aim of this study was to explore differences between FM patients with classical symmetric (s-FM) presentation and FM patients with marked asymmetric (a-FM) pain.METHODS: We performed two consecutive cross-sectional studies on FM patients and matched healthy volunteers (HV). FM patients were divided into a-FM (and s-FM groups according to their score of pain intensity on each body side; patients with a difference of ≥40 mm in VAS between left and right sides were classified as a-FM, otherwise classified as s-FM. Participants (FM = 32; HV = 31) were assessed for clinical, cortical excitability (CE), quantitative sensory testing (QST; study 1), and intraepidermal nerve fibre density (IENFD) determinations (study 2).RESULTS: While pain intensity did not significantly differ between s-FM and a-FM patients, pain interference in daily activities was significantly higher in the a-FM as compared to the s-FM group (54.7 ± 8.9 and 37.6 ± 13.5; p < .0001). PPT was significantly lower in the more painful side of a-FM as compared to the HV (27.7 ± 7.9 and 49.9 ± 13.0; p < .0001), while PPT in the less painful side of a-FM was significantly higher than PPT values in the s-FM (35.8 ± 8.3 and 27.7 ± 5.5; p = .031). S-FM and a-FM had significantly abnormal intracortical inhibition values on CE measurements compared to HV. There were no significant differences in IENFD between groups.CONCLUSIONS: Within the current FM criteria, there exist different phenotypes with clinical, psychophysics, and neurophysiological findings that are not related to peripheral IENFD abnormalities.SIGNIFICANCE: Current fibromyalgia criteria may contain different phenotypes of fibromyalgia based on the lateralization of pain.

KW - Cross-Sectional Studies

KW - Fibromyalgia

KW - Humans

KW - Pain

KW - Pain Measurement

KW - Phenotype

U2 - 10.1002/ejp.1620

DO - 10.1002/ejp.1620

M3 - Journal article

C2 - 32533900

SN - 1090-3801

VL - 24

SP - 1635

EP - 1647

JO - European Journal of Pain

JF - European Journal of Pain

IS - 8

ER -