- Email: [email protected]
Yet another questionnaire is born!
Ò
PAIN 150 (2010) 219
www.elsevier.com/locate/pain
Commentary
Yet another questionnaire is born! This issue of Pain contains a newly developed questionnaire, FiRST (Fibromyalgia Rapid Screening Tool), which is intended to facilitate identification of the fibromyalgia syndrome (FMS) [2]. FMS is a widespread pain condition with a duration of at least three months, with pain present in all four body quadrants as well as axial pain, as outlined by diagnostic criteria founded by the American College of Rheumatologists (ACR) in 1990 [3]. In addition, there is pain in 11 of 18 tender point sites on digital palpation. Non-painful symptoms may also parallel FMS, such as gastrointestinal disturbances and paresthesias. The authors have chosen to develop and validate their questionnaire using three comparators: rheumatoid arthritis (RA), diffuse (i.e., more than 3 joints involved) osteoarthritis (OA) and ankylosing spondylitis (AS). These are conditions, unlike FMS, with a clinical phenomenology that mainly derives from joint-related pathology and hence they present with symptoms and signs most frequently focused to joint areas [1]. The FiRST contains six questions, only two of which are directly related to the sensory-discriminative part of the pain experience, i.e., distribution and descriptors. Four questions focus on concomitant fatigue, non-pain sensory symptoms, gastrointestinal and urinary tract dysfunction and impact on life. My main concern with the new questionnaire is the choice of comparators, three conditions not characterized by widespread pain comparable to what is found in FMS. The authors refer to these three conditions as ‘‘other rheumatological conditions” paralleled by ‘‘chronic diffuse pain”. FMS has an unknown etiology and should not be referred to as a rheumatological condition. To label these as diffuse pain conditions is obviously an incorrect description of the typical patient suffering from any of the three conditions [1]. With the selected non-challenging comparators the usefulness of FiRST for FMS detection must be seriously questioned. FiRST is unlikely to offer any assistance to physicians in identifying FMS. As the clinical phenomenology of these conditions poses no differential diagnostic problem with regard to FMS, it is unlikely that a clinician with training in these conditions needs the suggested guidance. Therefore, the statement by the authors that ‘‘The present data tend to confirm that FMS constitutes a specific entity, at least on clinical grounds” is not surprising, due to the choice of comparators. If FiRST is going to have a future in daily clinical practise and research, as suggested by the authors, then the questionnaire needs to be re-born in a scenario where validation is performed with con-
ditions that challenge the sensitivity and specificity of the questionnaire, in real world situations, i.e., where there are conditions clinically demanding from the differential diagnostic perspective. The authors have suggested using ‘‘complex clinical syndromes with both multiple types of pain and multiple pain locations (e.g., multiple sclerosis)”. These are excellent proposals but also other widespread pain conditions of unknown etiology and pathogenesis that do not fulfill ACR criteria of FMS should be evaluated, as should cervical spinal cord injury patients with the ‘‘below level” type of pain affecting most body areas. Conflict of interest I am a member of advisory boards and/or have received honoraria for lectures by the following companies over the past year: Astellas, Pfizer, Lilly, Medtronic, Grunenthal. References [1] Merskey H, Bogduk N. Classification of chronic pain. Descriptions of chronic pain syndromes and definitions of pain terms. Seattle: IASP Press; 1994. [2] Perrot S, Bouhassira D, Fermanian J, the CEDR (Cercle d’Etude de la Douleur en Rhumatologie). Development and validation of the Fibromyalgia Rapid Screening Tool (FiRST). Pain 2010;150:250–6. [3] Wolfe F, Smythe HA, Yunus MB, Bennett 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, Russell IJ, Sheon RP. The American College of Rheumatology 1990 Criteria for the Classification of Fibromyalgia. Report of the Multicenter Criteria Committee. Arthritis Rheum 1990;33:160–72.
Per T Hansson Professor of Clinical Pain Research, Dept. of Molecular Medicine and Surgery, Karolinska Institutet, Sweden Senior consultant and section head, Specialist in neurology and pain management, Pain Center, Dept. of Anesthesiology and Intensive Care, Karolinska University Hospital, Solna, 17176 Stockholm, Sweden, Tel.: +46 8 51775435; fax: +46 8 51775625 E-mail address: [email protected]
0304-3959/$36.00 Ó 2010 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved. doi:10.1016/j.pain.2010.05.006
PAIN 150 (2010) 219
www.elsevier.com/locate/pain
Commentary
Yet another questionnaire is born! This issue of Pain contains a newly developed questionnaire, FiRST (Fibromyalgia Rapid Screening Tool), which is intended to facilitate identification of the fibromyalgia syndrome (FMS) [2]. FMS is a widespread pain condition with a duration of at least three months, with pain present in all four body quadrants as well as axial pain, as outlined by diagnostic criteria founded by the American College of Rheumatologists (ACR) in 1990 [3]. In addition, there is pain in 11 of 18 tender point sites on digital palpation. Non-painful symptoms may also parallel FMS, such as gastrointestinal disturbances and paresthesias. The authors have chosen to develop and validate their questionnaire using three comparators: rheumatoid arthritis (RA), diffuse (i.e., more than 3 joints involved) osteoarthritis (OA) and ankylosing spondylitis (AS). These are conditions, unlike FMS, with a clinical phenomenology that mainly derives from joint-related pathology and hence they present with symptoms and signs most frequently focused to joint areas [1]. The FiRST contains six questions, only two of which are directly related to the sensory-discriminative part of the pain experience, i.e., distribution and descriptors. Four questions focus on concomitant fatigue, non-pain sensory symptoms, gastrointestinal and urinary tract dysfunction and impact on life. My main concern with the new questionnaire is the choice of comparators, three conditions not characterized by widespread pain comparable to what is found in FMS. The authors refer to these three conditions as ‘‘other rheumatological conditions” paralleled by ‘‘chronic diffuse pain”. FMS has an unknown etiology and should not be referred to as a rheumatological condition. To label these as diffuse pain conditions is obviously an incorrect description of the typical patient suffering from any of the three conditions [1]. With the selected non-challenging comparators the usefulness of FiRST for FMS detection must be seriously questioned. FiRST is unlikely to offer any assistance to physicians in identifying FMS. As the clinical phenomenology of these conditions poses no differential diagnostic problem with regard to FMS, it is unlikely that a clinician with training in these conditions needs the suggested guidance. Therefore, the statement by the authors that ‘‘The present data tend to confirm that FMS constitutes a specific entity, at least on clinical grounds” is not surprising, due to the choice of comparators. If FiRST is going to have a future in daily clinical practise and research, as suggested by the authors, then the questionnaire needs to be re-born in a scenario where validation is performed with con-
ditions that challenge the sensitivity and specificity of the questionnaire, in real world situations, i.e., where there are conditions clinically demanding from the differential diagnostic perspective. The authors have suggested using ‘‘complex clinical syndromes with both multiple types of pain and multiple pain locations (e.g., multiple sclerosis)”. These are excellent proposals but also other widespread pain conditions of unknown etiology and pathogenesis that do not fulfill ACR criteria of FMS should be evaluated, as should cervical spinal cord injury patients with the ‘‘below level” type of pain affecting most body areas. Conflict of interest I am a member of advisory boards and/or have received honoraria for lectures by the following companies over the past year: Astellas, Pfizer, Lilly, Medtronic, Grunenthal. References [1] Merskey H, Bogduk N. Classification of chronic pain. Descriptions of chronic pain syndromes and definitions of pain terms. Seattle: IASP Press; 1994. [2] Perrot S, Bouhassira D, Fermanian J, the CEDR (Cercle d’Etude de la Douleur en Rhumatologie). Development and validation of the Fibromyalgia Rapid Screening Tool (FiRST). Pain 2010;150:250–6. [3] Wolfe F, Smythe HA, Yunus MB, Bennett 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, Russell IJ, Sheon RP. The American College of Rheumatology 1990 Criteria for the Classification of Fibromyalgia. Report of the Multicenter Criteria Committee. Arthritis Rheum 1990;33:160–72.
Per T Hansson Professor of Clinical Pain Research, Dept. of Molecular Medicine and Surgery, Karolinska Institutet, Sweden Senior consultant and section head, Specialist in neurology and pain management, Pain Center, Dept. of Anesthesiology and Intensive Care, Karolinska University Hospital, Solna, 17176 Stockholm, Sweden, Tel.: +46 8 51775435; fax: +46 8 51775625 E-mail address: [email protected]
0304-3959/$36.00 Ó 2010 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved. doi:10.1016/j.pain.2010.05.006