WIDESPREAD PAIN - IS AN IMPROVED CLASSIFICATION POSSIBLE

Objective, The classification of widespread pain, proposed by the Amer ican College of Rheumatology (ACR) for use in the clinic as a screen f or fibromyalgia, as described, does not require truly widespread pain, Studies considering the epidemiology of widespread pain per st may th erefore require a definition with greater face validity, which might a lso show enhanced associations with other physical and psychological m easures, We aimed to develop a more coherent definition of widespread pain for use in epidemiological studies and to compare performance in identifying individuals with significant morbidity. Methods. A group o f 172 subjects who had participated in a community based study on the occur occurrence of pain were identified and categorized by their pain experience as indicated on line drawings of the body according to ACR definition and to a new, more stringent definition that required the presence of more diffuse limb pain. A number of other clinical and psy chological measures were recorded for these individuals and the associ ation between their pain status measures and these other variables was assessed and compared, Results. Persons satisfying the newly proposed definition for chronic widespread pain, in comparison with those who satisfied only the present ACR definition. had a significantly higher score on the General Health Questionnaire [median difference (MD) 7, 9 5% CI 1,13], a higher score on the Health and Fatigue Questionnaire (M D 10, 95% CI 0,15), and greater problems with sleep (sleep problem sco re MD 4, 95% CI 0.9). Those satisfying the new definition also had a g reater number of tender points on examination (MD 3, 95% CI -1.7). The morbidity of those satisfying only the present ACR definition was clo ser to persons who had regional pain. Conclusion. A redefinition of wi despread pain has produced a group of subjects whose pain is (a) likel y to be more ''widespread'' and (b) is associated more strongly with f actors such as psychological disturbance, fatigue, sleep problems, and tender points. and may be more appropriate in epidemiological studies .