Self-Report Survey Accurately Assesses Musculoskeletal Pain

Results of a recent study suggest the Patient Self-Report Survey for the Assessment of Fibromyalgia may be a valuable method to assess the psychological and pain sensitivity factors in patients with fibromyalgia and musculoskeletal pain, according to research published in Journal of Pain Research.¹

Patients with nociplastic pain, a condition estimated to affect approximately 5-15% of the population, experience heightened nociceptive transmission in parts of the brain responsible for processing emotions and pain. These patients often experience depression and catastrophizing, among other negative psychological symptoms.²

“A current challenge in clinical practice is the lack of a gold standard for identifying individuals with nociplastic pain (or central sensitization),” wrote lead investigator, Abigail Wilson, PT, DPT, PhD, assistant professor in the School of Kinesiology and Physical Therapy at the University of Central Florida, and colleagues. “Clinicians report being able to identify central sensitization in viewpoint articles and clinical practicebased on a patient’s history of widespread pain and additional clinical symptoms. However, this approach lacks standardization in identifying central sensitization (or a nociplastic pain presentation).”

Currently, there are limited data exploring the validity of the Patient Self-Report Survey for the Assessment of Fibromyalgia against the psychophysical factors of pain sensitivity as well as the psychological symptoms in patients with musculoskeletal pain.

To determine the link between the total survey scores and pain sensitivity, psychological, and clinical factors, a secondary analysis of a cross-sectional study was performed. A cohort of patients with shoulder (n = 20) or low back (n = 20) pain were instructed to complete the 5-item Patient Self-Report Survey for the Assessment of Fibromyalgia, Quantitative Sensory Testing (QST), and pain-related psychological questionnaires. The Spearman correlation was used to evaluate the association between total scores and psychological factors, while pain sensitivity was assessed using QST, a tool used to examine both local and widespread hypersensitivity.

Of the included patients, the mean age was 26 years, 60% were female, and 71.80% were White. The mean total scores of the survey were 7.45 ± 4.13, which suggested patients were experiencing low-to-moderate pain intensity.

Upon analysis, greater negative psychological factors were reported in patients with a higher severity of symptoms, as indicated by the moderate-to-strong positive associations between negative psychological factors and the Patient Self-Report Survey for the Assessment of Fibromyalgia (rho range = .36–.80). Additionally, higher pain sensitivity was reported in patients with a higher severity of nociplastic pain symptoms, as suggested by the weak-to-moderate negative associations between the survey and pain sensitivity factors (PPT rho range = −.36- − .41)

Pain sensitivity factors demonstrated weak to moderate negative associations with the survey (pressure pain threshold [PPT] rho range = − 0.36- − 0.41), suggesting elevated pain sensitivity was detected in individuals with higher severity of nociplastic pain symptoms.

Investigators noted the small sample size as a limitation of the study. The secondary analysis design also prevented them from specifically recruiting patients with nociplastic pain. Additionally, they were unable to recruit patients with chronic pain. Lastly, the Central Sensitization Index (CSI) was not explored, which deterred the assessment of any link between the CSI and pain sensitivity and psychological factors.

“The Patient Self-Report Survey for the Assessment of Fibromyalgia demonstrates convergent validity with pain sensitivity and psychological factors in patients with shoulder or low back pain,” investigators concluded. “As a result, this questionnaire may have future application in clinical research.”

References

1. ^{Wilson AT, Razzell C, Hanney WJ. The Association Between the Patient Self-Report Survey for the Assessment of Fibromyalgia with Pain Sensitivity and Psychological Factors in Individuals with Musculoskeletal Pain. J Pain Res. 2023;16:3297-3308. Published 2023 Sep 28. doi:10.2147/JPR.S425687}
2. ^{Gracely RH, Geisser ME, Giesecke T, et al. Pain catastrophizing and neural responses to pain among persons with fibromyalgia. Brain. 2004;127(Pt 4):835–843. doi:10.1093/brain/awh098}