The Relationship of Centralized Pain in Fibromyalgia Syndrome with Sleep, Fatigue and Quality of Life , 2022, Unal-Ulutatar et al

Abstract

Introduction-aim
Pain in patients with fibromyalgia (FM) has negative effects on their lives. The aim of this study was to examine the central role of pain in patients’ lives by evaluating the relationship between the centralization of pain and clinical and functional parameters.

Methods
Adult patients aged 18-70, diagnosed with FM according to the 2016 ACR revised criteria were included in the study. Demographic and clinical data were noted. The Fibromyalgia Impact Questionnaire (FIQ) was used to assess the severity of FM, and the Centrality of Pain Scale (COPS) was used to assess pain centralization. The European Quality of Life Scale 5 Dimension (EQ-5D) assessed quality of life, the Jenkins Sleep Scale (JSS-TR) sleep, and the Beck Depression Inventory (BDI) depression. Descriptive statistical methods were used for demographic and clinical data. Spearman correlation coefficient (rho) was used to examine the relationship between COPS scores and other parameters, and p<0.05 was considered significant.

Results
165 FM patients (143 female) were included in the study. The mean age of the patients was 43.7 ± 10.1 years and the mean disease duration was 4.8 ± 7.8 years. Patients who did not work showed significantly higher centralized pain (mean of COPS = 32.3) compared to the employed (mean COPS = 29.1, p = 0.01). Centrality of pain was found to be related to FIQ (rho = 0.59, p = 0.0005), EQ-5D (rho = -0.53, p = 0.0005), JSS-TR (rho = 0.43, p = 0.0005), and BDI (rho = 0.41, p = 0.0005).

Conclusion
Centralization of pain in patients with FM was more common in unemployed patients with high disease severity, poor quality of life, and sleep and depression problems. It is important to evaluate the centralization of pain in the clinical follow-up of patients.

Open access, https://academic.oup.com/mr/advance-article/doi/10.1093/mr/roac002/6520254

 

I am confused by this abstract. Are they using ‘central/centralised’ in two different senses?

I am interpreting the phrase ‘the central role of pain’ as relating to the subject significance or importance of pain in their lives, however when they talk about ‘centralised pain’ are they mailing a neurological claim as in ‘the central nervous system’ or referring again to its psychological significance?

Either way are their findings just saying in the end, the worse the pain, the worst it’s impact?

 

A quick search suggests it basically means how disabling it is, how "central" it is to one's life. Which given that they observe that people with more pain work less and have lower quality of life is just duh, they are basically "finding" that people with more pain have more pain-related impact. Groundbreaking stuff, especially given this is probably the 100th or so identical "exploration" study.

It basically considers pain as just a feature, like the color of walls. Research completely detached from its context is really exactly as useful as it sounds.

You got right, Peter, this is basically "water=wet, scientists confused why".

 

No, I don't think the Centrality of Pain Scale or COPS refers to any central sensitization--neuro-type category.
It is a psych scale of how 'central' the chronic pain is to the person's life, as @rvallee just now pointed out.

My guess is we'll be seeing more about this instrument, the COPS scale as it has been written about positively in other research on validation of it.

Bit o'common sense, yeah?

Surely the psychs will be using that scale to pick on those who are unemployed because of severity of FM and castigate them further with untoward psych labels.

 

From the discussion in the article :

" Pain management strategies in FM should be holistic which means that target should not only be to reduce the pain severity, but also to manage the patient’s pain perception. In order to manage centrality of pain it is important to find out which factors are associated with COPS, which has been developed for chronic nonmalignant pain, and its validity has been shown in patients with FM [9]. Fibromyalgia is a complex disorder characterized by chronic widespread pain, and sleep and cognitive problems. Pain, the leading symptom of FM, is one of the symptoms with the highest frequency for seeking medical care [19]. The mechanism of pain in FM has recently been described as nociplastic pain which means “Pain that arises from altered nociception despite no clear evidence of actual or threatened tissue damage causing the activation of peripheral nociceptors or evidence for disease or lesion of the somatosensory system causing the pain” [19]. Psychological, behavioral, and social issues contribute to the pathogenesis of FM... "

Same BPS as always, does also refer to "central sensitization". Sigh...!

* underlined by me

* fixed a language error