文档介绍：e Measures in Fibromyalgia
Daniel J. Clauw, MD
Professor of Medicine, Division of Rheumatology
Director, Chronic Pain and Fatigue Research Program
University of Michigan Medical Center
Chronic Pain – Defined by Mechanisms
Peripheral (nociceptive)
Primarily due to inflammation or damage in periphery
NSAID, opioid responsive
Behavioral factors minor
Examples
OA
Acute pain models (. third molar, post-surgery)
RA
Cancer pain
Central (non-nociceptive)
Primarily due to a central disturbance in pain processing
Tricyclic responsive
Behavioral factors more prominent
Examples
Fibromyalgia
Irritable bowel syndrome
Tension and migraine headache
Interstitial cystitis / vulvodynia, non-cardiac chest pain / etc.
Mixed
Neuropathic
Effect Sizes of Various Treatments in Fibromyalgia - I (Rossy et. Al. Ann Behav Med 1999)
Pharmacologic
Exercise
CBT
Symptoms
.49 (n=35)
.56 (n=8)
.63 (n=6)
Psychological status
.52 (n=16)
.38 (n=5)
.60 (n=5)
Functional status
.19 (n=6)
.29 (n=3)
.38 (n=3)
Effect Sizes of Various Treatments in Fibromyalgia - II (Rossy et. Al. Ann Behav Med 1999)
Antidepressants
Muscle relaxants
NSAIDs
Symptoms
.49 (n=12)
.47 (n=8)
.06 (n=3)
Psychological status
.22 (n=4)
.26 (n=3)
.49 (n=1)
Functional status
.15 (n=4)
.24 (n=1)
-.25 (n=1)
Effect Sizes of Various Treatments in Fibromyalgia – III(Arnold et. al. Psychosomatics 2000)
Pooled effects sizes of nine trials of tricyclics
Sleep .69
Physician global .64
Pain .57
Fatigue .52
Patient global .50
Tenderness .36
Potential e Measures in FM
Pain
Type of scale
Measured how?
Functional status
Subjective
Activity monitoring
Patient global improvement
Other symptoms
Fatigue
Sleep
Cognitive symptoms
Process / surrogate e measures
Evoked pain
Functional imaging
Visual Analog Scale
No
Pain
Pain as
bad as it
could be
Problems with Current Methods of Pain Measurement
VAS not a good measure from reliability, validity standpoint
Anchor is something that patient may have nev