, Volume 15, Issue 3, pp 211-220

Screening for pain-persistence and pain-avoidance patterns in fibromyalgia

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Background: The heterogeneity of patients regarding pain-related cognitive-behavioral mechanisms, such as pain-avoidance and pain-persistence patterns, has been proposed to underlie varying treatment outcomes in patients with fibromyalgia (FM). Purpose: To investigate the validity of a screening instrument to discriminate between pain-persistence and pain-avoidance patterns in FM. Method: In a three-part study, a self-reported screening instrument that assesses pain-avoidance behavior was used to distinguish patients with pain-persistence and pain-avoidance patterns. The resultant groups were compared with regard to several pain-related cognitive-behavioral factors, performance on a physical fitness test, and with regard to the judgments of trained therapists based on a semi-structured interview. Results: The validity of the screening instrument to distinguish between pain-avoidance and pain-persistence patterns was supported by other validated self-report questionnaires for pain-related cognitive-behavioral factors, physical exercise tests, as well as by a high correspondence with blinded therapist judgment after intake assessments. Conclusion: These findings suggest that a short self-report screening instrument can be used to distinguish between pain-avoidance and pain-persistence patterns within the heterogeneous population of FM patients, which offers promising possibilities to improve treatment efficacy by tailoring treatment to specific patient patterns.

This study was supported in part by grants from the Dutch Arthritis Association (“Reumafonds”) and Netherlands Organization for Health Research and Development (“ZON-MW”). The authors would like to thank M. Effting, M. van Limborgh, A. de Jong, J. F. Haverman, K. J. Korff, as well as the Dutch patient organization for fibromyalgia (FES) for their help in collecting the research data.