Ragnhild Raak

Quantitative sensory testing in fibromyalgia patients and in healthy subjects: identification of subgroups.

ObjectiveTo determine perception and pain thresholds in patients with fibromyalgia syndrome and in healthy controls, and to investigate whether patients with fibromyalgia syndrome can be grouped with respect to thermal hyperalgesia and whether these subgroups differ from healthy controls and in clinical appearance. DesignThe authors conducted a quasi-experimental clinical study. SubjectsTwenty-nine women patients with fibromyalgia syndrome and 21 healthy pain-free age-matched women participated in the study. MethodsQuantitative sensory testing using a Thermotest instrument was performed on the dorsum of the left hand. Sleep and pain intensity were rated using visual analog scales. ResultsCold and heat pain but not perception thresholds differed significantly between patients with fibromyalgia syndrome and healthy subjects. Based on thermal pain thresholds, two subgroups could be identified in fibromyalgia syndrome using cluster analysis. ConclusionPatients with fibromyalgia syndrome were subgrouped by quantitative sensory testing (i.e., thermal pain thresholds). Subgroups show clinical differences in pain intensities, number of tender points, and sleep quality. Cold pain threshold was especially linked to these clinical aspects.

Quality of life in subgroups of individuals with whiplash-associated disorders.

Background: The term whiplash associated disorders (WAD) includes a wide range of complaints, with neck pain as predominating symptom. Living with long term pain influences quality of life. In previous studies of other chronic pain patients, subgrouping has been made according to thermal pain thresholds measured in quantitative sensory testing (QST).

Thermal thresholds and catastrophizing in individuals with chronic pain after whiplash injury

Thermal sensitivity, thermal pain thresholds, and catastrophizing were examined in individuals with whiplash associated disorders (WAD) and in healthy pain-free participants. Quantitative sensory testing (QST) was used to measure skin sensitivity to cold and warmth and cold and heat pain thresholds over both the thenar eminence and the trapezius muscle (TrM) in 17 participants with WAD (age 50.8± 11.3 years) and 18 healthy participants (age 44.8± 10.2 years). The Pain Catastrophizing Scale (PCS) was used to determine pain coping strategies, and visual analogue scales were used for self-assessment of current background pain in individuals in the WAD group as well as experienced pain intensity and unpleasantness after QST and sleep quality in all participants. There were significant differences in warmth threshold and cold and heat pain thresholds of the TrM site between the WAD and pain-free groups. Significant differences between the two groups were also found for the catastrophizing dimension of helplessness in the PCS and in self-assessed quality of sleep. A correlational analysis showed that current background pain is significantly correlated with both cold discrimination and cold pain threshold in the skin over the TrM in individuals with WAD. These findings imply that thermal sensitivity is an important factor to consider in providing nursing care to individuals with WAD. Because biopsychosocial factors also influence the experience of pain in individuals with WAD, the role of nurses includes not only the description of the pain phenomenon but also the identification of relieving and aggravating factors.

Work attendance despite headache and its economic impact: a comparison between two workplaces.

Objective.—To study work attendance despite headache in 2 different workplaces and its economic impact.

Coping strategies and life satisfaction in subgrouped fibromyalgia patients.

The present study describes pain- and stress-coping strategies and life satisfaction in subgroups of fibromyalgia patients. Thirty-two females with fibromyalgia syndrome (FMS) and 21 healthy pain-free women were studied. Those with FMS were classified as thermal (both heat and cold) pain sensitive or slightly cold pain sensitive based on pain thresholds determined using a Thermotest device. Global stress-coping styles, life satisfaction, and specific pain-coping strategies were measured. Patients classified as thermal pain sensitive were affected by physical symptoms to a greater extent than were those classified as slightly cold pain sensitive. The thermal pain sensitive group used more diverting attention coping strategies than the slightly cold pain sensitive group did. Separating fibromyalgia patients into subgroups might increase the potential for improving nursing care of these patients. Through the use of effective coping strategies in dealing with stress and pain, life satisfaction may also be enhanced.

Differences in sensory thresholds in the skin of women with fibromyalgia syndrome : A comparison between ketamine responders and ketamine non-responders

Objectives: To compare detection and pain thresholds in the skin of female fibromyalgia patients who were either ketamine responders or ketamine nonresponders. Methods: Detection thresholds to innocuous warmth, of cold, heat or cold pain, and touch and dynamic touch sensation were determined in the skin. Pressure pain thresholds, local and widespread pain intensity, and pain duration were also registered. Results: Ketamine nonresponse was associated with more pronounced hypersensitivity for thermal pain [especially cold pain] than ketamine response. Conclusions: Blockade of N-metyl-D-aspartic acid receptors by ketamine and the recording of pain thresholds in the skin, especially for cold pain, might reveal different mechanisms of allodynia.

514 HEALTH RELATED QUALITY OF LIFE IN SUBGROUPS OF WAD INDIVIDUALS WITH RESPECT TO COLD HYPERALGESIA IN QUANTITATIVE SENSORY TESTING (QST)

Background and Aims: The term Whiplash associated disorders (WAD) includes a wide range of complaints, with neck pain as predominating symptom. Living with long term pain influences quality of life. In previous studies of other chronic pain patients, subgrouping has been made according to thermal pain thresholds measured in QST. The aims of the present study are threefold, (1) to evaluate thermal pain thresholds and health related quality of life in WAD patients compared to healthy painfree individuals, (2) to explore whether subgrouping of the WAD patients is possible according to cold pain thresholds (CPT), and (3) to explore differences between the subgroups. Methods: Thermal pain thresholds were measured using QST. The SF-36 was used to assess health related quality of life. Results: WAD patients show significantly decreased CPT (p = 0.007) and lower scores on the SF-36 in all scales when compared with healthy pain-free individuals. After analyzing clusters (K-means algorithm) two subgroups of WAD emerge, slightly cold pain sensitive and highly pain sensitive. The slightly pain sensitive group differ significantly from the highly sensitive group in the Role Emotional scale of SF-36 (p = 0.025). Conclusions: Cold pain hyperalgesia seems to be a determinant for subgrouping of WAD patients, with respect to health related quality of life, and might be a result of central sensitization or peripheral mechanisms or a result of personal characteristics. These group differences might be of importance when guiding patients to treatment interventions as well as when exposing subjects to cold in the clinical situation.