Pain extent is associated with pain intensity but not with widespread pressure or thermal pain sensitivity in women with fibromyalgia syndrome

Widespread pain is considered a sign of central sensitization in people with chronic pain. Our aim was to examine whether pain extent, assessed from the pain drawing, relates to measures from quantitative sensory testing in fibromyalgia syndrome (FMS). Thirty women with FMS and no other co-morbid conditions completed pain drawings (dorsal and ventral views) and clinical and related disability questionnaires. Pain extent and pain frequency maps were obtained from the pain drawings using a novel customized software. Pressure pain thresholds were assessed over the 18 tender points considered by the 1990 American College of Rheumatology criteria for FMS diagnosis and over two additional standardized points. Heat and cold pain thresholds were also assessed on the dorsal aspect of the neck, the dorsal aspect of the wrist, and the tibialis anterior. Spearman's correlation coefficients were used to assess the relationship between pain extent and quantitative sensory testing outcomes as well as clinical symptoms. Larger extent of pain was associated with a higher pain intensity (dorsal area: r(s) = 0.461, P = 0.010; total area: r(s) = 0.593, P = 0.001), younger age (ventral area: r(s) = -0.544, P = 0.002; total area: r(s) = -0.409, P = 0.025), shorter history of pain (ventral area: r(s) = -0.367, P = 0.046), and higher cold pain thresholds over the tibialis anterior muscle (r(s) = -0.406, P = 0.001). No significant association was observed between pain extent and the remaining outcomes. Pain drawings constitute an easy and accurate approach to quantify widespread pain. Larger pain extent is associated with pain intensity but not with signs of central sensitization in women with FMS.