• Pablo de la Coba, Stephen Bruehl, and Del Paso Gustavo A Reyes GAR Department of Psychology, University of Jaén, Jaén, Spain; †Institute of Biomedical Research of Lleida, Lleida, Spain..
• Department of Psychology, University of Jaén, Jaén, Spain; †Institute of Biomedical Research of Lleida, Lleida, Spain.
• Pain Med. 2020 Dec 25; 21 (12): 3479-3487.

ObjectiveFibromyalgia is a chronic pain syndrome characterized by central sensitization. A novel protocol based on slowly repeated evoked pain (SREP) appears to be a useful marker of pain sensitization in fibromyalgia patients. Whether SREP enhances diagnostic accuracy beyond key clinical symptoms that characterize fibromyalgia has not been examined.MethodsFifty fibromyalgia patients, 30 rheumatoid arthritis patients, and 50 healthy individuals were evaluated to assess clinical pain, as well as fatigue, insomnia, pain catastrophizing, and negative mood. The SREP protocol consisted of a series of nine low-intensity painful pressure stimuli of five seconds' duration with 30-second interstimulus intervals. SREP sensitization was indexed by increases in pain intensity ratings across stimuli.ResultsSREP sensitization was observed in fibromyalgia but not in rheumatoid arthritis or healthy individuals. As expected, fibromyalgia patients exhibited a more negative psychosocial profile than did rheumatoid arthritis patients and healthy individuals. SREP was positively associated with clinical pain, fatigue, insomnia, and catastrophizing, but not with negative mood. SREP discriminated fibromyalgia cases from rheumatoid arthritis and healthy individuals even when current clinical pain was included in the analysis. Combining fatigue, insomnia, and SREP led to near perfect diagnostic accuracy (99%) in differentiating fibromyalgia from healthy individuals and 86.3% accuracy in discriminating fibromyalgia from rheumatoid arthritis.ConclusionsThese results provide further evidence of SREP as a marker of pain sensitization in fibromyalgia and suggest that it captures aspects of fibromyalgia not fully captured by clinical features. Combining SREP with assessment of clinical features could potentially improve fibromyalgia diagnosis.© The Author(s) 2020. Published by Oxford University Press on behalf of the American Academy of Pain Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

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