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


OBJECTIVE
To investigate the validity of a screening instrument to discriminate between pain-persistence and pain-avoidance patterns in FM.


METHODS
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.


CONCLUSIONS
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.
van Koulil
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Department of Medical Psychology, Nijmegen Medical Center, Radboud University, Nijmegen, The Netherlands. s.vankoulil@mps.umcn.nl
Kraaimaat
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van Lankveld
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van Helmond
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Vedder
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van Hoorn
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Cats
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van Riel
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D000328:Adult; D001362:Avoidance Learning; D001519:Behavior; D005080:Exercise Test; D005260:Female; D005356:Fibromyalgia / Q000523:psychology*; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D010146:Pain / Q000175:diagnosis* / Q000523:psychology*; D010147:Pain Measurement / Q000295:instrumentation* / Q000379:methods* / Q000592:standards; D016032:Randomized Controlled Trials as Topic