In Clinical Practice, the Term “Central Sensitivity Score” Is More Useful Than the Term “Polysymptomatic Distress Scale”: Comment on the Editorial by Wolfe
Arthritis & Rheumatology, 2015
To the Editor: We read with interest the recent editorial by Dr. Wolfe (1), in which he summarize... more To the Editor: We read with interest the recent editorial by Dr. Wolfe (1), in which he summarized the status of the American College of Rheumatology (ACR) 2010 preliminary diagnostic criteria for fibromyalgia (2) and the 2011 modification of those criteria (3). He notes that the 2 components of the 2010 criteria, the Widespread Pain Index and the Symptom Severity Scale, can be summated, and that the resultant score that is obtained will fall within a defined range, allowing a “fibromyalgia symptom scale” to be constructed (3). This score not only can define whether a patient meets the criteria for a diagnosis of fibromyalgia but also can indicate where the patient is on the “continuum of distress,” regardless of whether he or she has fibromyalgia. The features of fibromyalgia represent a continuous variable. Higher levels within the fibromyalgia symptom scale are more likely to be associated with fibromyalgia, and lower levels are less likely to do so. Because the scale can predict associations with characteristics of fibromyalgia (e.g., pain, poor sleep, fatigue), it has also been termed the “fibromyalgianess” scale (3). This scale has subsequently been termed the Polysymptomatic Distress (PSD) Scale, a term that is linked to previous associations between multiple symptoms and emotional distress (4,5). We agree that the modified version of the 2010 ACR criteria (now termed the fibromyalgia research criteria [6]) and the derived scale are significant advances for research into fibromyalgia in a wide range of clinical settings, including those outside rheumatology. Nonetheless, not everyone has adopted the term PSD Scale. For instance, in a recent study, this scale was referred to as the “fibromyalgia survey score” (7). The designated term PSD Scale implies that the scale is measuring distress and that by implication, emotional distress might be the key factor in fibromyalgia symptoms. We do not necessarily disagree with that proposition but believe that a broader term might be more useful within the wider medical community, and also to our patients. In our clinical practice, we now refer to this scale as the central sensitivity score, after initially considering the term central pain score. We believe that the score is measuring features that relate to central rather than peripheral factors in both normal persons and patients with fibromyalgia. Although pain is the dominant element contributing to the score, other critical non-pain symptoms are also rated (8). The scale emphasizes and assigns high ratings to levels of sleep disturbance, fatigue, and cognitive dysfunction, all of which relate to central factors. Other lesser-rated components of the scale include headache, abdominal pain, and depression. These elements can also have a large central component. This term thus highlights the key mechanism of sensitization in fibromyalgia and related disorders (9). Additionally, the number of pain regions reported by the patient also equates to the mechanism of central sensitivity. The more pain regions that are reported, the more there is centralization of the pain mechanism. Hence, we propose the term “central sensitivity score” rather than “polysymptomatic distress scale,” “fibromyalgianess scale,” or “fibromyalgia survey score.” The implications and clinical usefulness of the score may be expanded by this proposed alternative name, and more clinicians, including nonrheumatologists, might be disposed to use the score if fibromyalgia, “fibromyalgianess,” or “polysymptomatic distress” are not emphasized in the name.
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