The Impact of Centralized Pain on Acute and Chronic Pain Outcomes

It is now recognized that the phenotypic features of centralized pain exist in many common pain conditions. The 2011 Survey Criteria for Fibromyalgia can be used as a surrogate of centralized pain to detect patients with fibromyalgia-like or centralized pain characteristics. Patients with higher fibromyalgia survey scores describe a more negative pain phenotype preoperatively, including more opioid use, higher pain scores, higher levels of anxiety and depression, and lower physical function. It is known that patients with fibromyalgia have decreased mu-opioid receptor binding availability and higher endogenous opioid levels. These data suggest that exogenous opioids may not be effective in patients with a fibromyalgia-like or centralized pain phenotype. As such, this could provide a mechanistic rationale for nonopioid, multimodal analgesia. The fibromyalgia measure was independently predictive of poorer long-term outcomes following total knee and hip arthroplasty (less change in knee/hip pain, overall body pain, and patient global impression of change). In fact, even among patients who were below the threshold for being termed “fibromyalgia-positive,” the measure was still predictive of outcomes. As a demonstration of the generalizability of the finding, the measure was also independently predictive of increased pain 6-months after hysterectomy. This course will discuss ongoing work focusing on brain imaging signatures and experimental pain testing responses of the fibromyalgia measure. Long-term goals to create a better measure of centralized pain that could be used in routine clinical care to tailor care to the individual will be presented. (Recorded at PAINWeek 2018)