Chronic widespread pain

Definition

Chronic widespread pain (CWP) is diffuse pain in at least 4 of 5 body regions and is associated with significant emotional distress (anxiety, anger/frustration or depressed mood) and functional disability (interference in daily life activities and reduced participation in social roles) [1]. CWP is multifactorial: biological, psychological and social factors contribute to the pain syndrome. The diagnosis is appropriate when the pain is not directly attributable to a nociceptive process in those regions and there are features consistent with nociplastic pain [2] and identified psychological and social contributors. Other chronic pain diagnoses to be considered are chronic cancer pain, chronic postsurgical or posttraumatic pain, chronic neuropathic pain, chronic visceral pain and chronic musculoskeletal pain. Chronic widespread pain (CWP) is usually present in at least 3 or more body quadrants (quadrants are defined by upper-lower/left-right side of the body) and axial skeleton (neck, back, chest and abdomen) [1]. CWP is often associated with increased medical comorbidity, including sleep disturbances, obesity, hypertension, and diabetes [3]. Patients with CWP often report increased disability, depressed and anxious mood [3-8]. Patients present with spontaneous or evoked pain in the affected regions, accompanied by allodynia and/or hyperalgesia. Anxiety, depression, and distress generally, may amplify pain in patients with CWP [9]. Criteria Conditions A to C are fulfilled: A. Chronic pain (persistent or recurrent for longer than 3 months) is present in at least three body quadrants plus the axial skeleton (4 of 5 regions). B. The pain is associated with at least one of the following: B.1 Emotional distress due to pain is present. B.2 The pain interferes with daily life activities and social participation. C. The pain is not better accounted for by another chronic pain condition. Comments The presence of pain, emotional distress and interference in daily activities due to pain should be established based on a thorough assessment procedure using standardized measures.

Exclusions

• Acute pain

Inclusions

• Fibromyalgia syndrome

Index Terms