Geoffrey Littlejohn | Monash University (original) (raw)
Papers by Geoffrey Littlejohn
Seminars in Arthritis and Rheumatism, Dec 31, 2023
Journal of Pain Research, Dec 1, 2015
Complex regional pain syndrome has long been recognized as a severe and high impact chronic pain ... more Complex regional pain syndrome has long been recognized as a severe and high impact chronic pain disorder. However, the condition has historically been difficult to define and classify and little attention has been given to where complex regional pain syndrome sits within other apparently similar chronic pain disorders, such as fibromyalgia and regional pain syndrome. In this review challenges in regard to nomenclature, definitions, and classification of complex regional pain syndrome are reviewed and suggestions are provided about future directions.
The Open Rheumatology Journal, Dec 19, 2014
Objectives: We aimed to review the literature linking metabolic factors to Diffuse Idiopathic Ske... more Objectives: We aimed to review the literature linking metabolic factors to Diffuse Idiopathic Skeletal Hyperostosis (DISH), in order to assess associations between growth factors and DISH.
Journal of Pain Research, Dec 1, 2015
Complex regional pain syndrome has long been recognized as a severe and high impact chronic pain ... more Complex regional pain syndrome has long been recognized as a severe and high impact chronic pain disorder. However, the condition has historically been difficult to define and classify and little attention has been given to where complex regional pain syndrome sits within other apparently similar chronic pain disorders, such as fibromyalgia and regional pain syndrome. In this review challenges in regard to nomenclature, definitions, and classification of complex regional pain syndrome are reviewed and suggestions are provided about future directions.
Springer eBooks, 2010
... Rheumatol Int 27: 275280 Alexander RW, Bradley LA, Alarcon GS et al.(1998) Sexual and physic... more ... Rheumatol Int 27: 275280 Alexander RW, Bradley LA, Alarcon GS et al.(1998) Sexual and physical abuse in women with fibromyalgia: association ... J Rheumatol 17: 12021206 Buskila D, Neumann L, Hazanov I et al.(1996) Familial aggregation in the fibromyalgia syn-drome. ...
The Open Rheumatology Journal, Dec 19, 2014
Objectives: We aimed to review the literature linking metabolic factors to Diffuse Idiopathic Ske... more Objectives: We aimed to review the literature linking metabolic factors to Diffuse Idiopathic Skeletal Hyperostosis (DISH), in order to assess associations between growth factors and DISH.
Journal of Pain Research, Nov 1, 2012
We hypothesized that fibromyalgia (FM) patients would report lower levels of psychological contro... more We hypothesized that fibromyalgia (FM) patients would report lower levels of psychological control mechanisms and that higher levels of control would moderate key symptoms associated with FM, such as pain, fatigue, perceived stress, and mood disturbance. Methods: Ninety-eight women with FM diagnosed according to American College of Rheumatology criteria and 35 matched pain-free women were identified. Applied questionnaires included the Fibromyalgia Impact Questionnaire, Profile of Mood States, Perceived Control of Internal States Scale, Perceived Stress Scale, and Mastery Scale. Differences were sought using t-tests, one-way analysis of variance, bivariate correlations, and multiple regression analysis. Results: Comparison between FM patients and healthy individuals found significant differences in control (Perceived Control of Internal States Scale and Mastery Scale), pain, perceived stress, fatigue, confusion, and mood disturbance (all P , 0.001). There were significant associations found between both high and low levels of control on stress, mood, pain, and fatigue (P , 0.001-0.05). Strong negative correlations were present between internal control and perceived stress (P , 0.0005). Conclusion: FM patients use significantly different control styles compared with healthy individuals. Levels and type of psychological control buffer mood, stress, fatigue, and pain in FM. Control appears to be an important "up-stream" process in FM mechanisms and is amenable to intervention.
Springer eBooks, 2010
... Rheumatol Int 27: 275280 Alexander RW, Bradley LA, Alarcon GS et al.(1998) Sexual and physic... more ... Rheumatol Int 27: 275280 Alexander RW, Bradley LA, Alarcon GS et al.(1998) Sexual and physical abuse in women with fibromyalgia: association ... J Rheumatol 17: 12021206 Buskila D, Neumann L, Hazanov I et al.(1996) Familial aggregation in the fibromyalgia syn-drome. ...
Journal of Musculoskeletal Pain, 1997
Association Between Task Performance and Tender Point Pain Threshold to Pressure in Normal Subjec... more Association Between Task Performance and Tender Point Pain Threshold to Pressure in Normal Subjects Judith Farrell Geoffrey O. Littlejohn ABSTRACT, Objective; Work action patterns associated with in-crease in pain sensitivity in healthy people may be valuable predic-tors ...
Journal of Musculoskeletal Pain, 1997
Association Between Task Performance and Tender Point Pain Threshold to Pressure in Normal Subjec... more Association Between Task Performance and Tender Point Pain Threshold to Pressure in Normal Subjects Judith Farrell Geoffrey O. Littlejohn ABSTRACT, Objective; Work action patterns associated with in-crease in pain sensitivity in healthy people may be valuable predic-tors ...
The Medical Journal of Australia, Apr 1, 1998
The Medical Journal of Australia, Apr 1, 1998
Clinical Rheumatology, May 31, 2016
The clinical features of fibromyalgia are associated with various psychological factors, includin... more The clinical features of fibromyalgia are associated with various psychological factors, including stress. We examined the hypothesis that the path that psychological factors follow in influencing fibromyalgia symptoms is through their direct effect on stress. Ninety-eight females with ACR 1990 classified fibromyalgia completed the following questionnaires: The Big 5 Personality Inventory, Fibromyalgia Impact Questionnaire, Perceived Stress Scale, Profile of Mood States, Mastery Scale, and Perceived Control of Internal States Scale. SPSS (PASW version 22) was used to perform basic t tests, means, and standard deviations to show difference between symptom characteristics. Pathway analysis using structural equation modelling (Laavan) examined the effect of stress on the relationships between psychological factors and the elements that define the fibromyalgia phenotype. The preferred model showed that the identified path clearly linked the psychological variables of anxiety, neuroticism and mastery, but not internal control, to the three key elements of fibromyalgia, namely pain, fatigue and sleep (p < 0.001), via the person's perceived stress. Confusion, however, did not fit the preferred model. This study confirms that stress is a necessary link in the pathway between certain identified, established and significant psychological factors and key fibromyalgia symptoms. This has implications for the understanding of contributing mechanisms and the clinical care of patients with fibromyalgia.
Clinical Rheumatology, May 31, 2016
The clinical features of fibromyalgia are associated with various psychological factors, includin... more The clinical features of fibromyalgia are associated with various psychological factors, including stress. We examined the hypothesis that the path that psychological factors follow in influencing fibromyalgia symptoms is through their direct effect on stress. Ninety-eight females with ACR 1990 classified fibromyalgia completed the following questionnaires: The Big 5 Personality Inventory, Fibromyalgia Impact Questionnaire, Perceived Stress Scale, Profile of Mood States, Mastery Scale, and Perceived Control of Internal States Scale. SPSS (PASW version 22) was used to perform basic t tests, means, and standard deviations to show difference between symptom characteristics. Pathway analysis using structural equation modelling (Laavan) examined the effect of stress on the relationships between psychological factors and the elements that define the fibromyalgia phenotype. The preferred model showed that the identified path clearly linked the psychological variables of anxiety, neuroticism and mastery, but not internal control, to the three key elements of fibromyalgia, namely pain, fatigue and sleep (p < 0.001), via the person's perceived stress. Confusion, however, did not fit the preferred model. This study confirms that stress is a necessary link in the pathway between certain identified, established and significant psychological factors and key fibromyalgia symptoms. This has implications for the understanding of contributing mechanisms and the clinical care of patients with fibromyalgia.
Occupational Medicine, Aug 1, 2003
Background The lack of universally agreed criteria has hampered population studies of the prevale... more Background The lack of universally agreed criteria has hampered population studies of the prevalence and causation of soft-tissue disorders of the upper limb. Objectives To establish core variables for classification of the commonest disorders seen in population samples. Methods Consecutive new cases seen in clinical practice in five different centres were evaluated with respect to 30 variables shown to have discriminatory value in univariate analysis. Multivariate analysis using logistic regression modelling was carried out with these as the independent variables and with the clinical diagnosis as the dependent variable. Results A total of 1382 cases of soft-tissue disorder were recorded and only those diagnostic groups with 50 or more cases were included. In multivariate logistic regression, significant variables positively discriminating for each disorder were identified for carpal tunnel syndrome (n = 56), lateral epicondylitis (n = 87), tenosynovitis (n = 63), shoulder tendonitis (n = 157), non-specific upper limb disorder (n = 458), fibromyalgia (n = 124) and inflammatory arthritis (n = 100), which was used for comparison purposes. Significant discrimination for each model was demonstrated by the construction of receiver operating characteristic (ROC) curves and appropriate area under the curve statistics. Conclusions This approach to classification criteria is based on multivariate modelling rather than on a consensus statement. This includes the effects of negative as well as positive associations. Further work is required on both the reproducibility of the clinical signs and the application of the criteria to other datasets.
Occupational Medicine, Aug 1, 2003
Background The lack of universally agreed criteria has hampered population studies of the prevale... more Background The lack of universally agreed criteria has hampered population studies of the prevalence and causation of soft-tissue disorders of the upper limb. Objectives To establish core variables for classification of the commonest disorders seen in population samples. Methods Consecutive new cases seen in clinical practice in five different centres were evaluated with respect to 30 variables shown to have discriminatory value in univariate analysis. Multivariate analysis using logistic regression modelling was carried out with these as the independent variables and with the clinical diagnosis as the dependent variable. Results A total of 1382 cases of soft-tissue disorder were recorded and only those diagnostic groups with 50 or more cases were included. In multivariate logistic regression, significant variables positively discriminating for each disorder were identified for carpal tunnel syndrome (n = 56), lateral epicondylitis (n = 87), tenosynovitis (n = 63), shoulder tendonitis (n = 157), non-specific upper limb disorder (n = 458), fibromyalgia (n = 124) and inflammatory arthritis (n = 100), which was used for comparison purposes. Significant discrimination for each model was demonstrated by the construction of receiver operating characteristic (ROC) curves and appropriate area under the curve statistics. Conclusions This approach to classification criteria is based on multivariate modelling rather than on a consensus statement. This includes the effects of negative as well as positive associations. Further work is required on both the reproducibility of the clinical signs and the application of the criteria to other datasets.
The Lancet, May 1, 2021
Nociplastic pain is the semantic term suggested by the international community of pain researcher... more Nociplastic pain is the semantic term suggested by the international community of pain researchers to describe a third category of pain that is mechanistically distinct from nociceptive pain, which is caused by ongoing inflammation and damage of tissues, and neuropathic pain, which is caused by nerve damage. The mechanisms that underlie this type of pain are not entirely understood, but it is thought that augmented CNS pain and sensory processing and altered pain modulation play prominent roles. The symptoms observed in nociplastic pain include multifocal pain that is more widespread or intense, or both, than would be expected given the amount of identifiable tissue or nerve damage, as well as other CNS-derived symptoms, such as fatigue, sleep, memory, and mood problems. This type of pain can occur in isolation, as often occurs in conditions such as fibromyalgia or tension-type headache, or as part of a mixed-pain state in combination with ongoing nociceptive or neuropathic pain, as might occur in chronic low back pain. It is important to recognise this type of pain, since it will respond to different therapies than nociceptive pain, with a decreased responsiveness to peripherally directed therapies such as anti-inflammatory drugs and opioids, surgery, or injections.
The Lancet, May 1, 2021
Nociplastic pain is the semantic term suggested by the international community of pain researcher... more Nociplastic pain is the semantic term suggested by the international community of pain researchers to describe a third category of pain that is mechanistically distinct from nociceptive pain, which is caused by ongoing inflammation and damage of tissues, and neuropathic pain, which is caused by nerve damage. The mechanisms that underlie this type of pain are not entirely understood, but it is thought that augmented CNS pain and sensory processing and altered pain modulation play prominent roles. The symptoms observed in nociplastic pain include multifocal pain that is more widespread or intense, or both, than would be expected given the amount of identifiable tissue or nerve damage, as well as other CNS-derived symptoms, such as fatigue, sleep, memory, and mood problems. This type of pain can occur in isolation, as often occurs in conditions such as fibromyalgia or tension-type headache, or as part of a mixed-pain state in combination with ongoing nociceptive or neuropathic pain, as might occur in chronic low back pain. It is important to recognise this type of pain, since it will respond to different therapies than nociceptive pain, with a decreased responsiveness to peripherally directed therapies such as anti-inflammatory drugs and opioids, surgery, or injections.
The Medical Journal of Australia, Feb 1, 1997
To the Editor: Littlejohn has presented to readers of the Journal the current construct of fibrom... more To the Editor: Littlejohn has presented to readers of the Journal the current construct of fibromyalgia as proposed by the American College of Rheumatology (ACR).1,2 However, not only has he taken liberties with that construct, but he has failed to identify major problems with it. Littlejohn asserts that fibromyalgia is not a diagnosis of exclusion. In almost the same breath he states that it can co-exist with other disorders, especially painful ones such as "regional pain problems (including low back and pelvic pain syndromes and other similar syndromes)" (our italics). Further perusal of the clinical features reveals an anthology of complaints, including "an overlap with chronic fatigue syndrome". Therefore, the construct of fibromyalgia is so broad as to include almost every chronic pain state, thereby constituting a tautology. 3 How, then, is it possible to diagnose "nonfibromyalgia"? By departing from the ACR definition and including syndromes of localised or regional pain under the fibromyalgia banner, Littlejohn compounds the problem of tautology, thus making a parody of the exercise of differential diagnosis. There is no doubt that the clinical problem of diffuse musculoskeletal pain accompanied by mechanical allodynia (pain in response to a stimulus which is never noxious) exists. Littlejohn's assertion that this is a "disorder of function of the pain system" begs the question of whether there is such a system, rather than acknowledging the complex relationship between nociception (pain sense) and the psychosocial influences which lead to the distress and disability that characterise chronic pain." The evidence of altered nociception in patients with fibromyalgia may reflect central sensitisation," but whether this arises from "central pain modulatory factors" or from sustained peripheral nociceptive input cannot be determined from our current state of knowledge. The real damage from the clinical application of the flawed construct of fibromyalgia has only just begun to be appreciated." Its tautological nature allows it to be invoked in medicolegal settings using the fallacious proposition ofpost hoc ergo propter hoc. While fibromyalgia remains unlinked to a cogent theory of pathogenesis, and as long as understanding of clinical phenomena is
The Medical Journal of Australia, Feb 1, 1997
To the Editor: Littlejohn has presented to readers of the Journal the current construct of fibrom... more To the Editor: Littlejohn has presented to readers of the Journal the current construct of fibromyalgia as proposed by the American College of Rheumatology (ACR).1,2 However, not only has he taken liberties with that construct, but he has failed to identify major problems with it. Littlejohn asserts that fibromyalgia is not a diagnosis of exclusion. In almost the same breath he states that it can co-exist with other disorders, especially painful ones such as "regional pain problems (including low back and pelvic pain syndromes and other similar syndromes)" (our italics). Further perusal of the clinical features reveals an anthology of complaints, including "an overlap with chronic fatigue syndrome". Therefore, the construct of fibromyalgia is so broad as to include almost every chronic pain state, thereby constituting a tautology. 3 How, then, is it possible to diagnose "nonfibromyalgia"? By departing from the ACR definition and including syndromes of localised or regional pain under the fibromyalgia banner, Littlejohn compounds the problem of tautology, thus making a parody of the exercise of differential diagnosis. There is no doubt that the clinical problem of diffuse musculoskeletal pain accompanied by mechanical allodynia (pain in response to a stimulus which is never noxious) exists. Littlejohn's assertion that this is a "disorder of function of the pain system" begs the question of whether there is such a system, rather than acknowledging the complex relationship between nociception (pain sense) and the psychosocial influences which lead to the distress and disability that characterise chronic pain." The evidence of altered nociception in patients with fibromyalgia may reflect central sensitisation," but whether this arises from "central pain modulatory factors" or from sustained peripheral nociceptive input cannot be determined from our current state of knowledge. The real damage from the clinical application of the flawed construct of fibromyalgia has only just begun to be appreciated." Its tautological nature allows it to be invoked in medicolegal settings using the fallacious proposition ofpost hoc ergo propter hoc. While fibromyalgia remains unlinked to a cogent theory of pathogenesis, and as long as understanding of clinical phenomena is
Seminars in Arthritis and Rheumatism, Dec 31, 2023
Journal of Pain Research, Dec 1, 2015
Complex regional pain syndrome has long been recognized as a severe and high impact chronic pain ... more Complex regional pain syndrome has long been recognized as a severe and high impact chronic pain disorder. However, the condition has historically been difficult to define and classify and little attention has been given to where complex regional pain syndrome sits within other apparently similar chronic pain disorders, such as fibromyalgia and regional pain syndrome. In this review challenges in regard to nomenclature, definitions, and classification of complex regional pain syndrome are reviewed and suggestions are provided about future directions.
The Open Rheumatology Journal, Dec 19, 2014
Objectives: We aimed to review the literature linking metabolic factors to Diffuse Idiopathic Ske... more Objectives: We aimed to review the literature linking metabolic factors to Diffuse Idiopathic Skeletal Hyperostosis (DISH), in order to assess associations between growth factors and DISH.
Journal of Pain Research, Dec 1, 2015
Complex regional pain syndrome has long been recognized as a severe and high impact chronic pain ... more Complex regional pain syndrome has long been recognized as a severe and high impact chronic pain disorder. However, the condition has historically been difficult to define and classify and little attention has been given to where complex regional pain syndrome sits within other apparently similar chronic pain disorders, such as fibromyalgia and regional pain syndrome. In this review challenges in regard to nomenclature, definitions, and classification of complex regional pain syndrome are reviewed and suggestions are provided about future directions.
Springer eBooks, 2010
... Rheumatol Int 27: 275280 Alexander RW, Bradley LA, Alarcon GS et al.(1998) Sexual and physic... more ... Rheumatol Int 27: 275280 Alexander RW, Bradley LA, Alarcon GS et al.(1998) Sexual and physical abuse in women with fibromyalgia: association ... J Rheumatol 17: 12021206 Buskila D, Neumann L, Hazanov I et al.(1996) Familial aggregation in the fibromyalgia syn-drome. ...
The Open Rheumatology Journal, Dec 19, 2014
Objectives: We aimed to review the literature linking metabolic factors to Diffuse Idiopathic Ske... more Objectives: We aimed to review the literature linking metabolic factors to Diffuse Idiopathic Skeletal Hyperostosis (DISH), in order to assess associations between growth factors and DISH.
Journal of Pain Research, Nov 1, 2012
We hypothesized that fibromyalgia (FM) patients would report lower levels of psychological contro... more We hypothesized that fibromyalgia (FM) patients would report lower levels of psychological control mechanisms and that higher levels of control would moderate key symptoms associated with FM, such as pain, fatigue, perceived stress, and mood disturbance. Methods: Ninety-eight women with FM diagnosed according to American College of Rheumatology criteria and 35 matched pain-free women were identified. Applied questionnaires included the Fibromyalgia Impact Questionnaire, Profile of Mood States, Perceived Control of Internal States Scale, Perceived Stress Scale, and Mastery Scale. Differences were sought using t-tests, one-way analysis of variance, bivariate correlations, and multiple regression analysis. Results: Comparison between FM patients and healthy individuals found significant differences in control (Perceived Control of Internal States Scale and Mastery Scale), pain, perceived stress, fatigue, confusion, and mood disturbance (all P , 0.001). There were significant associations found between both high and low levels of control on stress, mood, pain, and fatigue (P , 0.001-0.05). Strong negative correlations were present between internal control and perceived stress (P , 0.0005). Conclusion: FM patients use significantly different control styles compared with healthy individuals. Levels and type of psychological control buffer mood, stress, fatigue, and pain in FM. Control appears to be an important "up-stream" process in FM mechanisms and is amenable to intervention.
Springer eBooks, 2010
... Rheumatol Int 27: 275280 Alexander RW, Bradley LA, Alarcon GS et al.(1998) Sexual and physic... more ... Rheumatol Int 27: 275280 Alexander RW, Bradley LA, Alarcon GS et al.(1998) Sexual and physical abuse in women with fibromyalgia: association ... J Rheumatol 17: 12021206 Buskila D, Neumann L, Hazanov I et al.(1996) Familial aggregation in the fibromyalgia syn-drome. ...
Journal of Musculoskeletal Pain, 1997
Association Between Task Performance and Tender Point Pain Threshold to Pressure in Normal Subjec... more Association Between Task Performance and Tender Point Pain Threshold to Pressure in Normal Subjects Judith Farrell Geoffrey O. Littlejohn ABSTRACT, Objective; Work action patterns associated with in-crease in pain sensitivity in healthy people may be valuable predic-tors ...
Journal of Musculoskeletal Pain, 1997
Association Between Task Performance and Tender Point Pain Threshold to Pressure in Normal Subjec... more Association Between Task Performance and Tender Point Pain Threshold to Pressure in Normal Subjects Judith Farrell Geoffrey O. Littlejohn ABSTRACT, Objective; Work action patterns associated with in-crease in pain sensitivity in healthy people may be valuable predic-tors ...
The Medical Journal of Australia, Apr 1, 1998
The Medical Journal of Australia, Apr 1, 1998
Clinical Rheumatology, May 31, 2016
The clinical features of fibromyalgia are associated with various psychological factors, includin... more The clinical features of fibromyalgia are associated with various psychological factors, including stress. We examined the hypothesis that the path that psychological factors follow in influencing fibromyalgia symptoms is through their direct effect on stress. Ninety-eight females with ACR 1990 classified fibromyalgia completed the following questionnaires: The Big 5 Personality Inventory, Fibromyalgia Impact Questionnaire, Perceived Stress Scale, Profile of Mood States, Mastery Scale, and Perceived Control of Internal States Scale. SPSS (PASW version 22) was used to perform basic t tests, means, and standard deviations to show difference between symptom characteristics. Pathway analysis using structural equation modelling (Laavan) examined the effect of stress on the relationships between psychological factors and the elements that define the fibromyalgia phenotype. The preferred model showed that the identified path clearly linked the psychological variables of anxiety, neuroticism and mastery, but not internal control, to the three key elements of fibromyalgia, namely pain, fatigue and sleep (p < 0.001), via the person's perceived stress. Confusion, however, did not fit the preferred model. This study confirms that stress is a necessary link in the pathway between certain identified, established and significant psychological factors and key fibromyalgia symptoms. This has implications for the understanding of contributing mechanisms and the clinical care of patients with fibromyalgia.
Clinical Rheumatology, May 31, 2016
The clinical features of fibromyalgia are associated with various psychological factors, includin... more The clinical features of fibromyalgia are associated with various psychological factors, including stress. We examined the hypothesis that the path that psychological factors follow in influencing fibromyalgia symptoms is through their direct effect on stress. Ninety-eight females with ACR 1990 classified fibromyalgia completed the following questionnaires: The Big 5 Personality Inventory, Fibromyalgia Impact Questionnaire, Perceived Stress Scale, Profile of Mood States, Mastery Scale, and Perceived Control of Internal States Scale. SPSS (PASW version 22) was used to perform basic t tests, means, and standard deviations to show difference between symptom characteristics. Pathway analysis using structural equation modelling (Laavan) examined the effect of stress on the relationships between psychological factors and the elements that define the fibromyalgia phenotype. The preferred model showed that the identified path clearly linked the psychological variables of anxiety, neuroticism and mastery, but not internal control, to the three key elements of fibromyalgia, namely pain, fatigue and sleep (p < 0.001), via the person's perceived stress. Confusion, however, did not fit the preferred model. This study confirms that stress is a necessary link in the pathway between certain identified, established and significant psychological factors and key fibromyalgia symptoms. This has implications for the understanding of contributing mechanisms and the clinical care of patients with fibromyalgia.
Occupational Medicine, Aug 1, 2003
Background The lack of universally agreed criteria has hampered population studies of the prevale... more Background The lack of universally agreed criteria has hampered population studies of the prevalence and causation of soft-tissue disorders of the upper limb. Objectives To establish core variables for classification of the commonest disorders seen in population samples. Methods Consecutive new cases seen in clinical practice in five different centres were evaluated with respect to 30 variables shown to have discriminatory value in univariate analysis. Multivariate analysis using logistic regression modelling was carried out with these as the independent variables and with the clinical diagnosis as the dependent variable. Results A total of 1382 cases of soft-tissue disorder were recorded and only those diagnostic groups with 50 or more cases were included. In multivariate logistic regression, significant variables positively discriminating for each disorder were identified for carpal tunnel syndrome (n = 56), lateral epicondylitis (n = 87), tenosynovitis (n = 63), shoulder tendonitis (n = 157), non-specific upper limb disorder (n = 458), fibromyalgia (n = 124) and inflammatory arthritis (n = 100), which was used for comparison purposes. Significant discrimination for each model was demonstrated by the construction of receiver operating characteristic (ROC) curves and appropriate area under the curve statistics. Conclusions This approach to classification criteria is based on multivariate modelling rather than on a consensus statement. This includes the effects of negative as well as positive associations. Further work is required on both the reproducibility of the clinical signs and the application of the criteria to other datasets.
Occupational Medicine, Aug 1, 2003
Background The lack of universally agreed criteria has hampered population studies of the prevale... more Background The lack of universally agreed criteria has hampered population studies of the prevalence and causation of soft-tissue disorders of the upper limb. Objectives To establish core variables for classification of the commonest disorders seen in population samples. Methods Consecutive new cases seen in clinical practice in five different centres were evaluated with respect to 30 variables shown to have discriminatory value in univariate analysis. Multivariate analysis using logistic regression modelling was carried out with these as the independent variables and with the clinical diagnosis as the dependent variable. Results A total of 1382 cases of soft-tissue disorder were recorded and only those diagnostic groups with 50 or more cases were included. In multivariate logistic regression, significant variables positively discriminating for each disorder were identified for carpal tunnel syndrome (n = 56), lateral epicondylitis (n = 87), tenosynovitis (n = 63), shoulder tendonitis (n = 157), non-specific upper limb disorder (n = 458), fibromyalgia (n = 124) and inflammatory arthritis (n = 100), which was used for comparison purposes. Significant discrimination for each model was demonstrated by the construction of receiver operating characteristic (ROC) curves and appropriate area under the curve statistics. Conclusions This approach to classification criteria is based on multivariate modelling rather than on a consensus statement. This includes the effects of negative as well as positive associations. Further work is required on both the reproducibility of the clinical signs and the application of the criteria to other datasets.
The Lancet, May 1, 2021
Nociplastic pain is the semantic term suggested by the international community of pain researcher... more Nociplastic pain is the semantic term suggested by the international community of pain researchers to describe a third category of pain that is mechanistically distinct from nociceptive pain, which is caused by ongoing inflammation and damage of tissues, and neuropathic pain, which is caused by nerve damage. The mechanisms that underlie this type of pain are not entirely understood, but it is thought that augmented CNS pain and sensory processing and altered pain modulation play prominent roles. The symptoms observed in nociplastic pain include multifocal pain that is more widespread or intense, or both, than would be expected given the amount of identifiable tissue or nerve damage, as well as other CNS-derived symptoms, such as fatigue, sleep, memory, and mood problems. This type of pain can occur in isolation, as often occurs in conditions such as fibromyalgia or tension-type headache, or as part of a mixed-pain state in combination with ongoing nociceptive or neuropathic pain, as might occur in chronic low back pain. It is important to recognise this type of pain, since it will respond to different therapies than nociceptive pain, with a decreased responsiveness to peripherally directed therapies such as anti-inflammatory drugs and opioids, surgery, or injections.
The Lancet, May 1, 2021
Nociplastic pain is the semantic term suggested by the international community of pain researcher... more Nociplastic pain is the semantic term suggested by the international community of pain researchers to describe a third category of pain that is mechanistically distinct from nociceptive pain, which is caused by ongoing inflammation and damage of tissues, and neuropathic pain, which is caused by nerve damage. The mechanisms that underlie this type of pain are not entirely understood, but it is thought that augmented CNS pain and sensory processing and altered pain modulation play prominent roles. The symptoms observed in nociplastic pain include multifocal pain that is more widespread or intense, or both, than would be expected given the amount of identifiable tissue or nerve damage, as well as other CNS-derived symptoms, such as fatigue, sleep, memory, and mood problems. This type of pain can occur in isolation, as often occurs in conditions such as fibromyalgia or tension-type headache, or as part of a mixed-pain state in combination with ongoing nociceptive or neuropathic pain, as might occur in chronic low back pain. It is important to recognise this type of pain, since it will respond to different therapies than nociceptive pain, with a decreased responsiveness to peripherally directed therapies such as anti-inflammatory drugs and opioids, surgery, or injections.
The Medical Journal of Australia, Feb 1, 1997
To the Editor: Littlejohn has presented to readers of the Journal the current construct of fibrom... more To the Editor: Littlejohn has presented to readers of the Journal the current construct of fibromyalgia as proposed by the American College of Rheumatology (ACR).1,2 However, not only has he taken liberties with that construct, but he has failed to identify major problems with it. Littlejohn asserts that fibromyalgia is not a diagnosis of exclusion. In almost the same breath he states that it can co-exist with other disorders, especially painful ones such as "regional pain problems (including low back and pelvic pain syndromes and other similar syndromes)" (our italics). Further perusal of the clinical features reveals an anthology of complaints, including "an overlap with chronic fatigue syndrome". Therefore, the construct of fibromyalgia is so broad as to include almost every chronic pain state, thereby constituting a tautology. 3 How, then, is it possible to diagnose "nonfibromyalgia"? By departing from the ACR definition and including syndromes of localised or regional pain under the fibromyalgia banner, Littlejohn compounds the problem of tautology, thus making a parody of the exercise of differential diagnosis. There is no doubt that the clinical problem of diffuse musculoskeletal pain accompanied by mechanical allodynia (pain in response to a stimulus which is never noxious) exists. Littlejohn's assertion that this is a "disorder of function of the pain system" begs the question of whether there is such a system, rather than acknowledging the complex relationship between nociception (pain sense) and the psychosocial influences which lead to the distress and disability that characterise chronic pain." The evidence of altered nociception in patients with fibromyalgia may reflect central sensitisation," but whether this arises from "central pain modulatory factors" or from sustained peripheral nociceptive input cannot be determined from our current state of knowledge. The real damage from the clinical application of the flawed construct of fibromyalgia has only just begun to be appreciated." Its tautological nature allows it to be invoked in medicolegal settings using the fallacious proposition ofpost hoc ergo propter hoc. While fibromyalgia remains unlinked to a cogent theory of pathogenesis, and as long as understanding of clinical phenomena is
The Medical Journal of Australia, Feb 1, 1997
To the Editor: Littlejohn has presented to readers of the Journal the current construct of fibrom... more To the Editor: Littlejohn has presented to readers of the Journal the current construct of fibromyalgia as proposed by the American College of Rheumatology (ACR).1,2 However, not only has he taken liberties with that construct, but he has failed to identify major problems with it. Littlejohn asserts that fibromyalgia is not a diagnosis of exclusion. In almost the same breath he states that it can co-exist with other disorders, especially painful ones such as "regional pain problems (including low back and pelvic pain syndromes and other similar syndromes)" (our italics). Further perusal of the clinical features reveals an anthology of complaints, including "an overlap with chronic fatigue syndrome". Therefore, the construct of fibromyalgia is so broad as to include almost every chronic pain state, thereby constituting a tautology. 3 How, then, is it possible to diagnose "nonfibromyalgia"? By departing from the ACR definition and including syndromes of localised or regional pain under the fibromyalgia banner, Littlejohn compounds the problem of tautology, thus making a parody of the exercise of differential diagnosis. There is no doubt that the clinical problem of diffuse musculoskeletal pain accompanied by mechanical allodynia (pain in response to a stimulus which is never noxious) exists. Littlejohn's assertion that this is a "disorder of function of the pain system" begs the question of whether there is such a system, rather than acknowledging the complex relationship between nociception (pain sense) and the psychosocial influences which lead to the distress and disability that characterise chronic pain." The evidence of altered nociception in patients with fibromyalgia may reflect central sensitisation," but whether this arises from "central pain modulatory factors" or from sustained peripheral nociceptive input cannot be determined from our current state of knowledge. The real damage from the clinical application of the flawed construct of fibromyalgia has only just begun to be appreciated." Its tautological nature allows it to be invoked in medicolegal settings using the fallacious proposition ofpost hoc ergo propter hoc. While fibromyalgia remains unlinked to a cogent theory of pathogenesis, and as long as understanding of clinical phenomena is