{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T16:59:04Z","timestamp":1789664344185,"version":"4.0.1"},"reference-count":29,"publisher":"Walter de Gruyter GmbH","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2019,12,18]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec id=\"j_sjpain-2019-0054_s_001\">\n                    <jats:title>Background and aims<\/jats:title>\n                    <jats:p>Persons with chronic widespread pain (CWP) have poor medical outcomes and increased mortality. But there are no universally accepted criteria for CWP or of methods to assess it. The most common criteria come from the 1990 American College of Rheumatology (ACR) fibromyalgia (FM) criteria, but that method (WP1990) can identify CWP with as few as three pain sites, and in subjects with wide differences in illness severity. Recently, to correct WP1990 deficiencies, the 2016 fibromyalgia criteria provided a modified CWP definition (WP2016) by dividing the body into five regions of three pain sites each and requiring a minimum of four regions of pain. Although solving the geographic problem of pain distribution, the problem of just how many pain sites (pain diffuseness) are required remained a problem, as WP2016 required as few as four painful sites. To better characterize CWP, we compared four CWP definitions with respect to symmetry, extent of pain sites and association with clinical severity variables.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"j_sjpain-2019-0054_s_002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We characterized pain in 40,960 subjects, including pain at 19 individual sites and five pain regions, and calculated the widespread pain index (WPI) and polysymptomatic distress scales (PDS) from epidemiology, primary care and rheumatology databases. We developed and evaluated a new definition for CWP, (WP2019), defined as pain in four or five regions and a pain site score of at least seven of 15 sites. We also tested a definition based on the number of painful sites (WPI\u2009\u2265\u20097).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"j_sjpain-2019-0054_s_003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>In rheumatology patients, WP1990 and WPI\u2009\u2265\u20097 classified patients with &lt;4 regions as WSP. CWP was noted in 51.3% by WP1990, 41.7% by WP2016, 37.6% of WPI\u2009\u2265\u20097 and 33.9% by WP2019. 2016 FM criteria was satisfied in WP1990 (51.1%), WP2016 (63.3%), WPI\u2009\u2265\u20097 (69.0%) and WP2019 (76.6%). WP2019 positive patients had more severe clinical symptoms compared with WP1990, WP2016 and WPI\u2009\u2265\u20097, and similar to but less than FM 2016 positive patients. In stepwise fashion, scores for functional disability, visual analog scale fatigue and pain, WPI, polysymptomatic distress score and Patient Health Questionnaire 15 (PHQ-15) worsened from WP1990 through WP2016, WPI\u2009\u2265\u20097 and WP2019.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"j_sjpain-2019-0054_s_004\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>WP2019 combines the high WPI scores of WPI\u2009\u2265\u20097 and the symmetry of WP2016, and is associated with the most abnormal clinical scores. The WP1990 does not appear to be an effective measure. We suggest that CWP can be better defined by combining 4-region pain and a total pain site score \u22657 (WP2019). This definition provides a simple, unambiguous measure that is suitable for clinical and research use as a standalone diagnosis that is integrated with fibromyalgia definitions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"j_sjpain-2019-0054_s_005\">\n                    <jats:title>Implications<\/jats:title>\n                    <jats:p>Definitions of CWP in research and clinic care are arbitrary and have varied, and different definitions of CWP identify different sets of patients, making a universal interpretation of CWP uncertain. In addition, CWP is a mandatory component of some fibromyalgia criteria. Our study provides quantitative data on the differences between CWP definitions and their criteria, allowing better understanding of research results and a guide to the use of CWP in clinical care.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1515\/sjpain-2019-0054","type":"journal-article","created":{"date-parts":[[2019,10,9]],"date-time":"2019-10-09T05:03:55Z","timestamp":1570597435000},"page":"77-86","source":"Crossref","is-referenced-by-count":86,"title":["Revised chronic widespread pain criteria: development from and integration with fibromyalgia criteria"],"prefix":"10.1515","volume":"20","author":[{"given":"Frederick","family":"Wolfe","sequence":"first","affiliation":[{"name":"National Data Bank for Rheumatic Diseases , Wichita, KS , USA"},{"name":"University of Kansas School of Medicine , 1035 N. Emporia, Ste 288 , Wichita, KS , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen H.","family":"Butler","sequence":"additional","affiliation":[{"name":"Pain Center, Academic Hospital of Uppsala , Uppsala , Sweden"},{"name":"Department of Family and Preventive Medicine , Uppsala University , Uppsala , Sweden"},{"name":"Center for Pain and Complex Disorders, St. Olav\u2019s Hospital , Trondheim , Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"MaryAnn","family":"Fitzcharles","sequence":"additional","affiliation":[{"name":"McGill University Health Center , Montreal , Quebec , Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Winfried","family":"H\u00e4user","sequence":"additional","affiliation":[{"name":"Department Internal Medicine 1 , Klinikum Saarbr\u00fccken , Saarbr\u00fccken , Germany"},{"name":"Department Psychosomatic Medicine and Psychotherapy , Technische Universit\u00e4t M\u00fcnchen , M\u00fcnchen , Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert L.","family":"Katz","sequence":"additional","affiliation":[{"name":"Rush Medical College , Chicago, IL , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philip J.","family":"Mease","sequence":"additional","affiliation":[{"name":"Swedish Medical Center, University of Washington , Seattle, WA , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johannes J.","family":"Rasker","sequence":"additional","affiliation":[{"name":"Faculty of Behavioral, Management and Social Sciences , University of Twente , Enschede , Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anthony S.","family":"Russell","sequence":"additional","affiliation":[{"name":"Department of Medicine , University of Alberta , Edmonton, Alberta , Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"I. Jon","family":"Russell","sequence":"additional","affiliation":[{"name":"Fibromyalgia Research and Consulting , San Antonio, TX , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brian","family":"Walitt","sequence":"additional","affiliation":[{"name":"National Institute of Nursing Research, National Institutes of Health , Bethesda, MD , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"374","published-online":{"date-parts":[[2019,10,9]]},"reference":[{"key":"2025120910005263858_j_sjpain-2019-0054_ref_001","doi-asserted-by":"crossref","unstructured":"Wolfe F, Smythe HA, Yunus MB, Bennett RM, Bombardier C, Goldenberg DL, Tugwell P, Campbell SM, Abeles M, Clark P, Fam AG, Farber SJ, Feichtner JJ, Franklin CM, Gatter RA, Hamaty D, Lessard J, Lichtbroun AS, Masi AT, McCain GA, et al. The American College of Rheumatology 1990 criteria for the classification of fibromyalgia. Report of the multicenter criteria committee. Arthritis Rheum 1990;33:160\u201372.","DOI":"10.1002\/art.1780330203"},{"key":"2025120910005263858_j_sjpain-2019-0054_ref_002","doi-asserted-by":"crossref","unstructured":"Butler S, Landmark T, Glette M, Borchgrevink P, Woodhouse A. Chronic widespread pain \u2013 the need for a standard definition. Pain 2016;157:541\u20133.","DOI":"10.1097\/j.pain.0000000000000417"},{"key":"2025120910005263858_j_sjpain-2019-0054_ref_003","doi-asserted-by":"crossref","unstructured":"Lindell L, Bergman S, Petersson IF, Jacobsson LT, Herrstr\u00f6m P. Prevalence of fibromyalgia and chronic widespread pain. Scand J Prim Health Care 2000;18:149\u201353.","DOI":"10.1080\/028134300453340"},{"key":"2025120910005263858_j_sjpain-2019-0054_ref_004","doi-asserted-by":"crossref","unstructured":"McBeth J, Jones K. Epidemiology of chronic musculoskeletal pain. Best Pract Res Clin Rheumatol 2007;21:403\u201325.","DOI":"10.1016\/j.berh.2007.03.003"},{"key":"2025120910005263858_j_sjpain-2019-0054_ref_005","doi-asserted-by":"crossref","unstructured":"Cimmino MA, Ferrone C, Cutolo M. Epidemiology of chronic musculoskeletal pain. Best Pract Res Clin Rheumatol 2011;25:173\u201383.","DOI":"10.1016\/j.berh.2010.01.012"},{"key":"2025120910005263858_j_sjpain-2019-0054_ref_006","doi-asserted-by":"crossref","unstructured":"Treede R-D, Rief W, Barke A, Aziz Q, Bennett MI, Benoliel R, Cohen M, Evers S, Finnerup NB, First MB. A classification of chronic pain for ICD-11. Pain 2015;156:1003.","DOI":"10.1097\/j.pain.0000000000000160"},{"key":"2025120910005263858_j_sjpain-2019-0054_ref_007","doi-asserted-by":"crossref","unstructured":"Nicholas M, Vlaeyen JW, Rief W, Barke A, Aziz Q, Benoliel R, Cohen M, Evers S, Giamberardino MA, Goebel A. The IASP classification of chronic pain for ICD-11: chronic primary pain. Pain 2019;160:28\u201337.","DOI":"10.1097\/j.pain.0000000000001390"},{"key":"2025120910005263858_j_sjpain-2019-0054_ref_008","doi-asserted-by":"crossref","unstructured":"Treede R-D, Rief W, Barke A, Aziz Q, Bennett MI, Benoliel R, Cohen M, Evers S, Finnerup NB, First MB. Chronic pain as a symptom or a disease: the IASP Classification of Chronic Pain for the: International Classification of Diseases (ICD-11). Pain 2019;160:19\u201327.","DOI":"10.1097\/j.pain.0000000000001384"},{"key":"2025120910005263858_j_sjpain-2019-0054_ref_009","unstructured":"White KP, Speechley M, Harth M, Ostbye T. The London Fibromyalgia Epidemiology Study: the prevalence of fibromyalgia syndrome in London, Ontario. J Rheumatol 1999;26:1570\u20136."},{"key":"2025120910005263858_j_sjpain-2019-0054_ref_010","doi-asserted-by":"crossref","unstructured":"Wolfe F, Clauw DJ, Fitzcharles M-A, Goldenberg DL, H\u00e4user W, Katz RL, Mease PJ, Russell AS, Russell IJ, Walitt B. 2016 Revisions to the 2010\/2011 fibromyalgia diagnostic criteria. Semin Arthritis Rheum 2016;46:319\u201329.","DOI":"10.1016\/j.semarthrit.2016.08.012"},{"key":"2025120910005263858_j_sjpain-2019-0054_ref_011","doi-asserted-by":"crossref","unstructured":"Wolfe F, Clauw D, Fitzcharles MA, Goldenberg D, Katz RS, Mease P, Russell AS, Russell IJ, Winfield J, Yunus MB. The American College of Rheumatology Preliminary Diagnostic Criteria for Fibromyalgia and measurement of symptom severity. Arthritis Care Res 2010;62:600\u201310.","DOI":"10.1002\/acr.20140"},{"key":"2025120910005263858_j_sjpain-2019-0054_ref_012","doi-asserted-by":"crossref","unstructured":"Wolfe F, Clauw D, Fitzcharles MA, Goldenberg D, H\u00e4user W, Katz RS, Mease P, Russell AS, Russell IJ, Winfield JB. Fibromyalgia criteria and severity scales for clinical and epidemiological studies: a modification of the ACR preliminary diagnostic criteria for fibromyalgia. J Rheumatol 2011;38:1113\u201322.","DOI":"10.3899\/jrheum.100594"},{"key":"2025120910005263858_j_sjpain-2019-0054_ref_013","doi-asserted-by":"crossref","unstructured":"Wolfe F, Walitt BT, Rasker JJ, Katz RS, H\u00e4user W. The use of polysymptomatic distress categories in the evaluation of fibromyalgia (FM) and FM severity. J Rheumatol 2015;42:1494\u2013501.","DOI":"10.3899\/jrheum.141519"},{"key":"2025120910005263858_j_sjpain-2019-0054_ref_014","doi-asserted-by":"crossref","unstructured":"Wolfe F, Br\u00e4hler E, Hinz A, H\u00e4user W. Fibromyalgia prevalence, somatic symptom reporting, and the dimensionality of polysymptomatic distress: results from a survey of the general population. Arthritis Care Res 2013;65:777\u201385.","DOI":"10.1002\/acr.21931"},{"key":"2025120910005263858_j_sjpain-2019-0054_ref_015","doi-asserted-by":"crossref","unstructured":"Srinivasan S, Maloney E, Wright B, Kennedy M, Kallail KJ, Rasker JJ, H\u00e4user W, Wolfe F. The problematic nature of fibromyalgia diagnosis in the community. ACR Open Rheumatol 2019;1:43\u201351.","DOI":"10.1002\/acr2.1006"},{"key":"2025120910005263858_j_sjpain-2019-0054_ref_016","doi-asserted-by":"crossref","unstructured":"Fries JF, Spitz PW, Kraines RG, Holman HR. Measurement of patient outcome in arthritis. Arthritis Rheum 1980;23:137\u201345.","DOI":"10.1002\/art.1780230202"},{"key":"2025120910005263858_j_sjpain-2019-0054_ref_017","doi-asserted-by":"crossref","unstructured":"Hern\u00e1ndez Alava M, Wailoo A, Wolfe F, Michaud K. The relationship between EQ-5D, HAQ and pain in patients with rheumatoid arthritis. Rheumatology 2013;52:944\u201350.","DOI":"10.1093\/rheumatology\/kes400"},{"key":"2025120910005263858_j_sjpain-2019-0054_ref_018","doi-asserted-by":"crossref","unstructured":"Kroenke K, Spitzer RL, Williams JBW. The PHQ-15: validity of a new measure for evaluating the severity of somatic symptoms. Psychosom Med 2002;64:258\u201366.","DOI":"10.1097\/00006842-200203000-00008"},{"key":"2025120910005263858_j_sjpain-2019-0054_ref_019","doi-asserted-by":"crossref","unstructured":"Kroenke K, Spitzer RL, Williams JB, L\u00f6we B. An ultra-brief screening scale for anxiety and depression: the PHQ-4. Psychosomatics 2009;50:613\u201321.","DOI":"10.1016\/S0033-3182(09)70864-3"},{"key":"2025120910005263858_j_sjpain-2019-0054_ref_020","unstructured":"Stata. Stata statistical software: release 15.0. College Station, TX: Stata Corporation, 2018."},{"key":"2025120910005263858_j_sjpain-2019-0054_ref_021","doi-asserted-by":"crossref","unstructured":"Landis J, Koch G. The measurement of observer agreement for categorical data. Biometrics 1977;33:159\u201374.","DOI":"10.2307\/2529310"},{"key":"2025120910005263858_j_sjpain-2019-0054_ref_022","doi-asserted-by":"crossref","unstructured":"Dean LE, Arnold L, Crofford L, Bennett R, Goldenberg D, Fitzcharles MA, Paiva ES, Staud R, Clauw D, Sarzi-Puttini P. Impact of moving from a widespread to multisite pain definition on other fibromyalgia symptoms. Arthritis Care Res (Hoboken) 2017;69:1878\u201386.","DOI":"10.1002\/acr.23214"},{"key":"2025120910005263858_j_sjpain-2019-0054_ref_023","doi-asserted-by":"crossref","unstructured":"Arnold LM, Bennett RM, Crofford LJ, Dean LE, Clauw DJ, Goldenberg DL, Fitzcharles M-A, Paiva ES, Staud R, Sarzi-Puttini P, Buskila D, Macfarlane GJ. AAPT diagnostic criteria for fibromyalgia. J Pain 2019;20:611\u201328.","DOI":"10.1016\/j.jpain.2018.10.008"},{"key":"2025120910005263858_j_sjpain-2019-0054_ref_024","doi-asserted-by":"crossref","unstructured":"Kamaleri Y, Natvig B, Ihlebaek CM, Benth JS, Bruusgaard D. Number of pain sites is associated with demographic, lifestyle, and health-related factors in the general population. Eur J Pain 2008;12:742\u20138.","DOI":"10.1016\/j.ejpain.2007.11.005"},{"key":"2025120910005263858_j_sjpain-2019-0054_ref_025","doi-asserted-by":"crossref","unstructured":"Hauser W, Schmutzer G, Brahler E, Glaesmer H. A cluster within the continuum of biopsychosocial distress can be labeled \u201cfibromyalgia syndrome\u201d \u2013 evidence from a representative German population survey. J Rheumatol 2009;36:2806\u201312.","DOI":"10.3899\/jrheum.090579"},{"key":"2025120910005263858_j_sjpain-2019-0054_ref_026","doi-asserted-by":"crossref","unstructured":"Coggon D, Ntani G, Palmer KT, Felli VE, Harari R, Barrero LH, Felknor SA, Gimeno D, Cattrell A, Vargas-Prada S. Patterns of multisite pain and associations with risk factors. PAIN\u00ae 2013;154:1769\u201377.","DOI":"10.1016\/j.pain.2013.05.039"},{"key":"2025120910005263858_j_sjpain-2019-0054_ref_027","doi-asserted-by":"crossref","unstructured":"Egloff N, von K\u00e4nel R, M\u00fcller V, Egle U, Kokinogenis G, Lederbogen S, Durrer B, Stauber S. Implications of proposed fibromyalgia criteria across other functional pain syndromes. Scand J Rheumatol 2015;44:416\u201324.","DOI":"10.3109\/03009742.2015.1010103"},{"key":"2025120910005263858_j_sjpain-2019-0054_ref_028","doi-asserted-by":"crossref","unstructured":"Wolfe F, Egloff N, H\u00e4user W. Widespread pain and low widespread pain index scores among fibromyalgia-positive cases assessed with the 2010\/2011 fibromyalgia criteria. J Rheumatol 2016;43:1743\u20138.","DOI":"10.3899\/jrheum.160153"},{"key":"2025120910005263858_j_sjpain-2019-0054_ref_029","doi-asserted-by":"crossref","unstructured":"Brummett CM, Bakshi RR, Goesling J, Leung D, Moser SE, Zollars JW, Williams DA, Clauw DJ, Hassett AL. Preliminary validation of the Michigan Body Map (MBM). Pain 2016;157:1205.","DOI":"10.1097\/j.pain.0000000000000506"}],"container-title":["Scandinavian Journal of Pain"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.degruyter.com\/view\/journals\/sjpain\/20\/1\/article-p77.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.degruyterbrill.com\/document\/doi\/10.1515\/sjpain-2019-0054\/xml","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.degruyterbrill.com\/document\/doi\/10.1515\/sjpain-2019-0054\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,9]],"date-time":"2025-12-09T12:22:10Z","timestamp":1765282930000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.degruyterbrill.com\/document\/doi\/10.1515\/sjpain-2019-0054\/html"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,10,9]]},"references-count":29,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2019,8,20]]},"published-print":{"date-parts":[[2019,12,18]]}},"alternative-id":["10.1515\/sjpain-2019-0054"],"URL":"https:\/\/doi.org\/10.1515\/sjpain-2019-0054","relation":{},"ISSN":["1877-8879","1877-8860"],"issn-type":[{"value":"1877-8879","type":"electronic"},{"value":"1877-8860","type":"print"}],"subject":[],"published":{"date-parts":[[2019,10,9]]}}}