CWPS Full Form in Pain Medicine
CWPS stands for Chronic Widespread Pain Syndrome, which is defined as pain lasting more than 3 months involving all four body quadrants (left, right, above and below the waist), the axial skeleton (neck and back), and is characterized by central sensitization mechanisms. 1, 2, 3
Clinical Definition and Diagnostic Criteria
CWPS is pain persisting in all four body quadrants plus axial pain (neck and back) for at least 3 months, representing the broader spectrum of widespread pain conditions 3, 4, 5
The International Association for the Study of Pain defines chronic pain as pain persisting beyond normal tissue healing time, assumed to be 3 months 6, 1
CWPS affects 5-10% of the general population, with point prevalence ranging from 4.7% to 17% depending on the specific definition used 2, 3, 5, 7
Relationship to Fibromyalgia
Fibromyalgia represents the extreme end of the CWPS spectrum, diagnosed when chronic widespread pain is accompanied by mechanical hyperalgesia at ≥11 tender-point sites 3
Fibromyalgia is characterized by generalized, widespread chronic pain (≥3 months) with multiple tender points upon physical examination, believed to result from inadequate filtering of nociceptor signaling by descending antinociceptive pathways (central sensitization) 6, 8
Fibromyalgia affects approximately 4% of women and 1% of men worldwide, representing 2-4% of community subjects 6
Key Clinical Features
CWPS is associated with more severe symptoms than localized pain, including higher pain intensity, longer pain duration, and greater disability 3
Characteristic symptoms include multifocal pain, fatigue, insomnia, memory difficulties, and higher rates of concomitant mood disorders 2
Psychological disturbance is 2.2 times more common in CWPS patients, with fatigue being 3.8 times more prevalent compared to those without widespread pain 7
Anxiety and depression are significantly more common in CWPS patients than among those with localized pain and pain-free controls 3
Pathophysiology
CWPS represents central sensitization, characterized by increased sensitivity mediated by the central nervous system despite no clear evidence of ongoing tissue damage 6, 2
The condition involves functional and structural changes (neuroplasticity) in the central nervous system at every level, distinguishing it from acute or localized pain 1
There is ongoing debate whether CWPS is entirely a neurotransmitter-related process or partially due to individual cognitive experiences and evaluations 2
Predictive Factors and Natural History
Approximately 53% of patients with CWPS continue to have widespread pain 11 years later, indicating that nearly half resolve over time 5
Obesity, poor sleep, and chronic disease predict persistent CWPS, while being male and/or 60 years or older is protective against persistence 5
Female gender is significantly associated with CWPS (odds ratio 4.2) after adjusting for other variables 4
Treatment Approach
FDA-approved first-line treatments for CWPS/fibromyalgia include pregabalin, duloxetine, and milnacipran 6, 8, 1
Additional effective medications include antidepressants (tricyclics and serotonin norepinephrine reuptake inhibitors), α2-δ calcium channel ligand anticonvulsants (gabapentin and pregabalin), the muscle relaxant cyclobenzaprine, and the opioid tramadol 6, 8
Cognitive behavioral therapy is essential to address pain catastrophizing, develop coping strategies, and manage comorbid depression/anxiety 8, 1
Regular physical activity tailored to patient capabilities should be incorporated into the treatment plan 8, 1
Common Pitfalls
Avoid focusing solely on pharmacological management without addressing physical function and psychological factors, as CWPS is multifactorial involving biological, psychological, and social components 8, 1
Opioids should be considered second-line treatments only, as they have limited evidence for long-term effectiveness in chronic non-cancer pain 6, 8
Do not overlook screening for and treating comorbid depression, anxiety, sleep disturbance, and fatigue, which commonly accompany CWPS and influence treatment outcomes 1