Depression: A Modifiable Risk Factor for Poor Outcomes in Fibromyalgia

Abstract

Background: About 4 out of 10 fibromyalgia patients suffer from depression. The European Alliance of Associations for Rheumatology (EULAR) guidelines recommend using antidepressants to treat fibromyalgia. Objective: To determine predictors of improved outcomes following a multicomponent treatment program. Design: We designed this longitudinal treatment outcome study to evaluate the prevalence of depression symptoms in patients diagnosed with fibromyalgia at a tertiary care facility, and the impact of depression on functional outcomes after completing a multicomponent fibromyalgia treatment program. Setting: Tertiary care center. Patients: This study included 411 adult patients with fibromyalgia who completed a multicomponent treatment program for fibromyalgia. Expert physicians performed comprehensive evaluations following American College of Rheumatology (ACR) criteria to confirm fibromyalgia before referral to the program. Intervention: An intensive outpatient multicomponent treatment program consisting of 16 hours of cognitive behavioral strategies served as the intervention. Measurements: Functional status was assessed using the Fibromyalgia Impact Questionnaire Revised (FIQR). Depression was evaluated with the Center for Epidemiologic Study of Depression (CES-D) measure. Measures were administered prior to participation in the program and approximately 5 months following completion of the program. Results: The cohort had a high prevalence of depressive symptoms (73.2% had depression at admission). Higher depression scores at baseline predicted poorer outcomes following multi-component treatment. Effectively treated depression resulted in improved functioning at follow-up. Limitations: Findings limited to tertiary care center cohort of fibromyalgia patients. Patients did not undergo a structured clinical diagnostic interview to diagnose depression. Conclusions: The current data links depression to poorer outcomes in patients with fibromyalgia. Depression is an important modifiable factor in the management of fibromyalgia. Guidelines should reflect the importance of assessing and effectively treating depression at the time of diagnosis of fibromyalgia, to improve functional outcomes. Registration: Specific registry and specific study registration number—Institutional Review Board—(IRB# 19-000495). Funding Source: No funding.

A retrospective analysis of the prevalence and impact of associated comorbidities on fibromyalgia outcomes in a tertiary care center

“…The prevalence of psychiatric disorders found in our study was 48.2% which is significantly higher than a previous report where only 25.3% were found to have a psychiatric disorder ( 27 ). However, Kleycamp et al ( 43 ) completed a systematic overview of psychiatric and chronic pain comorbidities among patients diagnosed with FM and noted the most prevalent comorbidity was depression that was found in over 50% of patients similar to our findings. Depression ( 38 ) is a significant comorbidity associated with FM and prevalence was consistent with results of another cross-sectional studies ( 44 ) In addition, Gynecological comorbidities were associated with worse depressive symptoms at follow-up.…”

The Association Between the Patient Self-Report Survey for the Assessment of Fibromyalgia with Pain Sensitivity and Psychological Factors in Individuals with Musculoskeletal Pain

“…Elevated negative pain-related psychological factors are also present in patients with nociplastic pain conditions, such as fibromyalgia. Higher rates of depression are observed in this population, 5 and nociplastic pain is associated with higher levels of anxiety and negative mood. 27 Collectively, elevated sensory-related and psychological factors are present in nociplastic pain conditions.…”

“… 4 Negative psychological factors are also heightened in this population, with greater levels of catastrophizing and depression reported. 5 , 6 Heightened sensory and negative psychological factors are demonstrated in patients with nociplastic pain. 7–10 …”

Effects of Prolonged Medical Fasting during an Inpatient, Multimodal, Nature-Based Treatment on Pain, Physical Function, and Psychometric Parameters in Patients with Fibromyalgia: An Observational Study

“…These findings on wellbeing are of particular interest in FMS, as many patients suffer from alexithymia and depression. Four in ten FMS patients are reported to show depressive symptomatology [7]. Depression has been linked to poorer outcomes in FMS patients [7] and alexithymia has been positively associated with pain [8].…”

“…Further associations have been found with biosocial stressors and trauma, especially physical abuse history [6]. FMS is often accompanied by psychological symptomatology, including depression [7] and alexithymia [8].…”