Patients With Fibromyalgia Reporting Severe Pain but Low Impact of the Syndrome: Clinical and Pain‐Related Cognitive Features

Abstract

Background Fibromyalgia (FM) is a prevalent and highly disabling chronic pain syndrome. However, differences among patients regarding how pain impacts on daily life are remarkable. The main aim of this study was to identify clinical and pain‐related cognitive variables characterizing patients reporting high adaptability despite experiencing severe chronic pain. Methods Two hundred and eighty‐three Spanish patients with FM with high levels of pain were classified into 2 groups: (1) those reporting low impact of the syndrome, and (2) those with moderate‐to‐high impact. Perceived stress, anxiety, and depressive symptoms along with pain catastrophizing, psychological inflexibility, and perceived control over pain were evaluated. Differences in sociodemographics, years with FM, past/current major depressive disorder comorbidity, and health‐related economic costs (ie, medications, use of medical services, lost productivity due to sick leave) were also assessed. Stepwise logistic regression analyses predicting group membership from clinical variables and pain‐related cognitive processes as predictors were performed. Results Lower stress, anxiety, and depressive symptoms, along with reduced pain catastrophism, psychological inflexibility, and perceived control over pain, were found in the low‐impact group. Significant predictors of group membership (low‐impact vs. moderate‐to‐high impact) in regression analyses were “cognitive fusion” (psychological inflexibility), “helplessness” (pain catastrophizing), and depressive symptomatology, together with pain intensity and other FM symptoms. Conclusions The present study provides further evidence on resilience resources in chronic pain by identifying some variables (ie, reduced depressive symptomatology, pain catastrophizing, and psychological inflexibility) differentially characterizing a profile of patients with FM who are especially able to adapt to high levels of pain.

Pain acceptance and its impact on function and symptoms in fibromyalgia

“…In the cross-sectional study, higher age, high educational level, work, no depression and lower degree of illness (Fibromyalgianess Score) were found associated with the outcome, lower FIQ score, i.e., better daily functional level and lower symptoms in patients with fibromyalgia. Previous studies have identified high age, low educational level and low socioeconomic status as associative factors for fibromyalgia [39,41], and depression has been found to bea common comorbidity as well as associated with a higher impact of the illness [42]. The mean values of FIQ total do not change substantially from T1 to T2.…”

Associations of Cognitive Fusion and Pain Catastrophizing with Fibromyalgia Impact through Fatigue, Pain Severity, and Depression: An Exploratory Study Using Structural Equation Modeling

“…In this sense, the psychological flexibility model suggests that cognitive fusion would explain the inability of some individuals to implement adaptive coping methods in the presence of pain or related symptomatology [15]. Indeed, there is evidence to support the influence of cognitive fusion on outcomes in patients with FM [16,17]. Research supports the idea that both processes are distinct and that they could potentially interact and influence each other [18].…”

“…In the light of the previous literature [1,7,8,13,17], our goals is to test the hypothesized associations of pain catastrophizing, cognitive fusion, and FM symptom severity (pain, fatigue, and depression) in a theoretically-sound model that accounts for the contribution of these elements altogether in relation to functional limitation. We hypothesize that catastrophizing components and cognitive fusion will be associated with greater disability (see Figure 1).…”

Brief Acceptance and Commitment Therapy for Fibromyalgia: Feasibility and Effectiveness of a Replicated Single-Case Design

“…Fibromyalgia (FM) is a rheumatic disease characterized by a history of widespread musculoskeletal chronic pain, sleep disturbance, debilitating fatigue, joint stiffness, and cognitive (memory, attention, perception, coordination) dysfunction and is frequently associated with depression and anxiety-related disorders [ 1 – 3 ]. FM is a very prevalent disease worldwide, with estimates suggesting that between 2% and 5% of individuals, mostly females, experience this syndrome globally [ 4 , 5 ].…”