Anxiety and depressive symptoms in fibromyalgia are related to poor perception of health but not to pain sensitivity or cerebral processing of pain.

OBJECTIVE Mood disturbance is common among patients with fibromyalgia (FM), but the influence of psychological symptoms on pain processing in this disorder is unknown. We undertook the present study to investigate the differential effect of depressive symptoms, anxiety, and catastrophizing on 1) pain symptoms and subjective ratings of general health status and 2) sensitivity to pain and cerebral processing of pressure pain. METHODS Eighty-three women (mean ± SD age 43.8 ± 8.1 years) who fulfilled the American College of Rheumatology 1990 criteria for the classification of FM participated in the study. Patients rated pain intensity (100-mm visual analog scale [VAS]), severity of FM (Fibromyalgia Impact Questionnaire), general health status (Short Form 36), depressive symptoms (Beck Depression Inventory), anxiety (State-Trait Anxiety Inventory), and catastrophizing (Coping Strategies Questionnaire). Experimental pain in the thumb was induced using a computer-controlled pressure stimulator. Event-related functional magnetic resonance imaging was performed during administration of painful stimuli representing 50 mm on a pain VAS, as well as nonpainful pressures. RESULTS A correlation analysis including all self-ratings showed that depressive symptoms, anxiety, and catastrophizing scores were correlated with one another (P < 0.001), but did not correlate with ratings of clinical pain or with sensitivity to pressure pain. However, the subjective rating of general health was correlated with depressive symptoms and anxiety (P < 0.001). Analyses of imaging results using self-rated psychological measures as covariates showed that brain activity during experimental pain was not modulated by depressive symptoms, anxiety, or catastrophizing. CONCLUSION Negative mood in FM patients can lead to a poor perception of one's physical health (and vice versa) but does not influence performance on assessments of clinical and experimental pain. Our data provide evidence that 2 partially segregated mechanisms are involved in the neural processing of experimental pain and negative affect.

[1]  C. Spielberger,et al.  Manual for the State-Trait Anxiety Inventory , 1970 .

[2]  David A. Williams,et al.  Differences in unpleasantness induced by experimental pressure pain between patients with fibromyalgia and healthy controls , 2005, European journal of pain.

[3]  P. Matthews,et al.  Exacerbation of Pain by Anxiety Is Associated with Activity in a Hippocampal Network , 2001, The Journal of Neuroscience.

[4]  F. Wolfe,et al.  The prevalence and characteristics of fibromyalgia in the general population. , 1995, Arthritis and rheumatism.

[5]  M. Detke,et al.  Efficacy and safety of duloxetine for treatment of fibromyalgia in patients with or without major depressive disorder: Results from a 6-month, randomized, double-blind, placebo-controlled, fixed-dose trial , 2008, PAIN.

[6]  R M Bennett,et al.  The fibromyalgia impact questionnaire: development and validation. , 1991, The Journal of rheumatology.

[7]  Daniel J Clauw,et al.  Functional magnetic resonance imaging evidence of augmented pain processing in fibromyalgia. , 2002, Arthritis and rheumatism.

[8]  H. Bliddal,et al.  [Fibromyalgia, diagnosis and prevalence. Are gender differences explainable?]. , 2009, Ugeskrift for laeger.

[9]  P. Tugwell,et al.  The American College of Rheumatology 1990 Criteria for the Classification of Fibromyalgia. Report of the Multicenter Criteria Committee. , 1990, Arthritis and rheumatism.

[10]  Karl J. Friston,et al.  Human Brain Function , 1997 .

[11]  R. Edwards,et al.  Catastrophizing and pain in arthritis, fibromyalgia, and other rheumatic diseases. , 2006, Arthritis and rheumatism.

[12]  M. Yunus.  The role of gender in fibromyalgia syndrome , 2001, Current rheumatology reports.

[13]  P. Hansson,et al.  Somatosensory perception and function of diffuse noxious inhibitory controls (DNIC) in patients suffering from rheumatoid arthritis , 2002, European journal of pain.

[14]  C. Sherbourne,et al.  The MOS 36-Item Short-Form Health Survey (SF-36) , 1992 .

[15]  S. Clare,et al.  Imaging how attention modulates pain in humans using functional MRI. , 2002, Brain : a journal of neurology.

[16]  M. Hotopf,et al.  Is fibromyalgia a distinct clinical entity? Historical and epidemiological evidence. , 1999, Bailliere's best practice & research. Clinical rheumatology.

[17]  D. Goldenberg.  The interface of pain and mood disturbances in the rheumatic diseases. , 2010, Seminars in arthritis and rheumatism.

[18]  D. Chialvo,et al.  Chronic Pain and the Emotional Brain: Specific Brain Activity Associated with Spontaneous Fluctuations of Intensity of Chronic Back Pain , 2006, The Journal of Neuroscience.

[19]  Michel Magnin,et al.  Emotional Modulation of Pain: Is It the Sensation or What We Recall? , 2006, The Journal of Neuroscience.

[20]  Ulf Lindblom,et al.  CLASSIFICATION OF CHRONIC PAIN , 2004 .

[21]  Alan C. Evans,et al.  Anatomical mapping of functional activation in stereotactic coordinate space , 1992, NeuroImage.

[22]  P. Hansson,et al.  Modulatory influence on somatosensory perception from vibration and heterotopic noxious conditioning stimulation (HNCS) in fibromyalgia patients and healthy subjects , 1997, Pain.

[23]  Serge Marchand,et al.  The Deficit of Pain Inhibition in Fibromyalgia Is More Pronounced in Patients With Comorbid Depressive Symptoms , 2009, The Clinical journal of pain.

[24]  G. Alpers,et al.  Affective pain modulation in fibromyalgia, somatoform pain disorder, back pain, and healthy controls , 2008, European journal of pain.

[25]  Francis J. Keefe,et al.  The use of coping strategies in chronic low back pain patients: Relationship to patient characteristics and current adjustment , 1983, Pain.

[26]  A. Beck,et al.  An inventory for measuring depression. , 1961, Archives of general psychiatry.

[27]  R. Staud.  Fibromyalgia pain: do we know the source? , 2004, Current opinion in rheumatology.

[28]  A. Craig.  A new view of pain as a homeostatic emotion , 2003, Trends in Neurosciences.

[29]  G. Ehrlich.  Fibromyalgia, a virtual disease , 2003, Clinical Rheumatology.

[30]  Irene Tracey,et al.  The Cerebral Signature for Pain Perception and Its Modulation , 2007, Neuron.

[31]  I. Tracey.  Nociceptive processing in the human brain , 2005, Current Opinion in Neurobiology.

[32]  D. Clauw,et al.  Pain catastrophizing and neural responses to pain among persons with fibromyalgia. , 2004, Brain : a journal of neurology.

[33]  M. Ingvar.  Pain and functional imaging. , 1999, Philosophical transactions of the Royal Society of London. Series B, Biological sciences.

[34]  W. Drevets,et al.  Functional neuroimaging studies of depression: the anatomy of melancholia. , 1998, Annual review of medicine.

[35]  S. Lautenbacher,et al.  Possible deficiencies of pain modulation in fibromyalgia. , 1997, The Clinical journal of pain.

[36]  David A. Williams,et al.  The relationship between depression, clinical pain, and experimental pain in a chronic pain cohort. , 2005, Arthritis and rheumatism.

[37]  Daniel J Clauw,et al.  Increased pain sensitivity in fibromyalgia: effects of stimulus type and mode of presentation , 2003, Pain.

[38]  W. Katon,et al.  Depression and pain comorbidity: a literature review. , 2003, Archives of internal medicine.

[39]  Steven C. R. Williams,et al.  Evidence of dysfunctional pain inhibition in Fibromyalgia reflected in rACC during provoked pain , 2009, PAIN®.

[40]  Irene Tracey,et al.  Investigation into the neural correlates of emotional augmentation of clinical pain , 2008, NeuroImage.

[41]  Jan Ekholm,et al.  Sensory dysfunction in fibromyalgia patients with implications for pathogenic mechanisms , 1996, Pain.

[42]  L. Arnold,et al.  A randomized, double-blind, placebo-controlled trial of duloxetine in the treatment of women with fibromyalgia with or without major depressive disorder , 2005, Pain.

[43]  Khek Yu Ho,et al.  Cortical effects of anticipation and endogenous modulation of visceral pain assessed by functional brain MRI in irritable bowel syndrome patients and healthy controls , 2006, Pain.