ABSTRACT
BACKGROUND: Identification of fibromyalgia has been a challenge for healthcare professionals due to the lack of a clinical biomarker. A well-supported integrative hypothesis holds that this condition is a chronic pain problem partly caused by long-term dysregulation of stress response. Therefore, stress assessment from a biopsychosocial perspective may be a useful approach to recognizing fibromyalgia. PURPOSE: A cross-sectional case-control study was conducted to explore stress markers from a multidimensional perspective, including heart rate variability (as a biomarker of stress) as well as psychological distress and social stress. METHODS: Forty-seven women with fibromyalgia were recruited from support groups and another 47 were recruited as matched pain-free controls. Comparison and discriminant function analyses were performed. RESULTS: The data support the goodness of biopsychosocial stress markers in women with fibromyalgia, resulting in the identification of between 70% and 74.5% of fibromyalgia cases (sensitivity) and 85%-87% pain-free controls (specificity), with medium-high levels of fit (λ = 0.58 and λ = 0.59; p < .00). Women with fibromyalgia were characterized by high levels of psychological distress, social stress (disorder levels), and autonomic dysregulation. Although distress and social stress had a greater weight in discriminant functions, dysregulation in terms of low parasympathetic activity and high sympathetic activity at rest was also relevant. CONCLUSIONS: A biopsychosocial approach to stress with an objective biomarker such as heart rate variability may be a useful tool to identify and manage FM.
