Psychological factors mediate key symptoms of fibromyalgia through their influence on stress.

The clinical features of fibromyalgia are associated with various psychological factors, including stress. We examined the hypothesis that the path that psychological factors follow in influencing fibromyalgia symptoms is through their direct effect on stress. Ninety-eight females with ACR 1990 classified fibromyalgia completed the following questionnaires: The Big 5 Personality Inventory, Fibromyalgia Impact Questionnaire, Perceived Stress Scale, Profile of Mood States, Mastery Scale, and Perceived Control of Internal States Scale. SPSS (PASW version 22) was used to perform basic t tests, means, and standard deviations to show difference between symptom characteristics. Pathway analysis using structural equation modelling (Laavan) examined the effect of stress on the relationships between psychological factors and the elements that define the fibromyalgia phenotype. The preferred model showed that the identified path clearly linked the psychological variables of anxiety, neuroticism and mastery, but not internal control, to the three key elements of fibromyalgia, namely pain, fatigue and sleep (p < 0.001), via the person's perceived stress. Confusion, however, did not fit the preferred model. This study confirms that stress is a necessary link in the pathway between certain identified, established and significant psychological factors and key fibromyalgia symptoms. This has implications for the understanding of contributing mechanisms and the clinical care of patients with fibromyalgia.

Rumination modulates stress and other psychological processes in fibromyalgia.

OBJECTIVE: Fibromyalgia (FM) is characterized by widespread pain and high levels of sleep disturbance, fatigue, and altered cognition. Psychological stress can modulate these features. In this study, we examined the thinking style of rumination in women with FM to assess the effect of rumination on stress levels and other psychological variables in FM. MATERIAL AND METHODS: Ninety-eight women with FM completed questionnaires to assess levels of rumination, stress, anxiety, depression, optimism, control, and coping. T-tests and bivariate (Pearson) analysis was performed to assess relationships between rumination and other psychological factors. RESULTS: We found that those with higher levels of rumination had increased the use of negative coping techniques (p<0.001), higher anxiety (p<0.001), depression (p<0.001), and poor sleep levels (p<0.05). Higher rumination correlated with lower optimism (p<0.001) and control (Mastery) (p<0.001). High rumination correlated strongest with stress (p<0.001). Rumination predicted 26% of variance for perceived stress. CONCLUSION: Rumination influenced several psychological processes deemed important in FM and was an important contributor to stress in FM. Specific interventions targeting rumination in FM may improve FM symptoms and outcomes.

Stress modulates key psychological processes and characteristic symptoms in females with fibromyalgia.

OBJECTIVES: To examine how stress interacts with psychological processes and key phenotypic symptom characteristics in females with fibromyalgia. METHODS: Ninety-eight women with fibromyalgia, diagnosed according to ACR 1990 criteria, and 35 female healthy controls without pain were studied. Applied questionnaires included the following: Perceived Stress scale [PSS], Fibromyalgia Impact Questionnaire [FIQ], Perceived Control of Internal States (PCOIS), Mastery scale and the Profile of Mood States scale (POMS). RESULTS: Perceived stress correlated significantly with the characteristic features of fibromyalgia including pain (p<0.05) and sleep change, fatigue and cognitive dysfunction (all p<0.001). Perceived stress correlated inversely with measures of control and positively with mood and neuroticism (all p<0.001). When controlling for stress, most of these variables were no longer significant, suggesting that stress impacts on the majority of variables associated with FM. CONCLUSIONS: Stress in females with fibromyalgia associates with both key symptoms and a range of relevant psychological variables. Stress appears to have a major role in modulating several key 'up-stream' processes in fibromyalgia.

Psychological control is a key modulator of fibromyalgia symptoms and comorbidities.

OBJECTIVE: We hypothesized that fibromyalgia (FM) patients would report lower levels of psychological control mechanisms and that higher levels of control would moderate key symptoms associated with FM, such as pain, fatigue, perceived stress, and mood disturbance. METHODS: Ninety-eight women with FM diagnosed according to American College of Rheumatology criteria and 35 matched pain-free women were identified. Applied questionnaires included the Fibromyalgia Impact Questionnaire, Profile of Mood States, Perceived Control of Internal States Scale, Perceived Stress Scale, and Mastery Scale. Differences were sought using t-tests, one-way analysis of variance, bivariate correlations, and multiple regression analysis. RESULTS: Comparison between FM patients and healthy individuals found significant differences in control (Perceived Control of Internal States Scale and Mastery Scale), pain, perceived stress, fatigue, confusion, and mood disturbance (all P < 0.001). There were significant associations found between both high and low levels of control on stress, mood, pain, and fatigue (P < 0.001-0.05). Strong negative correlations were present between internal control and perceived stress (P < 0.0005). CONCLUSION: FM patients use significantly different control styles compared with healthy individuals. Levels and type of psychological control buffer mood, stress, fatigue, and pain in FM. Control appears to be an important "up-stream" process in FM mechanisms and is amenable to intervention.

Personality and fibromyalgia syndrome.

OBJECTIVES: We aimed to review how personality characteristics contribute to the onset, maintenance or modulation of fibromyalgia. METHOD: The databases Medline and PsychINFO were examined from 1967 to 2012 to identify studies that investigated associations between fibromyalgia and personality. Search terms included fibromyalgia and personality, trait psychology, characteristics and individual differences. RESULTS: Numerous studies indicate that patients with fibromyalgia experience psychological distress. Various instruments have been used to evaluate distress and related psychological domains, such as anxiety or depression, in fibromyalgia. In many cases, these same instruments have been used to study personality characteristics in fibromyalgia with a subsequent blurring of cause and effect between personality and psychological distress. In addition, the symptoms of fibromyalgia may change pre-illness personality characteristics themselves. These issues make it difficult to identify specific personality characteristics that might influence the fibromyalgia process. Despite this inherent problem with the methodologies used in the studies that make up this literature review, or perhaps because of it, we found no defined personality profile specific to fibromyalgia. However, many patients with fibromyalgia do show personality characteristics that facilitate psychological responses to stressful situations, such as catastrophising or poor coping techniques, and these in turn associate with mechanisms contributing to fibromyalgia. CONCLUSION: No specific fibromyalgia personality is defined but it is proposed that personality is an important filter that modulates a person's response to psychological stressors. Certain personalities may facilitate translation of these stressors to physiological responses driving the fibromyalgia mechanism.

Neuroticism in young women with fibromyalgia links to key clinical features.

Objective. We examined personality traits in young women with FM, in order to seek associations with key psychological processes and clinical symptoms. Methods. Twenty-seven women with FM and 29 age-matched female healthy controls [HC] completed a series of questionnaires examining FM symptoms, personality and psychological variables. Results. Significant differences between characteristic FM symptoms (sleep, pain, fatigue, and confusion) as well as for the psychological variables of depression, anxiety, and stress were found between FM and HC (P < 0.001). Neuroticism was the only subscale of the Big Five Inventory that showed a significant difference between the FM group and HC group [P < 0.05]. Within the FM group, there was a significant association between the level of the neuroticism and each of pain, sleep, fatigue, and confusion, depression, anxiety, and stress (P < 0.05-0.01). The association between the level of neuroticism and the level of stress was the strongest of all variables tested (P < 0.001). Conclusion. The personality trait of neuroticism significantly associates with the key FM characteristics of pain, sleep, fatigue and confusion as well as the common co-morbidities of depression, anxiety and stress. Personality appears to be an important modulator of FM clinical symptoms.