Attentional deficits in fibromyalgia and its relationships with pain, emotional distress and sleep dysfunction complaints

Abstract

Cognitive complaints are common among subjects with fibromyalgia (FM). Yet, few studies have been able to document these deficits with cognitive tasks. A main limitation of existing studies is that attention has been broadly defined and the tasks used to measure attention are not designed to cover all the main components of the attentional system. Research on attention has identified three primary functions of attention, known as alerting, orienting and executive functioning. This study used the attentional network test-interactions task to explore whether and which of the three attentional networks are altered in FM. Results showed that FM patients have impaired executive control (greater interference), reduced vigilance (slower overall reaction time) and greater alertness (higher reduction in errors after a warning cue). Vigilance and alertness showed several relations with depression, anxiety and sleep quality. Sleep dysfunction was a significant predictor for alertness, whereas there were no significant predictors for vigilance. These findings highlight that the treatment of sleep difficulties in FM patients may help with some of their cognitive complaints.

Vigilance behaviors and EEG activity in sustained attention may affect acute pain

“…In another study, errors in a visual Sustained Attention and working memory task were correlated with pain of any etiology at the time of the online testing in a large internet survey in selfenrolled individuals [13]. These results may be congruent with those in patients with chronic pain due to fibromyalgia who showed increased errors versus healthy controls [15,57], and correlation of errors with both clinical symptoms and effects of EEG biofeedback therapy [14]. Patients with chronic 'nonmalignant' pain versus controls had lower performance and increased errors in a visual CPT task [16].…”

Fibromyalgia: A Critical and Comprehensive Review

“…Sleep quality would also be expected to affect cognition and was correlated with perceived memory deficits [213]. It was also found to be the only significant predictor of objectively assessed alertness [189], but attention and memory deficits persisted after adjustment for self-reported sleep duration and quality [194], and others did not detect any significant correlations [192].…”

“…However, the effect of pain may be task-and domain-specific. In addition, the correlation may only become obvious when pain at the time of neuropsychological testing is assessed rather than average pain over the last week [189]. In partial contrast to the results of objective cognitive assessment, pain ratings were significantly associated with self-reported language deficits, but not with perceived attention or concentration [213].…”

“…Most neuropsychological assessments of FMS patients include only a small number of subjects who are taking a variety of different medications, which makes it difficult to detect a significant effect of any single class of pharmaceuticals and renders it almost impossible to control for medication intake. This may explain the mixed results that have been obtained regarding the influence of FMS medications on cognitive function [185,192,194,229], with the majority of studies not revealing any significant effect [188,189,200,203]. Cognitive function has rarely been among the outcome measures investigated in clinical trials, even though self-assessed improvements in this domain make an important contribution to the Patient Global Impression of Change ratings [230].…”

“…Unfortunately, this concept has been rather broadly or incompletely defined in many studies. When attention is broken down into processes of alerting, orienting, and executive functioning, FMS patients show deficits in alerting and temporal orienting, but not visual orienting, and in various aspects of executive control [125,186,187,[189][190][191][192]. Cognitive inhibition, i.e., the ability to keep focused despite distractions, can be conceptualized as a component of executive function and is quite consistently found to be impaired in FMS patients.…”