Cognitive Impairments in Fibromyalgia Syndrome: Associations With Positive and Negative Affect, Alexithymia, Pain Catastrophizing and Self-Esteem

Abstract

Fibromyalgia syndrome (FMS) is a chronic condition characterized by widespread pain accompanied by symptoms like depression, anxiety, sleep disturbance and fatigue. In addition, affected patients frequently report cognitive disruption such as forgetfulness, concentration difficulties or mental slowness. Though cognitive deficits in FMS have been confirmed in various studies, not much is known about the mechanisms involved in their origin. This study aimed to investigate the contribution of affect-related variables to cognitive impairments in FMS. For this purpose, 67 female FMS patients and 32 healthy control subjects completed a battery of cognitive tests measuring processing speed, attention, visuospatial and verbal memory, cognitive flexibility and planning abilities. In addition, participants completed self-report questionnaires pertaining to positive and negative affect, alexithymia, pain catastrophizing and self-esteem. Clinical characteristics including pain severity, symptoms of depression and anxiety, insomnia and fatigue were also assessed. FMS patients showed markedly poorer performance than healthy controls in all of the cognitive domains assessed, in addition to greater levels of depression, anxiety, negative affect, alexithymia and pain catastrophizing, and lower self-esteem and positive affect. In exploratory correlation analysis in the FMS sample, lower cognitive performance was associated with higher pain severity, depression, anxiety, negative affect, alexithymia and pain catastrophizing, as well as lower self-esteem and positive affect. However, in regression analyses, pain, self-esteem, alexithymia, and pain catastrophizing explained the largest portion of the variance in performance. While interference effects of clinical pain in cognition have been previously described, the present findings suggest that affective factors also substantially contribute to the genesis of cognitive impairments. They support the notion that affective disturbances form a crucial aspect of FMS pathology, whereas strategies aiming to improve emotional regulation may be a beneficial element of psychological therapy in the management of FMS.

Subjective sleep quality as a mediator in the relationship between pain severity and sustained attention performance in patients with fibromyalgia

“…In this study, pain severity was positively associated with the number of PVT lapses. Our findings corroborated previous findings that patients with fibromyalgia who experience intense pain also have considerably poorer learning and memory performance (Wu et al., ), attention function and psychomotor processing speed (Galvez‐Sánchez, Reyes Del Paso, & Duschek, ; Park, Glass, Minear, & Crofford, ; Veldhuijzen et al., ) in cognitive domains compared with healthy individuals. However, we noted that pain severity was not associated with RT—a finding consistent with that of Coppieters et al.…”

The 4 U’s Rule of Fibromyalgia: A Proposed Model for Fatigue in a Sample of Women with Fibromyalgia: A Qualitative Study

“…Third, in relation to the cognitive–emotional behavior of fatigue, we found that difficulty thinking, difficulty concentrating, and negative emotions were the most referenced. According to previous research, many people dealing with fibromyalgia have problems maintaining their attention on the task at hand; therefore, they have problems memorizing as well as remembering [ 46 ]. Another reported problem is in relation to keeping track of a story’s plot while reading or watching television [ 8 ].…”

Effects of Mindfulness Training on Sleep Problems in Patients With Fibromyalgia

“…Similar maintenance effects have also been observed in other studies of mindfulness involving patients with FMS ( Grossman et al, 2007 ; Amutio et al, 2015a ; Cash et al, 2015 ; Van Gordon et al, 2017 ), as well as in studies following a similar approach to the model of mindfulness training adopted by the Meditación-Fluir intervention used in the present study ( Amutio et al, 2015a ; Franco et al, 2017 ). Some plausible explanations as to why the effects of mindfulness training programs are frequently maintained at follow-up assessments is that mindfulness is a technique that enhances positive affect and that it is relatively easy to integrate into daily life ( Davis and Zautra, 2013 ; Amutio et al, 2015b ; Galvez-Sánchez et al, 2018 ). This is an important consideration for patients with FMS that due to pain-related concentration deficits can experience difficulties in adapting to new psychological strategies ( Schmidt et al, 2011 ; Van Gordon et al, 2016 ).…”

“…Furthermore, both poor quality sleep and pain can elicit catastrophizing thought and behavior patterns which in turn lead to the impairment of pain coping cognitive strategies ( Prados and Miró, 2012 ; Di Tella et al, 2018 ). Thus, sleep problems play an important role in the exacerbation of FMS symptoms and increase the likelihood of both depression and impaired physical and psychological functioning in this patient group ( Bigatti et al, 2008 ; González et al, 2010 ; Finan et al, 2013 ; Galvez-Sánchez et al, 2018 ).…”