Fibromyalgia as a Heterogeneous Condition: Subgroups of Patients Based on Physical Symptoms and Cognitive-Affective Variables Related to Pain

Abstract

Fibromyalgia (FM) is a chronic syndrome characterized by heterogeneous clinical manifestations, and knowing this variability can help to develop tailored treatments. To understand better the heterogeneity of FM the present cross-sectional study analyzed the role of several physical symptoms (pain, fatigue and poor sleep quality) and cognitive-affective variables related to pain (pain catastrophizing, pain vigilance, self-efficacy in pain management, and pain acceptance) in the configuration of clinical profiles. A sample of 161 women with FM fulfilled an interview and several self-report measures to explore physical symptoms, cognitive-affective variables, disability and psychopathology. To establish FM groups a hierarchical cluster analysis was performed. The findings revealed three clusters that differed in the grouping variables, Wilks’ λ = .17, F(14, 304) = 31.50, p < .001, ηp2 = .59. Group 1 (n = 72) was characterized by high physical and psychological affectation, Group 2 (n = 19) by low physical affectation and high pain self-efficacy, and Group 3 (n = 70) by moderate physical affectation and low pain catastrophizing. The external validation of the clusters was confirmed, Wilks’ λ = .72, F(4, 314) = 14.09, p < .001, ηp2 = .15, showing Group 1 the highest levels of FM impact and psychopathological distress. Considering the distinctive clinical characteristics of each subgroup therapeutic strategies addressed to the specific needs of each group were suggested. Assessing FM profiles may be key for a better understanding and approach of this syndrome.

Exploring the clinical usefulness of an electronic diary in fibromyalgia patients: A pilot study

“…Several clinical aspects (pain, fatigue, restful sleep, emotional distress, difficulty in daily functioning, and coping with the disease), representative of physical/ psychological experience of FM (see Martínez et al, 2021) and consonant with the questionnaire items, were selected from the ED. The reliability of this set of variables was acceptable (α = .72) in all periods of the day.…”

“…FM patients complain of poor sleep quality, a greater number of awakenings and the presence of a fragmented sleep, with a greater proportion of phases N1 and N2 of NREM sleep and reduction of slow wave sleep (Díaz-Piedra et al, 2015). Nonrestorative sleep is related to higher levels of pain, emotional distress and lower self-efficacy and daily functioning (Andrade et al, 2020;Choy, 2015;Miró et al, 2011a), being a key aspect in the establishment of subgroups of FM patients (Martínez et al, 2021). Also, it has been shown that cognitive-behavioral therapy for insomnia (CBT-I) improves several of these aspects such as cognitive function (Miró et al, 2011b), daily functioning and psychological well-being , and that the combined CBT for insomnia and pain (CBT-IP) produces positive changes in pain-related variables (Lami et al, 2018a).…”

Distress and Sensitization as Main Mediators of Severity in Women with Fibromyalgia: A Structural Equation Model

“…This plethora of manifestations suggests complex interactions explaining the heterogeneity in the clinical presentation observed in people with FMS. In fact, there is evidence suggesting the presence of different subgroups of women with FMS combining higher or lower sensitivity, and more or less stress [7][8][9][10]. These studies used pain-and disabilityrelated, cognitive, or psychological aspects to identify subgroups of patients with FMS using cluster analysis.…”

“…These studies used pain-and disabilityrelated, cognitive, or psychological aspects to identify subgroups of patients with FMS using cluster analysis. Additionally, considering that one of the most common features of FMS is hypersensitivity to pressure pain (expressed as a decreased pressure pain threshold), these previous studies did not include this psychophysiological outcome when evaluating altered nociceptive pain processing in their analyses [7][8][9][10]. The application of cluster analysis is able to identify subgroups of individuals based on common variables; however, it does not identify complex interactions or mediating effects between the variables.…”

Digital pain extent is associated with pain intensity but not with pain-related cognitions and disability in people with chronic musculoskeletal pain: a cross-sectional study

“…Nevertheless, the role that psychological protective factors (i.e., general self-efficacy) play in how people with chronic pain perceive the extension of that pain undergone limited evaluation [ 20 , 21 ]. Resilience, a psychological protective factor, has been associated with widespread pain sensitivity in participants with shoulder pain [ 8 ].Expectations of recovery, optimism, pain acceptance, and pain self-efficacy are involved in widespread pain conditions such as fibromyalgia [ 22 – 25 ]. To our knowledge, no observational studies have analysed the potential association between these psychological protective factors and digital pain extent in chronic musculoskeletal pain.…”