The Affective Dimension of Pain Appears to Be Determinant within a Pain–Insomnia–Anxiety Pathological Loop in Fibromyalgia: A Case-Control Study

Abstract

Background: Fibromyalgia (FM) is a chronic pain disease characterized by multiple symptoms whose interactions and implications in the disease pathology are still unclear. This study aimed at investigating how pain, sleep, and mood disorders influence each other in FM, while discriminating between the sensory and affective pain dimensions. Methods: Sixteen female FM patients were evaluated regarding their pain, while they underwent—along with 11 healthy sex- and age-adjusted controls—assessment of mood and sleep disorders. Analysis of variance and correlations were performed in order to assess group differences and investigate the interactions between pain, mood, and sleep descriptors. Results: FM patients reported the typical widespread pain, with similar sensory and affective inputs. Contrary to controls, they displayed moderate anxiety, depression, and insomnia. Affective pain (but neither the sensory pain nor pain intensity) was the only pain indicator that tendentially correlated with anxiety and insomnia, which were mutually associated. An affective pain–insomnia–anxiety loop was thus completed. High ongoing pain strengthened this vicious circle, to which it included depression and sensory pain. Conclusions: Discriminating between the sensory and affective pain components in FM patients disclosed a pathological loop, with a key role of affective pain; high ongoing pain acted as an amplifier of symptoms interaction. This unraveled the interplay between three of most cardinal FM symptoms; these results contribute to better understand FM determinants and pathology and could help in orienting therapeutic strategies.

Integrating mechanistic-based and classification-based concepts into perioperative pain management: an educational guide for acute pain physicians

“…In the perioperative period, nociplastic pain may present as surgical pain that is disproportionate to the procedure performed, pain outside of the surgical field and severe pain accompanied by myriad-related non-pain measures such as anxiety, sleep dysfunction and mood disorder, and poor response (including side effects) to analgesic interventions. Nociplastic pain is associated with endogenous opioid system dysregulation (eg, less mu opioid receptor availability, lower antinociceptive activity) and a more prominent affective component, which may make symptoms less responsive to opioids 27 28. Although the studies are mixed, it appears that patients with nociplastic pain are also more likely to experience PPSP after a variety of surgeries 24 29 30.…”

Depressive Symptoms in Patients with Fibromyalgia: Current Evidence and Preventive Approaches

“…Despite the prevalence of fibromyalgia ranging from 2% to 4% in epidemiological studies, accurate diagnosis remains challenging, potentially leading to the underestimation of its actual prevalence [ 2 ]. Fibromyalgia is often accompanied by comorbidities in various systems, including autoimmune diseases [ 3 , 4 ], psychiatric disorders [ 5 , 6 ], and central nervous system dysfunctions [ 7 , 8 ]. The issue of psychiatric comorbidity status in fibromyalgia has long been discussed since the onset of a psychiatric disorder could massively influence the patient quality of life, in turn worsening the prognosis of fibromyalgia [ 9 ].…”