There has been debate about the involvement of physical and psychological factors in FM. People with FM often resist acknowledging psychological factors due to concerns that their symptoms might be discounted. This study investigated the causal attributions of 2583 people with FM regarding the onset and exacerbations of their symptoms. Data was obtained in an anonymous internet survey, and had no influence on their treatment. Responders selected factors contributing to the onset of their FM from a list, and indicated the extent to which a set of factors aggravated their symptoms. Onset factors were grouped into Emotional and Physical, and exacerbating factors into Emotional, Physical, and Environmental (e.g., weather changes). Many participants endorsed multiple onset (Mean = 2.4±2.01) and aggravating (Mean = 11.91±4.51) factors, and often endorsed both emotional and physical variables. 60% of participants cited emotional factors as contributing to onset of FM, and 94.2% cited emotional factors as exacerbating their symptoms. 857 participants indicated that only 1 type of trigger (Emotional or Physical) was involved in symptom onset; 42.01% of them endorsed Emotional and 57.99% Physical factors. These 2 groups did not differ in demographic variables. However, participants who identified emotional precipitants reported more emotional exacerbating factors (F1, 801 = 46.57, p < .001) and had higher psychological symptom scores (F1, 784 = 23.43, p < .001). These data indicate that when there are no consequences associated with responses, people with FM identify psychological factors as triggers and aggravators of their symptoms. Those who make such attributions report higher levels of affective distress, but are otherwise indistinguishable from others with FM. Treatment of FM patients should include interventions that address stressors in patients’ lives and their capacity to cope with stress. Survey was supported by an unrestricted grant to the National Fibromyalgia Association by Pfizer.
© 2008 American Pain Society. Published by Elsevier Inc. All rights reserved.