Autonomic symptom profile and fibromyalgia

Autonomic dysregulation is thought to play a role in the pathophysiology and symptoms of fibromyalgia (FM). The Autonomic Symptom Profile (ASP) is a validated self-report measure that comprehensively assesses autonomic symptoms in various domains namely - orthostatic intolerance, syncope, sexual dysfunction, bladder dysfunction, diarrhea, constipation, gastroparesis, secretomotor dysfunction, sleep dysfunction, vasomotor, and pupillomotor. The purpose of this study was to assess self-reported autonomic symptoms in patients with FM utilizing the ASP. Eight hundred fifty-eight of 1303 (66% response rate) randomly selected patients with FM who presented to a tertiary medical center between 1/1/2001 and 11/30/2011 completed the ASP and the Fibromyalgia Impact Questionnaire (FIQ-R). Association between ASP and FIQ-R were assessed using Pearson correlation and multivariate regression analysis. Though there were statistically significant (p < .0001) correlations between the FIQR-symptom subscale and 10 of the 11 autonomic symptom domains, only 9 of those remained significant in the multiple regression model (sleep β = 1.33, p < 0.0001; pupillomotor β = .83, p < .0001; bladder β = .83, p < .0001; constipation β = .83, p < .0001; diarrhea β = .83, p < .0001; gastroparesis β = .83, p < .0001; secretomotor β = .83, p < .0001; vasomotor β = .83, p < .0001; syncope β = .33, p < .0001). Our results indicate patients with FM report symptoms attributable to multiple autonomic domains. This is consistent with clinical observations and published literature where patients with FM report symptoms of heat intolerance, changes in sweating, dry eyes and mouth, difficulty focusing, photophobia, light sensitivity and visual blurring, bladder and bowel symptoms and sleep difficulties. Work is underway to corroborate self-report symptoms with objective physiologic autonomic measures. (Low, Diabetes Care, 2004; Suarez, Neurology, 1999.)