Highlights
- •Unique psychophysiological response patterns were observed in fibromyalgia.
- •Group 1 shows a hypertone stress response with high pain, anxiety, and pain behaviors.
- •Group 2 shows a hypotone stress response with high level of activity and stress.
- •Psychophysiological patterns are linked to psychological coping and mental disorders.
- •The results suggest mediating mechanisms and differential treatment strategies.
Abstract
This study examined the relationship of psychophysiological response patterns in fibromyalgia
with psychological characteristics and comorbid mental disorders. Surface electromyographic
data, systolic and diastolic blood pressure, heart rate (HR), and skin conductance
levels were recorded continuously during baseline, stress, and relaxation tasks. Cluster
analysis revealed 4 subgroups of patients who differed on pain characteristics and
cognitive, affective, and behavioral responses to pain and stress. The largest group
(46.7%) was characterized by elevated blood pressure levels and stress reactivity
(a disposition assumed to be a vulnerability factor for the development of diseases)
associated with pain, anxiety, physical interference, low activity, and pain behaviors.
A second group (41.6%) showed low baseline blood pressure and reactivity, and high
activity and stress. A third group (9.2%) displayed high baseline skin conductance
level, reactivity, and depression, and a fourth small group (2.5%) displayed elevated
baseline electromyographic response and reactivity with high levels of anxiety and
depression. These data suggest that unique psychophysiological response patterns are
associated with psychological coping and mental disorders in fibromyalgia patients.
The identification of the mechanisms that contribute to these group differences will
further our understanding of the mechanisms involved in the development and maintenance
of fibromyalgia and suggest differential treatment strategies.
Perspective
This article presents psychological characteristics and comorbidity with mental disorders
of psychophysiological subgroups of fibromyalgia patients. This mechanistic analysis
will assist scientific identification of systems-based pathways that contribute to
autonomic and stress mechanisms that mediate chronic pain. Demonstration of distinct,
homogeneous subgroups is an important step towards personalized, mechanism-oriented
treatments.
Key words
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References
- Psychophysiologic and affective parameters associated with pain intensity of cardiac cardioverter defibrillator shock discharges.Psychosom Med. 2006; 68: 591-597
- The State-Trait Anxiety Inventory, Trait version: Structure and content re-examined.Behav Res Ther. 1998; 36: 777-788
- Provocation of hypotension and pain during upright tilt table testing in adults with fibromyalgia.Clin Exp Rheumatol. 1997; 15: 239-246
- Group differences in pain modulation: Pain-free women compared to pain-free men and to women with TMD.Pain. 2002; 96: 227-237
- Stability of patient adaptation classifications on the Multidimensional Pain Inventory.Pain. 2004; 109: 94-102
- Altered cardiovascular/pain regulatory relationships in chronic pain.Int J Behav Med. 1998; 5: 63-75
- The relationship between resting blood pressure and acute pain sensitivity in healthy normotensives and chronic back pain sufferers: The effects of opioid blockade.Pain. 2002; 100: 191-201
- The Fibromyalgia Impact Questionnaire: Development and validation.J Rheumatol. 1991; 18: 728-733
- A randomized controlled clinical trial of education and physical training for women with fibromyalgia.J Rheumatol. 1994; 20: 714-720
- Blood pressure reactivity and marital distress in employed women.Psychosom Med. 1998; 60: 639-643
- Basal circadian and pulsatile ACTH and cortisol secretion in patients with fibromyalgia and/or chronic fatigue syndrome.Brain Behav Immun. 2004; 18: 314-325
- Cognitive-behavioral profiles among different categories of orofacial pain patients: Diagnostic and treatment implications.Eur J Oral Sci. 1997; 105: 377-383
- Three major haplotypes of the beta2 adrenergic receptor define psychological profile, blood pressure, and risk for development of a common musculoskeletal pain disorder.Am J Med Genet B Neuropsychiatr Genet. 2006; 141: 449-462
- Attenuation of baroreflexes during operant cardiac conditioning.Psychophysiology. 2007; 19: 609-614
- Psychiatric disorders in patients with fibromyalgia.Psychosomatics. 1999; 40: 57-63
- Resting blood pressure and thermal pain responses among females: Effects on pain unpleasantness but not pain intensity.Int J Psychophysiol. 1998; 30: 313-318
- First M.B. Spitzer R.L. Gibbon M. Williams J.B.W. User's Guide for the Structured Clinical Interview for DSM-IV Personality Disorders (SCID II). American Psychiatric Press, Inc, Washington, DC1996
- Flor H. Psychobiologie des Schmerzes [Psychobiology of Pain]. Verlag Hans Huber Bern, Göttingen, Toronto1991
- Assessment of pain-related cognitions in chronic pain patients.Behav Res Ther. 1993; 31: 63-73
- Flor H. Birbaumer N. Psychobiologie und interdisziplinäre Therapie chronischer Wirbelsäulensyndrome [Psychobiology and Interdisciplinary Treatment of Chronic Back Pain]. GSF Forschungszentrum, Munich1994
- Conditioned stress-induced analgesia in humans.Eur J Pain. 1999; 3: 317-324
- Zur Anwendbarkeit des West Haven-Yale Multidimensional Pain Inventory im deutschen Sprachraum: Daten zur Reliabilität und Validität des MPI-D.Der Schmerz. 1990; 4: 82-87
- Guidelines for human electromyographic research.Psychophysiology. 1986; 23: 567-589
- Abnormalities of cardiovascular neural control and reduced orthostatic tolerance in patients with primary fibromyalgia.J Rheumatol. 2005; 32: 1787-1793
- Hypoalgesia to pressure pain in referred pain areas triggered by spatial summation of experimental muscle pain from unilateral or bilateral trapezius muscles.Eur J Pain. 2003; 7: 531-537
- Arterial hypertension is associated with hypoalgesia in humans.Hypertension. 1988; 12: 491-497
- Fragebogen zur Partnerschaftsdiagnostik. [Questionnaire for the assessment of spousal relationships].Hogrefe, Göttingen1996
- Decreased central mu-opioid receptor availability in fibromyalgia.J Neurosci. 2007; 27: 10000-10006
- Allgemeine Depressionsskala. [The German version of the Center for Epidemiologic Studies Depression Scale.].Hogrefe, Göttingen1993
- Committee report. Publication guidelines for heart rate studies in man.Psychophysiology. 1981; 18: 226-231
- The West Haven-Yale Multidimensional Pain Inventory (WHYMPI).Pain. 1985; 23: 345-356
- Exercise capacity and 24-h blood pressure in prehypertensive men and women.Am J Hypertens. 2006; 19: 251-258
- The role of anxiety and depression in fatigue and patterns of pain among subgroups of fibromyalgia patients.Br J Med Psychol. 1998; 71: 185-194
- The State-Trait Anxiety Inventory (STAI) [Das State-Trait- Angstinventar].Bern Hogrefe, Göttingen1981
- The relationship between spouse solicitousness and pain behavior: Searching for more experimental evidence.Pain. 1992; 51: 75-79
- Relationship between pain sensitivity and resting arterial blood pressure in patients with painful temporomandibular disorders.Psychosom Med. 1997; 59: 503-511
- Regulation of acute and chronic orofacial pain.in: Fricton J.R. Dubner R. Orofacial Pain and Temporomandibular Disorders. Raven Press, New York, NY1995
- The association of arithmetic calculation and noise as a mental stressor in the functional evaluation of recent myocardial infarction.G Ital Cardiol. 1989; 19: 1028-1031
- Descending control of pain.Prog Neurobiol. 2002; 66: 355-474
- Sex, gender, and blood pressure: Contributions to experimental pain report.Psychosom Med. 2001; 21: 853-860
- Validation of a German version of the Fibromyalgia Impact Questionnaire (FIQ-G).J Rheumatol. 2000; 27: 1984-1988
- A standardized manual tender point survey: I. Development and determination of a threshold point for the identification of positive tender points in fibromyalgia syndrome.J Rheumatol. 1997; 24: 77-83
- Electrodermal and microcirculatory activity in patients with fibromyalgia during baseline, acoustic stimulation and cold pressor tests.J Rheumatol. 1991; 18: 1383-1389
- Psychophysiology of arterial baroreceptors and the etiology of hypertension.Biol Psychol. 2001; 57: 179-201
- Effect of a corticotropin releasing hormone receptor antagonist on colonic sensory and motor function in patients with irritable bowel syndrome.Gut. 2004; 53: 958-964
- Beta-blocker plasma concentrations and inflammatory disease: Clinical implications.Clin Pharmacokinet. 1982; 7: 281-284
- Genetic variants associated with development of TMD and its intermediate phenotypes: The genetic architecture of TMD in the OPPERA prospective cohort study.J Pain. 2013; 14: T91-T101
- STAI Manual.Consulting Psychologists Press, Palo Alto, CA1995
- Operant behavioral treatment of Fibromyalgia: A controlled study.Arthritis Rheum. 2003; 15: 314-320
- Psychophysiological responses in patients with fibromyalgia syndrome.J Psychosom Res. 2006; 61: 671-679
- Predictors of pain behaviors in fibromyalgia patients.Arthritis & Rheum/Arthritis Care Res. 2005; 53: 343-350
- Heterogeneity of psychophysiological stress responses in fibromyalgia patients.Arthritis Res Ther. 2006; 8: R9
- Comorbid depression and anxiety in fibromyalgia syndrome: Relationship to somatic and psychosocial variables.Psychosom Med. 2004; 66: 837-844
- Responder criteria for operant and cognitive-behavioral treatment of fibromyalgia syndrome.Arthritis Care Res. 2007; 57: 830-836
- Heterogenity in chronic pain—The importance of patient subgroups. Symposia presented at the 32nd Annual Scientific Meeting of the American Pain Society.2011 (Austin, TX)
- Customizing treatment for chronic pain patients: Who, what, and why.Clin J Pain. 1999; 6: 255-270
- Differential responses by psychosocial subgroups of fibromyalgia syndrome patients to an interdisciplinary treatment.Arthritis Care Res. 1998; 11: 397-404
- Pain, disability, and physical functioning of patients with fibromyalgia.J Rheumatol. 1996; 23: 1255-1262
- Assessing depressive symptoms in five psychiatric populations: A validation study.Am J Epidemiol. 1997; 106: 203-214
- Strukturiertes Klinisches Interview für DSM-IV. Manual zum SKID-I und SKID-II. [Structured clinical interview for DSM-IV. Manual for SCID-I and SCID-II].Hogrefe, Göttingen1997
- Fibromyalgia criteria and severity scales for clinical and epidemiological studies: A modification of the ACR Preliminary Diagnostic Criteria for Fibromyalgia.J Rheumatol. 2011; 38: 1113-1122
- The American College of Rheumatology 1990. Criteria for the classification of fibromyalgia. Report of the Multicenter Criteria Committee.Arthritis Rheum. 1990; 33: 160-172
Article info
Publication history
Published online: November 26, 2014
Accepted:
November 14,
2014
Received in revised form:
November 10,
2014
Received:
August 21,
2014
Footnotes
Supported by grants of the Deutsche Forschungsgemeinschaft to K.T. (Th 899-1/1 and 899-7/1) and a grant of the Federal Ministry for Education and Science, (01GW0531) and the Max-Planck Award for International Cooperation to H.F., as well as a grant from the National Institutes of Health/National Institute of Arthritis and Musculoskeletal and Skin Diseases (AR44724) to D.C.T. and P01NS045685 to W.M. and R.G.
None of the authors have any conflicts of interest to declare.
Identification
Copyright
© 2015 American Pain Society. Published by Elsevier Inc. All rights reserved.
