Highlights
- •Fibromyalgia patients experience daily variability in pain, fatigue, and mood.
- •Differences in pain and social functioning emerged across variability clusters.
- •Targeting symptom variability may be an important clinical initiative.
Abstract
The current study examined between- and within-subject variability in pain-related
symptoms as predictors of pain and fatigue, and identified patient subgroups on the
basis of symptom variability characteristics. Two hundred fifty-six fibromyalgia (FM)
patients completed daily diaries up to a period of 154 days and reported on symptoms
of pain intensity, pain unpleasantness, fatigue, anxiety, and depressed mood. Measures
of health status, quality of life, and somatic symptoms were obtained at baseline,
and hierarchical linear modeling and cluster analyses were used. Significant intra-
and interindividual variability in daily FM symptoms was observed. Higher levels of
pain were associated with greater fluctuations in pain unpleasantness, fatigue, and
depressed mood. Similar effects were observed for fatigue and individual variability
in anxiety also emerged as a robust predictor. Three FM subgroups were revealed: low
variability in symptoms (cluster 1), high symptom variability (cluster 2), and a mixed
variability group characterized by low fluctuation in pain unpleasantness; moderate
pain, fatigue, and depressed mood variability; and high anxiety variability (cluster
3). Cluster 3 exhibited lower social functioning and higher levels of pain, compared
with cluster 1. These findings support the dynamic nature of FM pain and suggest the
presence of FM subgroups on the basis of variation in mood and pain symptomatology.
Perspective
FM patients show significant intra- and interindividual variability in pain, mood,
and fatigue. Subgroups in mood and pain-related variability emerged, with phenotypic
clusters differing across levels of pain intensity and social functioning. Better
understanding of the processes affecting pain variability may facilitate targeted
treatments for the control of pain.
Key words
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Article info
Publication history
Published online: December 15, 2017
Accepted:
November 16,
2017
Received in revised form:
November 7,
2017
Received:
October 18,
2017
Footnotes
This work was funded by the National Institute of Nursing Research (R01NR01404901) awarded to Dr. Roland Staud. Preparation of the article was supported by the National Institutes of Health/National Institute on Aging (K99AG052642) awarded to Dr. Emily Bartley.
The authors have no conflicts of interest to declare.
Identification
Copyright
© 2017 by the American Pain Society
