A preliminary investigation of dissociation between subjective cognitive complaints and objective cognitive impairments in female patients with fibromyalgia: a role of information processing speed
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The concern of the paper is, by using the example of schizophrenia, to show in a survey that it is possible and necessary to base the examination of cognitive disturbances and their exaplanation on the methodological concept of information processing. Departing from the stage reached in cognition-psychological schizophrenia research, a survey is given of such studies of cognitive disturbances in schizophrenia that are based on general psychological concepts of cognitive information processing. The approach to an identification of the defect within the frame of a model of the cognitive information processing is explained by two examples (performance of recognition, reproduction deficit).
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We proposed that (a) processing interest for affective over cognitive information is captured by meta-bases (i.e., the extent to which people subjectively perceive themselves to rely on affect or cognition in their attitudes) and (b) processing efficiency for affective over cognitive information is captured by structural bases (i.e., the extent to which attitudes are more evaluatively congruent with affect or cognition). Because processing speed can disentangle interest from efficiency by being manifest as longer or shorter reading times, we hypothesized and found that more affective meta-bases predicted longer affective than cognitive reading time when processing efficiency was held constant (Study 1). In contrast, more affective structural bases predicted shorter affective than cognitive reading time when participants were constrained in their ability to allocate resources deliberatively (Study 2). When deliberation was neither encouraged nor constrained, effects for meta-bases and structural bases emerged (Study 3). Implications for affective–cognitive processing and other attitudes-relevant constructs are discussed.
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Abstract Until recently, nobody knew how many people had fibromyalgia. Several surveys suggest that while 2 percent of the adult U.S. population have full-blown fibromyalgia (3.5 percent of adult women and 0.5 percent of adult men), 11 percent have chronic widespread pain and 20 percent have chronic regional pain. Recently, Dr. Larry Bradley at the University of Alabama has found that for every diagnosed fibromyalgia patient in the United States, there is an undiagnosed individual who has the requisite tender points, but never seeks medical attention for this. This has been termed community fibromyalgia. A survey in Great Britain found that 13 percent of the population had chronic widespread pain, 72 percent of whom sought medical attention for it. Of those, 21 percent fulfilled the ACR criteria for fibromyalgia. In other words, of individuals with chronic neuromuscular pain, less than half have diagnosed fibromyalgia or community fibromyalgia. Fibromyalgia is the third or fourth most common reason for consulting a rheumatologist. Approximately 15–20 percent of all patients seeking rheumatology referrals have fibromyalgia. The 5,000 rheumatologists in the United States who are trained in internal medicine and subspecialize in managing more than 150 musculoskeletal and immune system disorders are very familiar with the diagnosis and treatment of fibromyalgia.
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Abstract Objective. To determine the frequency of a precipitating event occurring prior to the onset of fibromyalgia syndrome, in a consecutive series of patients. Outcome in patients in whom there was a causative factor was compared with that in patients with primary fibromyalgia. Methods. Records of patients presenting over a 4‐year period who fulfilled criteria for fibromyalgia were reviewed, and patients were classified as having reactive fibromyalgia if a specific event prior to the onset of illness could be identified. Outcome features, including employment status and disability compensation, were compared in patients with reactive fibromyalgia versus those with primary fibromyalgia. Results. Twenty‐nine of 127 patients (23%) with a primary rheumatologic diagnosis of fibromyalgia reported having trauma, surgery, or a medical illness before the onset of fibromyalgia, and were classified as having reactive fibromyalgia. Patients in this group were more disabled than those with primary fibromyalgia, resulting in loss of employment in 70%, disability compensation in 34%, and reduced physical activity in 45% Conclusion. The development of fibromyalgia after a precipitating event may represent the onset of a prolonged and disabling pain syndrome with considerable social and economic implications.
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Position paper
Fibromyalgia syndrome
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This journal recently published a paper by Sleurs et al., entitled ‘Comorbidities of self-reported fibromyalgia in United States adults: A cross-sectional study from The National Epidemiological Survey on Alcohol and Related Conditions (NESARC-III). (Sleurs, Tebaka, Scognamiglio, Dubertret, & lLe strat, 2020)’. While its primary message is that persons reporting a physician diagnosis of fibromyalgia have very high rates of physical and mental comorbidities, this study provides other important information on the nature and validity of fibromyalgia and fibromyalgia diagnosis, as it is likely the most of the reported fibromyalgia patients in the study would not satisfy criteria for fibromyalgia. In the clinic, diagnosis of fibromyalgia is in ‘the eye of the beholder’. Close to 20 years ago George Ehrlich observed that ‘no one has FM until it is diagnosed’—that diagnosis is arbitrary. A striking result of the Sleurs et al. epidemiological study is the observation that 87.5% of those with reported fibromyalgia are women, confirming results from other population derived estimates of physician diagnosed fibromyalgia. In contrast, population-based studies applying current published criteria have found that around 60% or fewer fibromyalgia patients are women (Häuser, Brähler, Ablin, & Wolfe, 2020). In addition, we know from multiple studies that most clinically diagnosed patients do not satisfy criteria for fibromyalgia, and in a recent population study only 14.6% of persons who satisfied published criteria for fibromyalgia had received a clinical diagnosis of fibromyalgia (Häuser et al., 2020). Presumably, had such persons been interviewed in the Sleurs et al. study they would not have been included as fibromyalgia patients. Data such as these underscore problems of fibromyalgia definition and diagnosis. Fibromyalgia can be an arbitrary diagnosis. It appears to be diagnosed disproportionally in women and almost never thought of in men and, if multiple studies are correct, most community diagnosed fibromyalgia patients may not even satisfy fibromyalgia criteria. In studies where published criteria are applied, many patients diagnosed with one set of criteria will not be the same as those diagnosed with another set (Häuser et al., 2020)? Readers might reasonably ask, ‘What is fibromyalgia’? Do other characteristics, such as sex, mental symptoms and social factors influence the diagnosis and definition of fibromyalgia? This study throws light on another important issue. What are we to make of the extremely high rates of mental illness and physical comorbidity in those with fibromyalgia in this study? One hundred percent of reported fibromyalgia cases had at least one physical disorder, 68% had four or more disorders, 67% reported ‘arthritis’ and 80% were found to have a mental disorder. Some might try to separate these patients into primary of secondary fibromyalgia groupings, though it would seem clear that trying to guess the specific causal path would be hazardous. According to the authors, ‘The strengths of the relationships between mental disorders and self-reported fibromyalgia in our study support the hypothesis of central sensitization in fibromyalgia’. However, readers should be aware that current knowledge does not allow for the fibromyalgia sensitization hypothesis to be falsified, and mental and physical illness could be the cause or result (or some mixture) of fibromyalgia—a disorder that has no gold standard and whose definition has changed repeated over the last 60 years. We recently reported a similar study of self-reported physical and mental comorbidities in 12,215 patients in a research databank (Wolfe, Ablin, Guymer, Littlejohn, & Rasker, 2020), and obtained results similar to those of this study. Using a criteria-based definition of fibromyalgia as well as the quantitative measure of fibromyalgia severity, the polysymptomatic distress (PSD) scale, we found that criteria-based fibromyalgia as well as PSD were associated with an increase in the number of comorbidities. In addition, we found the association of PSD was present above and below the fibromyalgia diagnostic cut point. That is the degree of fibromyalgia-like symptom severity is more important than the presence or absence of fibromyalgia. Readers should also know that patients with fibromyalgia in this study are likely to satisfy diagnoses that fall under the rubric of bodily distress and other functional somatic syndromes. The main difference between these syndromes and fibromyalgia is the organizational beliefs and medical specialties of those making diagnoses and performing research. Considering fibromyalgia symptoms quantitatively with the PSD avoids the problems inherent with diagnostic and selection bias. In addition, it sidesteps the issue of central sensitivity attributions associated with diagnosis since if applies to the entire spectrum of patient symptom severity. No one argues about fibromyalgia symptoms. Instead the controversy regarding fibromyalgia is how to classify and understand the symptoms and their social meaning. It is unfortunate that the authors of this very important current study were unable to administer the PSD, as it would have further defined the nature of comorbidity in symptomatic patients. We advise that this simple scale—which also provides a fibromyalgia diagnosis for those who require it—be used in future similar studies. None declared. None declared.
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Fibromyalgia has previously been categorized as primary, secondary, and juvenile fibromyalgia. However, these definitions do not adequately explain the etiopathology of disease, nor do they help direct new specific therapies. Herein, we review the previously known categorizations of fibromyalgia. Based on common patient characteristics and previously studied pathophysiologies, we propose new subcategorizations of fibromyalgia that we have self-narrated, including hormonal fibromyalgia, neuroendocrine fibromyalgia, psychologic fibromyalgia, inflammatory fibromyalgia, and lastly, neuropathic fibromyalgia. Future research needs to be done to verify, add to, and fully describe these self-narrated categories of fibromyalgia that we have proposed.
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Objectives: Although there are studies in the literature about how Behçet's disease is affected in the presence of fibromyalgia, there is no information about how the severity of fibromyalgia is in the presence of Behçet's disease. This study aims to evaluate the severity of fibromyalgia by comparing the impact of fibromyalgia and pain thresholds between fibromyalgia patients with and without Behçet's disease. Methods: Twenty-five fibromyalgia patients with Behçet's disease and 34 primary fibromyalgia patients were included in this cross-sectional study. All participants completed the fibromyalgia impact questionnaire, and pain thresholds were measured at 18 tender points using algometry. Results: The mean fibromyalgia impact questionnaire scores in fibromyalgia patients with and without Behçet's disease were 66.6 ± 18.4 and 60.4 ± 14.5, respectively (p = 0.157). Pain thresholds were not different between the groups in 15 of the 18 tender points (TP). In fibromyalgia patients with Behçet's disease, pain thresholds in TP-15, TP-16 and TP-17 were 11.44 ± 4.84, 11.92 ± 5.00 and 15.16 ± 4.89 pounds, respectively, while in primary fibromyalgia patients those were 8.41 ± 2.68, 8.14 ± 2.76 and 12.14 ± 4.06 pounds respectively. Pain thresholds in TP-15, TP-16 and TP-17 were significantly different between the groups (p = 0.003, p = 0.003, p = 0.014, respectively). Conclusions: According to the literature data, although fibromyalgia has an effect on Behçet's disease, especially in cases associated with central sensitization syndromes, the severity of fibromyalgia was not found to be different in fibromyalgia patients with and without Behçet's disease in this study. There may be a relationship between Behçet's disease and fibromyalgia due to non-inflammatory causes such as central sensitization.
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Fibromyalgia was almost completely absent from an urban affluent population compared with poor urban and rural communities. Seventeen percent of Gulf War veterans with soft tissue syndromes had fibromyalgia, a much higher rate than was seen in previous studies of rheumatic disease in the military population. A state of central hyperexcitability in the nociceptive system was reported in fibromyalgia. Altered functioning of the stress-response system has been further documented in fibromyalgia and chronic fatigue syndrome. Administration of growth hormone to patients with fibromyalgia who have low levels of insulinlike growth factor 1 resulted in improvement in their symptoms and tenderness. An association between chronic fatigue syndrome and initial infections was demonstrated. A correlation between particular immunologic abnormalities and measures of disease severity was documented in chronic fatigue syndrome. Concomitant fibromyalgia in other rheumatic diseases was a major contributor to poor quality of life. A favorable outcome of fibromyalgia in children was reported; the majority of patients improved over 2 to 3 years of follow-up. Treatment of patients with fibromyalgia continues to be of limited success.
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Dr. Mary-Ann Fitzcharles from McGill University Health Center moderated the topic Fibromyalgia: New Clinical Concepts with Drs. Frederick Wolfe from the University of Kansas School of Medicine, Winfried Hauser from Technische Universitat Munchen, and Brian Walitt from the Georgetown University Medical Center participating The discussion focused primarily on: The evolution and changing concepts of fibromyalgia; the criteria for diagnosis of fibromyalgia emphasizing the subjective nature of symptoms; the great variation in symptomatology among fibromyalgia patients; pharmacological and nonpharmacological treatment for fibromyalgia and the importance of the latter; the long-term outcomes for fibromyalgia patients; the appropriate goals and expectations of fibromyalgia treatment; and the societal and legal implications of the diagnosis of fibromyalgia. Med Roundtable Gen Med Ed. 2013;2(1):e26–e33.
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