Psychological Fibromyalgianess Exists on a Continuous Spectrum

Research Article

Austin J Orthopade & Rheumatol. 2014;1(1): 7.

Psychological Fibromyalgianess Exists on a Continuous Spectrum

Katrina Malin M* and Geoffrey Owen Littlejohn

Departments of Medicine and Rheumatology, Monash University and Monash Health, Australia

*Corresponding author: Katrina Malin, Department of Medicine, Level 5, Block E, Monash Medical Centre, 246 Clayton Road, Clayton, Victoria, Australia

Received: August 12, 2014; Accepted: October 04, 2014; Published: October 10, 2014


Objective: To determine if key psychological factors associated with the fibromyalgia (FM) phenotype, herein termed psychological fibromyalgianess, exist on a spectrum with asymptomatic persons at one end and those with FM at the other.

Methods: Ninety-eight women with FM, diagnosed according to ACR 1990 criteria, and 35 female healthy controls without pain were studied. Applied questionnaires included the following: Big 5 personality scale, Perceived Stress scale, Fibromyalgia Impact Questionnaire, Perceived control of internal states, Mastery scale, Optimism scale and the profile of mood states scale.

Results: Normality plots showed key psychological variables of FM subjects and HCs to be in the same population. These variables showed a gradient effect with lower levels in controls and higher levels in FM subjects, all associating with the FM phenotypic features of sleep and cognitive change and fatigue (p<0.001), with pain showing a ceiling effect. Both the psychological factors and the FM-related symptoms were of a much lesser degree in controls compared to patients with FM.

Conclusions: Selected key psychological factors in females that associate with the FM clinical phenotype are also present in healthy controls and exist on a spectrum, with lower levels seen in asymptomatic non-FM women and higher levels seen in those with FM. Variation in the extent of certain psychological factors (psychological fibromyalgianess) links to clinical features of FM, consistent with these factors being key contributors to FM.

Keywords: Psychological variables; Fibromyalgia; Fibromyalgianess; Pain; Spectrum; Normality


The robust and characteristic clinical phenotype of fibromyalgia [FM] is reflected in the key items that contribute to the ACR 2010 Preliminary Clinical Diagnostic Criteria [1] and the 2011 Fibromyalgia Research Criteria [2]. These comprise symptoms of widespread pain, high levels each of fatigue, poor quality sleep and cognitive dysfunction, as well as a mix of other somatic complaints. Wide spread abnormal tenderness is also present in FM [3], more clearly reflecting changes in central pain-related control mechanisms.

It has been suggested that the “volume control” of central sensory systems, including pain, is increased in FM, with stimulus-response curves for many modalities (pain, noise, light etc.) being shifted to the left [4-6]. The key clinical sign of tenderness also exemplifies this [7]. Patients with fibromyalgia are found to the right of the normal “bell-shaped” curve of tenderness across a population [8].

We have previously shown that a number of psychological factors associate with the clinical phenotype of FM. Strong links are present between personality, attitude, types of control style and stress and the pain, fatigue, sleep and cognitive changes found in FM [9-12]. We have also found similar associations, of a lesser absolute amount but still of significant degree, between these same psychological variables and the same FM clinical phenotypic characteristics in healthy controls without criteria for FM. Higher versus lower levels of these key psychological variables associate with higher or lower levels respectively of the FM clinical phenotypic features in both those with FM and healthy controls.

In this study we explore the proposal that the psychological variables associated with the clinical features of FM, so-called psychological fibromyalgianess, exist on the same spectrum in FM patients as those of healthy pain free controls. If this were so increasing the “gain” in putative upstream psychological processes, particularly those that relate to stress, would then increase downstream symptoms that provide the substrate to define the FM phenotype. The model used to guide this study is shown in Figure 1. This would then imply that when psychological situations in persons without fibromyalgia reach certain threshold levels then changes occur in central pain-related control processes and pathways that in turn result in the characteristic symptoms that define the clinical phenotype of FM. We use the term “psychological fibromyalgianess” to describe this tendency of certain psychological factors to associate with the clinical phenotypic features of fibromyalgia.