•Clinical and psychological factors play a relevant role in the decrease of Health Related Quality of Life in Fibromyalgia Syndrome patients.•Fibromyalgia Syndrome pain and related functional ...disability may increase depression and anxiety, aggravating the primary symptoms of Fibromyalgia Syndrome and indirectly increasing the negative influence of pain on Health Related Quality of Life.•It is necessary to evaluate and treat aversive emotional states in Fibromyalgia Syndrome.
Fibromyalgia syndrome (FMS) is a chronic pain condition associated with a substantial decrease in health-related quality of life (HRQoL). This study investigated the relationships of HRQoL with clinical parameters of FMS (pain, insomnia and fatigue) and affective variables (depression and anxiety).
Women with FMS (n=145) and healthy women (n=94) completed the Short-Form Health Survey (SF-36) to evaluate HRQoL, and self-report questionnaires pertaining to clinical pain, symptoms of anxiety and depression, fatigue and insomnia. Patterns of associations were assessed by correlation, multiple linear regression, and mediation analyses.
FMS patients showed lower scores on all SF-36 scales than healthy individuals. Clinical and emotional factors were inversely associated with SF-36 scores. Although depression was the strongest predictor of global HRQoL (explaining 36% of its variance), clinical pain and fatigue were the main predictors of physical components of HRQoL; depression and trait-anxiety were the main predictors of mental HRQoL components. Results of mediation analysis showed that depression, trait-anxiety and fatigue mediated the effect of clinical pain on HRQoL. Additionally, depression, trait-anxiety and fatigue mutually influenced each other, increasing their negative effects on the different areas of HRQoL.
Among all emotional factors, only anxiety and depression were considered.
Our results suggest that FMS pain and related functional disability may increase depression and anxiety, in turn aggravating the primary symptoms of FMS and indirectly increasing the negative influence of pain on HRQoL. These results showed the need to evaluate and treat negative affective states in FMS.
Fibromyalgia syndrome (FMS) is a chronic disorder characterized by widespread and persistent musculoskeletal pain and other frequent symptoms such as fatigue, insomnia, morning stiffness, cognitive ...impairment, depression, and anxiety. FMS is also accompanied by different comorbidities like irritable bowel syndrome and chronic fatigue syndrome. Although some factors like negative events, stressful environments, or physical/emotional traumas may act as predisposing conditions, the etiology of FMS remains unknown. There is evidence of a high prevalence of psychiatric comorbidities in FMS (especially depression, anxiety, borderline personality, obsessive-compulsive personality, and post-traumatic stress disorder), which are associated with a worse clinical profile. There is also evidence of high levels of negative affect, neuroticism, perfectionism, stress, anger, and alexithymia in FMS patients. High harm avoidance together with high self-transcendence, low cooperativeness, and low self-directedness have been reported as temperament and character features in FMS patients, respectively. Additionally, FMS patients tend to have a negative self-image and body image perception, as well as low self-esteem and perceived self-efficacy. FMS reduces functioning in physical, psychological, and social spheres, and also has a negative impact on cognitive performance, personal relationships (including sexuality and parenting), work, and activities of daily life. In some cases, FMS patients show suicidal ideation, suicide attempts, and consummated suicide. FMS patients perceive the illness as a stigmatized and invisible disorder, and this negative perception hinders their ability to adapt to the disease. Psychological interventions may constitute a beneficial complement to pharmacological treatments in order to improve clinical symptoms and reduce the impact of FMS on health-related quality of life.
The baroreflex consists of a negative feedback loop adjusting heart activity to blood pressure fluctuations. This review is concerned with interactions between baroreflex function and behavior. In ...addition to changes in baroreflex cardiac control subject to behavioral manipulations, interindividual differences in reflex function predicted psychological and central nervous features. The sensitivity of the reflex was inversely related to cognitive performance, evoked potential amplitudes, experimental pain sensitivity, and the severity of clinical pain. Possible variables moderating the strength of the associations are tonic blood pressure, gender, and psychiatric disease. It is suggested that these observations reflect inhibition of higher brain function by baroreceptor afferents. While in many cases increased baroreflex function implies stronger inhibition, individual and situational factors modulate the behavioral impact of cardiac regulation.
Fibromyalgia syndrome (FMS) is a chronic condition characterized by widespread pain accompanied by symptoms like depression, anxiety, sleep disturbance and fatigue. In addition, affected patients ...frequently report cognitive disruption such as forgetfulness, concentration difficulties or mental slowness. Though cognitive deficits in FMS have been confirmed in various studies, not much is known about the mechanisms involved in their origin. This study aimed to investigate the contribution of affect-related variables to cognitive impairments in FMS. For this purpose, 67 female FMS patients and 32 healthy control subjects completed a battery of cognitive tests measuring processing speed, attention, visuospatial and verbal memory, cognitive flexibility and planning abilities. In addition, participants completed self-report questionnaires pertaining to positive and negative affect, alexithymia, pain catastrophizing and self-esteem. Clinical characteristics including pain severity, symptoms of depression and anxiety, insomnia and fatigue were also assessed. FMS patients showed markedly poorer performance than healthy controls in all of the cognitive domains assessed, in addition to greater levels of depression, anxiety, negative affect, alexithymia and pain catastrophizing, and lower self-esteem and positive affect. In exploratory correlation analysis in the FMS sample, lower cognitive performance was associated with higher pain severity, depression, anxiety, negative affect, alexithymia and pain catastrophizing, as well as lower self-esteem and positive affect. However, in regression analyses, pain, self-esteem, alexithymia, and pain catastrophizing explained the largest portion of the variance in performance. While interference effects of clinical pain in cognition have been previously described, the present findings suggest that affective factors also substantially contribute to the genesis of cognitive impairments. They support the notion that affective disturbances form a crucial aspect of FMS pathology, whereas strategies aiming to improve emotional regulation may be a beneficial element of psychological therapy in the management of FMS.
The study investigated relationships between autonomic cardiovascular control and attentional performance. In 60 healthy subjects R-wave to pulse interval (RPI), respiratory sinus arrhythmia (RSA), ...heart rate variability in the mid-frequency (MF) band and sensitivity of the cardiac baroreflex (BRS) were assessed at rest and during a visual attention test. All parameters decreased markedly during test execution. Lower values of resting BRS predicted increased performance. On-task RPI, RSA, MF power and BRS were inversely related to attentional functioning, with RSA accounting for the largest portion of test score variance. The inverse association between resting BRS and performance is discussed as reflecting the bottom-up modulation of cerebral function by baroreceptor activity. The results concerning the on-task measures suggest that a pattern of cardiovascular adjustment including enhanced sympathetic and reduced vagal cardiovascular influences, as well as baroreflex inhibition may induce an adaptive state associated with improved cognitive-attentional functioning.
Concentration difficulties, forgetfulness and mental slowness are common in fibromyalgia syndrome (FMS); initial findings suggest that rheumatoid arthritis (RA) may also be accompanied by cognitive ...impairments. This study aimed to compare attentional performance between patients with FMS and RA. Attention was quantified in the domains of alerting, orienting and executive control using the Attentional Network Test-Interaction (ANT-I) in 56 women with FMS, 41 women with RA and 50 healthy women. Pain severity was statistically controlled in the group comparison. While FMS patients exhibited longer reaction times and made more errors on the ANT-I than RA patients and healthy women, performance did not differ between RA patients and healthy women. The magnitude of group differences did not vary by the experimental conditions of the ANT-I, suggesting a general attentional deficit in FMS rather than specific impairments in the domains of alerting, orienting and executive control. Differences between patient groups may relate to the different pathogenetic mechanisms involved in the disorders, i.e. inflammatory processes in RA and central nervous sensitization in FMS. In FMS, heightened activity in the pain neuromatrix may interfere with attention, because it requires enhanced neural resources in brain areas that are involved in both pain and attentional processing.
Several investigations suggest the presence of deterioration of executive function in fibromyalgia syndrome (FMS). The study quantified executive functions in patients with FMS. A wide array of ...functions was assessed, including updating, shifting and inhibition, as well as decision making and mental planning. Moreover, clinical variables were investigated as possible mediators of executive dysfunction, including pain severity, psychiatric comorbidity, medication and body mass index (BMI).
Fifty-two FMS patients and 32 healthy controls completed a battery of 14 neuropsychological tests. Clinical interviews were conducted and the McGill Pain Questionnaire, Beck Depression Inventory, State-Trait Anxiety Inventory, Fatigue Severity Scale and Oviedo Quality of Sleep Questionnaire were presented.
Patients performed poorer than controls on the Letter Number Sequencing, Arithmetic and Similarities subtests of the Wechsler Adult Intelligence Scale, the Spatial Span subtest of the Wechsler Memory Scale, an N-back task, a verbal fluency task, the Ruff Figural Fluency Test, the Inhibition score of the Stroop Test, the Inhibition and Shifting scores of the Five Digits Test, the Key Search Test and the Zoo Map Task. Moreover, patients exhibited less steep learning curves on the Iowa Gambling Task. Among clinical variables, BMI and pain severity explained the largest proportion of performance variance.
This study demonstrated impairments in executive functions of updating, shifting inhibition, decision making and planning in FMS. While the mediating role of pain in cognitive impairments in FMS had been previously established, the influence of BMI is a novel finding. Overweight and obesity should be considered by FMS researchers, and in the treatment of the condition.
Mental processes related to visceral activity have gained growing interest during the last few years. The following study is the first to investigate possible interactions between interoceptive ...awareness and measures of attentional performance. We tested the hypothesis whether interoceptive awareness is positively related to indices of selective and divided attentional performances. Using a heartbeat perception task, 29 healthy female participants were separated into two groups scoring either high or low in an interoceptive awareness task. Attentional performance was assessed by several tests including the ‘d2 test of attention’ and subtests from the ‘TAP: Test Battery for Attentional Performance’. We observed a significantly better performance in selective and divided attention for participants with high interoceptive awareness. Our data suggests that interoceptive awareness is related to a better performance especially in tasks assessing selective and divided attention. We conclude 1) that perception of bodily states might be a crucial determinant for the processing of external, visual stimuli, 2) that the ability to perceive internal signals might be an indicator of self-focused attention, and 3) that bodily signals may use, at least in part, similar processing resources as signals from the attention system.
•We tested the relationship between cardiac interoceptive awareness and neural responses preceding decision-making.•Cardiac interoceptive awareness was associated with activity in the right anterior ...insula and the left postcentral gyrus.•Right anterior insula activity was related to decision-making performance in accurate cardiac interoceptive awareness.•These findings support a relationship between body feedback and decision-making.
The current study examined the relationship between conscious perception of somatic feedback (interoceptive awareness) and neural responses preceding decision-making. Previous research has suggested that decision-making is influenced by body signals from the periphery or the central representation of the periphery. Using event-related fMRI, participants whose interoceptive awareness was assessed using a heartbeat perception paradigm performed the Iowa Gambling Task. The results show a positive relationship between the degree of interoceptive awareness and selection related activity in the right anterior insula and the left postcentral gyrus. Neural activity within the right anterior insula was associated with decision-making performance only in individuals with accurate but not in those with non-accurate interoceptive awareness. These findings support the role of somatic feedback in decision-making processes. They indicate that the right anterior insula holds a representation of somatic markers and that these are more strongly processed with increased interoceptive awareness.
This review article includes a systematic evaluation of the empirical data concerning deficits in mental ability, brain perfusion, and cerebral functioning due to chronically low blood pressure. A ...number of studies have provided strong evidence for reduced cognitive performance in hypotension, particularly in the domains of attention and memory. EEG studies have demonstrated that the hypotension-related poorer mental ability is also reflected in diminished cortical activity. Contrary to convention, more recent research has suggested a deficient regulation of cerebral blood flow in persons with low blood pressure. In addition to reduced tonic brain perfusion, studies demonstrated insufficient adjustment of blood flow to cognitive requirements. Altogether, these findings suggest that more attention should be allocated to chronic hypotension in both research and clinical practice.
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