An Integrative Neuropsychological Approach to Chronic Pain, Emotions and Clinical Symptoms, 2022, Montoro and Galvez-Sánchez

[Andy]

Abstract

Background. Fibromyalgia syndrome (FMS) is a chronic musculoskeletal pain condition characterized by widespread pain, sleep problems (i.e., insomnia and unrefreshing sleep), fatigue, cognitive, and emotional difficulties. Although pain has been proposed the factor mostly impacting in the FMS patients’ function, emotional and psychological FMS-associated factors are also known to exert a negative impact in quality of life and functional capacity. Nonetheless, the relationship between these factors and functional limitations in FMS patients is considered to be complex and not clearly defined. Therefore, the present study is aimed at assessing the associations between FMS functional capacity, FMS symptoms (pain, fatigue, insomnia, depression, and state and trait anxiety), and associated psychological factors such as pain catastrophizing, as well as the possible mediating role of these latter in the relationship between pain and FMS functional capacity.

Method. 115 women diagnoses with FMS completed a set of self-administered questionnaires to evaluate the clinical and psychological variables of the study.

Results. FMS functional capacity was positively associated with the majority of FMS symptoms except state anxiety. Regression analyses confirmed a greater prediction for FMS functional capacity by depression, fatigue, and pain catastrophizing, in this sequence. Both, pain catastrophizing and depression were important factors mediating the association between clinical pain (total and intensity) and FMS functional capacity.

Conclusions. Findings support a key role of pain catastrophizing and depression in the disability associated to pain in FMS. Treatment goals directed to lessen depression and pain catastrophizing levels should be promoted to reduce the impact of pain in FMS patients’ daily function.

Open access, https://www.hindawi.com/journals/bn/2022/9770047/

 

[Hutan]

Straightforward case of mis-attribution of causality.

Regression analyses confirmed a greater prediction for FMS functional capacity by depression, fatigue, and pain catastrophizing, in this sequence.

115 women with fibromyalgia, recruited from the Fibromyalgia Association of Jaén (AFIXA; Spain) (I've said it before, where is the responsibility in patient organisations that encourage their members to put themselves in harm's way, facilitate it even?)



Lots of questionnaires:
Fibromyalgia Impact Questionnaire (FIQ)
10 items that evaluates functional domains affected in FMS patients (e.g., problems with muscle tasks, problems with work, pain, fatigue, stiffness, depression, anxiety, and morning tiredness). The first item of the FIQ (i.e., the physical impairment subscale) is further divided into several sub-items. The maximum possible score of each item is 10. The final score ranges in a continuum between 0 and 100.


McGill Pain Questionnaire (MPQ)
State-Trait Anxiety Inventory (STAI)
Beck Depression Inventory (BDI)
Fatigue Severity Scale (FSS)
Oviedo Quality of Sleep Questionnaire (COS)
Coping Strategies Questionnaire (CSQ)

Second, multiple regression analyses were performed.

Lots of data points, lots of opportunities to find something.




Trait anxiety
First, let's note that the Fibromyalgia Impact Questionnaire (FIQ) measures anxiety, among other things such as problems functioning, and fatigue, and morning tiredness.

Second, the authors aren't claiming any correlation with state anxiety, only trait anxiety, which seems odd if anxiety was causing fibromyalgia

Third, the questions about trait anxiety in the State/Trait Anxiety Inventory include:
Questions that a person with fatigue will score poorly on e.g. *I feel rested; *I tire easily;
Questions that a person with a chronic illness that prevents them from living the life they want is likely to score poorly on e.g. *I felt satisfied with myself, * I feel like a failure, *I am happy, *I lack self-confidence, *I feel inadequate, *I feel content
Questions that are legitimate concerns for someone who is struggling to earn a living e.g. *I feel that difficulties are piling up
Questions about anxiety e.g. I worry too much over something.

So, the FIQ which partly measures anxiety is correlated with the State Anxiety Inventory questionnaire that partly measures anxiety. Not surprising.
The FIQ which partly measures fatigue, is correlated with the SAI that partly measures fatigue
The FIQ, which partly measures illness impact, is correlated with the SAI that measures how people feel about not being able to live the life they expected to be able to live, and how they feel about real difficulties.

It's entirely circular. The association is largely due to the surveys asking the same things (and not entirely the things you would expect from the survey titles). It's also due to issues that anyone with a chronic debilitating health condition, especially a stigmatised one, faces, causing sadness and worry.

I could go through the other associations that were found positive, but the issues will be similar.

The mean body mass index in the FMS patients’ sample of this study was 28.15 kg/,which indicates obesity degree in level I [63]; despite the high mean body mass index, this was not related with functional impairments.

A BMI of 28.15 is in the overweight range - it does not indicate obesity. The mean age of the women was 52, BMI's in this range are not unusual.

Most of the studies prompt to include the replacement of maladaptive coping strategies (especially pain catastrophizing) by others more adaptative and mature in the treatment of chronic pain (e.g., [71]); however, our findings go further and encourage a more integrated approach on the management of FMS, not only centred in coping strategies but also in the emotional disturbances—either because of their association with maladaptive coping.

It's nasty, patient-blaming stuff. And the treatments aren't about making life easier but instead about encouraging acceptance.

At this regard, acceptance and commitment therapy (ACT), which is considered an effective therapeutic approach for FMS [72, 73], has shown medium-large effect size in the reduction of the FMS impact, measured by the FIQ [74–77]. However, it is important to be cautious with the expected ACT benefits. Lami et al. [70], in an attempt to elucidate the association between pain acceptance and pain, did not find any correlation but a significant influence of pain acceptance on FMS disability. Similar results were observed by Esteve et al. [78].

(A few edits to make things clearer.)

 

[Hutan]

Casandra Isabel Montoro Aguilar
Good grief, this woman is certainly prolific. Someone, stop giving her patients to play with.

2022 papers so far (yes, 12, and that's not counting this latest one)

• Algometry for the assessment of central sensitisation to pain in fibromyalgia patients: a systematic review
• Central nervous activity during an emotional Stroop task in fibromyalgia syndrome
• Personality, Intervention and Psychological Treatment: Untangling and Explaining New Horizons and Perspectives
• The Mediating Role of Depression and Pain Catastrophizing in the Relationship between Functional Capacity and Pain Intensity in Patients with Fibromyalgia
• Variability of Reaction Time as a Marker of Executive Function Impairments in Fibromyalgia
• Chronic Pain: Clinical Updates and Perspectives
• Fibromyalgia Syndrome and Cognitive Decline: The Role of Body Mass Index and Clinical Symptoms
• Chronic Pain and Emotional Stroop: A Systematic Review
• Central Nervous Activity during a Dot Probe Task with Facial Expressions in Fibromyalgia
• Narcissistic Personality and Its Relationship with Post-Traumatic Symptoms and Emotional Factors: Results of a Mediational Analysis Aimed at Personalizing Mental Health Treatment
• The Link between Fibromyalgia Syndrome and Anger: A Systematic Review Revealing Research Gaps
• Migraine and Neuroticism: A Scoping Review

And here's the last one from 2021, just because it seems to sum up the aim behind a lot of her work:

• Personalized behavior management as a replacement for medications for pain control and mood regulation

 

[Andy]

From search results I see for research papers published, there does seem to be a lot of fibromyalgia papers published by Spanish based researchers which seem to focus on what we would consider "patient blaming" concepts.

 

[rvallee]

Medicine is seriously on its way to becoming a pseudoscience. There are limits to how much quackery and nonsense a scientific discipline can support while being able to remain grounded in reality.

I think that tipping point has been reached. Pseudoscience and scientific illiteracy have become so common that no one sees it anymore, it's become a normal sight seen every day and everywhere.

Medicine can either be grounded in science or pseudoscience. It can't have both, they are mutually exclusive as the pseudoscience has the same effect as raw sewage onto drinking water: there is no safe amount, and eventually you are left with sewer water. It doesn't have to be 100% raw sewage, there is a point at which there is simply too much in the water to call it potable.

And this pseudoscience exists precisely as an excuse to medicine's failure, making it impossible to fix those. It plays a cultural role more than anything, and those are immune to science and reason.

 

[shak8]

As a PwFM, I will (n=1) attest that adequate pain relief in fibromyalgia is attainable through medication only, if then.

When pain is relieved, a miracle has occurred and one's mood shifts correspondingly.


Moderate to severe pain is inherently catastrophic to the patient. That's the function of pain---to alert you that something is WRONG.

Perhaps if the pain that day is extremely mild, fleeting, transitory, then some light psychologizing might be peripherally useful.

 

[alktipping]

I find it extremely narcistic to assume that you can possibly know how or what other people think . In the past when people made such claims of knowing the unknowable they would be thought of as bad or mad and if you brought about the displeasure of people in power you would be sentenced to death for it . Today though wiser people just ignore such stupidity such a shame there are no consequences to printing tripe when vested interest can use it for their own nefarious purposes .

 

[shak8]

Yes, Carmen Galvez-Sanchez of Jaen and her group focus on chronic pain. Their mixing up of cause and effect is most unhelpful.

Apparently, they have no idea how severe having FM chronic pain can be and how the experience of pain itself can make one depressed in the moment, usurp any precious energy for exercise, destroy mood (again in the moments of severe pain).

There's a lack here in the researcher and group, of basic human empathy.

 

[Joan Crawford]

Are there any Spanish patient groups or charities that are holding them to account?

 

[Milo]

It's also due to issues that anyone with a chronic debilitating health condition, especially a stigmatised one, faces, causing sadness and worry.

Add this on top of being told it's fibromyalgia and that it's all in your head and that you shouldn't go on disability and you should ignore your pain and exercise and carry on as usual. It's gaslighting over gaslighting and at every level of health care, whatever you are presenting for, you should not be believe and you should be deemed unreliable for telling what is happening in your own body and everything you say should be construed as drug seeking.

It's nasty, patient-blaming stuff. And the treatments aren't about making life easier but instead about encouraging acceptance

And discouraging medicalization.

It is striking that fibromyalgia research is not thinking outside the box. It is all psychiatric, psychological stuff, building on the constructs that have been supposedly accepted (central sensitization, catastrophization, "faulty software").

Narcissistic Personality and Its Relationship with Post-Traumatic Symptoms and Emotional Factors: Results of a Mediational Analysis Aimed at Personalizing Mental Health Treatment

That is vile.

The Link between Fibromyalgia Syndrome and Anger: A Systematic Review Revealing Research Gaps

Also vile.

Not related to the quotes I have pulled from your posts @Hutan but I wanted to say that I truly enjoy your paper analysis, all of them

 

[Trish]

I agree wholeheartedly with members' commentary on this. It is truly nasty stuff, patient blaming, lacking in understanding of the effects of pain, or empathy, misusing correlations to imply causations the wrong way around.
An absolutely classic and powerful case of medical gaslighting. It's tragic such mistreatment is allowed and even lauded by a large subset of the medical establishment and it's so widespread.

Surely anyone looking at this from a biomedical field should be able to see immediately that this research is bogus. Using overlapping questionnaires will inevitably lead to correlations, as Hutan has spelled out, and even if they didn't overlap, any correlation between pain and low mood or anxiety is likely to be the traumatic and life changing effect on mood of being in constant severe pain, and that the way to treat this, as shak8 says, is to try provide more effective pain killing medications.

 

[shak8]

Back in the 1990s there was a flurry of biomedical research into FM. Dr. Robert Bennett's group in Univ. of Oregon, for example, looked at cerebral spinal fluid and found levels of Substance P elevated in FM. He discovered that growth hormone levels low, related to sleep problems. All of this related to pain augmentation.

There were other researchers and it was an interesting, hopeful time for patients. Then came the FDA-approved drugs that were, in my opinion, disappointing.

Bottom line: this condition or syndrome is highly recalcitrant; the pain and other symptoms persist.

Emotional distress is part of having FM. First off: pain itself is distressing. Your life is turned upside down and you spend you day combating pain and fatigue, and confusion.

You have to be wary of how you are using your muscles because any repetition or sudden movement can or may result in several days of undue pain due to the aberrant flooding of pain signals to brain.

When the psychologists grabbed the field after the FDA drugs were approved (as if that was the end of FM pain!) they churned out paper after paper: tai chi, ACT, mindfulness, stop your pain catastrophizing.

I'm sure they mean well (most?) and I think for those with mild symptoms, very mild, some modalities above might be helpful. But for the recalcitrants (myself included), it is a delusion, a distraction and I wish it would end.



'

 

[Arnie Pye]

Are there any Spanish patient groups or charities that are holding them to account?

It may be difficult for patient groups to keep up with recently published research because the papers are published in English rather than Spanish. It would be like asking me to keep up with research published in Russian or Danish.

 

[Hutan]

It may be difficult for patient groups to keep up with recently published research because the papers are published in English rather than Spanish. It would be like asking me to keep up with research published in Russian or Danish.

Patient groups might have had a fair excuse before translations facilities on the internet. Now it's just a matter of running papers through some software.

The patient group helped these Spanish researchers source participants for the study, a lot of participants. Basic due diligence would require that they be aware of the work done previously by the researchers; I don't think there would be language barrier for that, and, if there was, then they could just ask the researchers for copies of papers in Spanish.

I think the only possible scenarios to explain how a patient charity could help serve up 115 women to these researchers are office holders who are either grossly incompetent and/or are fully captured by these BPS ideas. But, there's plenty of blame to go around and, yes, there should be some understanding too. Few, if any, of the people involved in this are truly evil, most will be thinking that they are helping people.

The BPS patient-blaming ideas thrive when people (researchers, research funders, patients and their families, politicians and more) are poorly educated in science, when systems for quality control in science are absent, when eminence is more importance than evidence, when misogeny goes unchallenged. The thriving of BPS ideas is a symptom of deeper problems in societies.

 

[NelliePledge]

As we know the problem of patient groups being taken in by researchers with this agenda is pretty widespread internationally. And they have also gone as far as setting up ‘tame’ patient groups so they can guarantee compliance.

 

[Sean]

The thriving of BPS ideas is a symptom of deeper problems in societies.

Just another example of humanity's endless search for simple, easy, cheap answers to complicated, difficult, expensive problems.