The impact of COVID-19 stress on pain and fatigue in people with and without a central sensitivity syndrome, 2021, Kopperta et al

[Andy]

Highlights

• Stress may augment somatic symptoms in central sensitivity syndromes (CSS).
• The COVID-19 pandemic offers a unique context to examine this hypothesis.
• No convincing evidence indicated a COVID-19 stress-somatic symptoms link.
• Also, no buffering effect of psychological flexibility on this link was implied.
• The impact of the COVID-19 pandemic on somatic symptoms seems uncertain.

Abstract

Objectives
Stress may augment somatic symptoms in central sensitivity syndromes (CSS) such as fibromyalgia, chronic fatigue syndrome, and irritable bowel syndrome. To test this hypothesis, we examined whether the association between COVID-19 stress and somatic symptom severity would be stronger in people with than without CSS and whether psychological flexibility would buffer the impact of this stress on symptom severity.

Methods
In a 2-sample, repeated cross-sectional design, we analysed questionnaire data from Dutch people with and without CSS, collected in two independent surveys: before the COVID-19 pandemic (2018; CSS: n = 194, non-CSS: n = 337) and at the peak of the pandemic (2020; CSS: n = 428, non-CSS: n = 1101). Somatic symptom severity, worry and stress due to the pandemic, and psychological flexibility were examined in regression analyses. Two stress operationalisations were analysed: stress levels during the peak of the pandemic, and a comparison of measurements in 2020 and 2018 (assuming higher stress levels in 2020).

Results
Higher worry and stress during the pandemic (standardized β = 0.14), the presence of a CSS (β = 0.40), and lower psychological flexibility (β = −0.33) were all (p < .0001) associated with more severe somatic symptoms, but the associations of each stress operationalisation with somatic symptoms was not particularly strong in people with CSS (β = −0.026, p = .27; β = −0.037, p = .22), and psychological flexibility (β = −0.025, p = .18; β = 0.076, p = .35) did not buffer this association.

Conclusions
Findings do not support the hypotheses that COVID-19 stress augments somatic symptoms, particularly in CSS, or that psychological flexibility buffers this impact. Rather, COVID-19-related stress appears to have an uncertain impact on somatic symptoms.

Open access, https://www.sciencedirect.com/science/article/pii/S0022399921003007

 

[Trish]

I think what this is saying is that people with FM, CFS and IBS are no more affected by stress than healthy people, and that 'psychological flexibility' does not make any difference.
So is this effectively saying that these are not psychosomatic conditions, and can't be treated with psychotherapy whose aim is to reduce stress responses and increase psychological flexibility?

Combining this with the paper today that shows anxiety and other mood disorders and IBS are associated due to genetics, not to anxiety causing IBS, surely adds to the picture that the whole psychosomatic ocean liner is sinking increasingly rapidly.

 

[rvallee]

Stress may augment somatic symptoms in central sensitivity syndromes (CSS) such as fibromyalgia, chronic fatigue syndrome, and irritable bowel syndrome. To test this hypothesis

Given that this hypothesis is literally the "theoretical" basis for the construct of CSS, this is basically the equivalent of pulling yourself by your own bootstraps. It's quite amazing that something can both be a hypothesis worth testing but also the very basis for the construct itself.

And that's on top of the delusion that "the effects of Covid-19" stress can be assessed with all other things being equal. Nevermind that CSS was invented largely to account for the phenomenon of chronic illness.

It's actually surprising that they allowed for their conclusions to be negative, but of course this will never stop people, probably the same people, from making those very claims. Because no one in this field of study trusts research to be reliable, negative results are simply ignored.

 

[Mithriel]

Conclusions

Findings do not support the hypotheses that COVID-19 stress augments somatic symptoms, particularly in CSS, or that psychological flexibility buffers this impact. Rather, COVID-19-related stress appears to have an uncertain impact on somatic symptoms.

So findings did not support the hypothesis but they conclude this means that the impact on somatic symptoms is "uncertain". It is not uncertain it is unequivocal, there is not relationship.

 

[Ash]

Nevermind that CSS was invented largely to account for the phenomenon of chronic illness.

It's actually surprising that they allowed for their conclusions to be negative, but of course this will never stop people, probably the same people, from making those very claims. Because no one in this field of study trusts research to be reliable, negative results are simply ignored.

Yeah isn’t it?
As you say doesn’t trouble them to ignore own findings.

I dream of a career where I talk shit all day about people less fortunate and considerably sicker than myself. For the status and the salary.

 

[NelliePledge]

So findings did not support the hypothesis but they conclude this means that the impact on somatic symptoms is "uncertain". It is not uncertain it is unequivocal, there is not relationship.

Yes indeed fudge and humbug

 

[Joan Crawford]

I think what this is saying is that people with FM, CFS and IBS are no more affected by stress than healthy people, and that 'psychological flexibility' does not make any difference.
So is this effectively saying that these are not psychosomatic conditions, and can't be treated with psychotherapy whose aim is to reduce stress responses and increase psychological flexibility?

Combining this with the paper today that shows anxiety and other mood disorders and IBS are associated due to genetics, not to anxiety causing IBS, surely adds to the picture that the whole psychosomatic ocean liner is sinking increasingly rapidly.

That was my understanding. I have the full paper from the author. Tough read but I understood it as you do. They quote my Correspondence in Psychological Medicine from early 2021 where I debunked the link between 'lifetime stressors' and Fibromyalgia. Nice to see people reading and seeing the poor quality research in the past linking 'stress' and x or y poorly understood medical conditions for what it is. Woo.

 

[Joan Crawford]

Given that this hypothesis is literally the "theoretical" basis for the construct of CSS, this is basically the equivalent of pulling yourself by your own bootstraps. It's quite amazing that something can both be a hypothesis worth testing but also the very basis for the construct itself.

And that's on top of the delusion that "the effects of Covid-19" stress can be assessed with all other things being equal. Nevermind that CSS was invented largely to account for the phenomenon of chronic illness.

It's actually surprising that they allowed for their conclusions to be negative, but of course this will never stop people, probably the same people, from making those very claims. Because no one in this field of study trusts research to be reliable, negative results are simply ignored.

My understanding and experience with professionals like our pain consultant, physios etc is that CSS is very much a poorly understood biomedical phenomenon and there is no drive towards 'stress' causation or understanding it in those terms. It's seen as altered biological functioning which cannot be undone via any current method. Only taking good care of oneself, pacing, rest, adapting as best one can do to live with it is all.

It would not surprise me that the BPSers have tried to hijack this. I think they tried via the British Pain Society a while ago. That got well and truly stamped on. I wasn't around at the time professionally but there was a big stink made about this probably around 2007ish.

I hope that makes sense

 

[hibiscuswahine]

Puts a bit of a spanner in the works of their new psychosomatic, “bio-psycho” model of “CSS”. Lots of assumptions and presumptions.

Probably a bit surprised how resilient their sample is, of note most were recruited from social media illness groups and social support is an important factor for everyone’s mental health, but especially in people who have restricted social activities from their illness and are also stigmatised and marginalised.

The psychological flexibility scale is strongly reliant of the principles of MBSR (mindfulness based stress reduction therapy) and ACT (acceptance and commitment therapy). Rogge, Ronald. (2016). The Multidimensional Psychological Flexibility Inventory (MPFI). 10.13140/RG.2.1.1645.9129.

 

[Joan Crawford]

Puts a bit of a spanner in the works of their new psychosomatic, “bio-psycho” model of “CSS”. Lots of assumptions and presumptions.

Probably a bit surprised how resilient their sample is, of note most were recruited from social media illness groups and social support is an important factor for everyone’s mental health, but especially in people who have restricted social activities from their illness and are also stigmatised and marginalised.

The psychological flexibility scale is strongly reliant of the principles of MBSR (mindfulness based stress reduction therapy) and ACT (acceptance and commitment therapy). Rogge, Ronald. (2016). The Multidimensional Psychological Flexibility Inventory (MPFI). 10.13140/RG.2.1.1645.9129.

It is a big time spanner in the works.

It is no surprise to me that pw pain, exhaustion, high levels of debilitay, and so forth are often psychologically resilient. Their condition and circumstances often make them so. This is a frequent finding in my assessments and reports