The role of lifetime stressors in adult fibromyalgia: systematic review and meta-analysis of case-control studies, Kaleycheva, Chalder et al, 2021

Andy

Andy

Senior Member (Voting rights)
Background
Fibromyalgia is a chronic condition characterised by widespread musculoskeletal pain. Although accumulating evidence suggests that exposure to stressful events increases the risk for this complex disorder, this is the first meta-analysis to compare the impact of a full range of lifetime stressors (e.g. physical trauma through to emotional neglect) on adult fibromyalgia.

Methods
This review was performed in accordance with PRISMA guidelines. Random-effects models examined associations between different stressor exposures and fibromyalgia status with meta-regression investigating the effects of publication year and study quality on effect sizes.

Results
Nineteen studies were included in the meta-analysis. Significant associations with fibromyalgia status were observed for all six exposure types examined: odds ratios (OR) were highest for physical abuse (OR 3.23, 95% confidence interval 1.99–5.23) and total abuse (3.06, 1.71–5.46); intermediate for sexual abuse (2.65, 1.85–3.79) and smaller for medical trauma (1.80, 1.19–2.71), other lifetime stressors (1.70, 1.31–2.20), and emotional abuse (1.52, 1.27–1.81). Results were not significantly changed when childhood, as opposed to adult, exposures were used in studies that reported both. Meta-regression analyses demonstrated no effect of publication year or study quality on effect sizes.

Conclusions
This study confirmed a significant association between stressor exposure and adult fibromyalgia with the strongest associations observed for physical abuse. Limitations related to current available literature were identified; we provide several suggestions for how these can be addressed in future studies. Stressors are likely to be one of many risk factors for fibromyalgia which we argue is best approached from a biopsychosocial perspective.
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Paywall, https://www.cambridge.org/core/jour...trol-studies/5329C49CDEF274DD931A544514EC4E8A
 
Nineteen studies were included in the meta-analysis.
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Meta-regression analyses demonstrated no effect of publication year or study quality on effect sizes.
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(I haven't read this study)

What's the bet that the nineteen studies were retrospective, with all the bias in reporting that that implies.

And, even if it is true that a higher risk of abuse correlates with a higher risk of fibromyalgia, it's correlation, not causation. A higher risk of abuse probably correlates with poverty, and so all sorts of potential risk factors, including less nutritious food, poorer medical (including dental) treatment, higher rates of smoking. Having a tendency to fibromyalgia bad enough to limit employment in the family might well mean that your family is more likely to be poor, and therefore you are more likely to be at a higher risk of suffering 'lifetime stressors'.

And, even if abuse does actually contribute to the incidence of fibromyalgia, not everyone with fibromyalgia can point to abuse, and not everyone who has suffered abuse gets fibromyalgia. So, this type of research doesn't really get us very far in terms of thinking about the cause. I'd far rather research money was spent on trying to understand what 'fibromyalgia' actually is, than on propping up the Chalder gravy train.

This research doesn't get us very far in terms of thinking about a treatment either. Psychological treatments should stand on their record of treatment success, not on questionable correlations between life-time stressors and illness, and questionable assumptions about what 'thinking differently' can do for chronic health conditions.
 
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Stressful life events are so ubiquitous to being alive and human that it is vanishingly unsurprisingly that there is such a link using retrospective, biased ways of studying these things. (To be fair I haven't read the paper. Might do tomorrow when I am sober ).

Can't quite believe anyone with a PhD sets out to study this in this way and gets it passed peer review. Sad state of affairs.
 
I wrote a critical 1200 word Correspondence regarding this article. I've had the following response today:

Ref.: Ms. No. PSM-D-21-00663R1
The role of stressors in adult fibromyalgia - a response to Kaleycheva et al.

Psychological Medicine

Dear Ms Crawford,

Congratulations - your paper is now accepted for publication in Psychological Medicine. We are offering Dr Kaleycheva an opportunity to respond and if so then we will publish both letters together.

==

Yay - I'll share it when I it is published :-)

Thought @Michiel Tack @Hutan @Sean @Andy @Sly Saint @Trish might like to know :-)

Brightened up my evening.
 
Joan Crawford said:
I wrote a critical 1200 word Correspondence regarding this article. I've had the following response today:

Ref.: Ms. No. PSM-D-21-00663R1
The role of stressors in adult fibromyalgia - a response to Kaleycheva et al.

Psychological Medicine

Dear Ms Crawford,

Congratulations - your paper is now accepted for publication in Psychological Medicine. We are offering Dr Kaleycheva an opportunity to respond and if so then we will publish both letters together.

==

Yay - I'll share it when I it is published :)

Thought @Michiel Tack @Hutan @Sean @Andy @Sly Saint @Trish might like to know :)

Brightened up my evening.
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Brava !
 
Hello there,

A wee update - I have had my Correspondence with Psychological Medicine about this paper published today. Yay. I can't see an authors response so far - perhaps that'll come along in time.

https://www.cambridge.org/core/jour...ycheva-et-al/F8AC978336EDA0E9AAFCEBBC8CA9641E

Let me know if you can't read/access and I can probably PM you with it.

@Michiel Tack
@Sean
@Amw66
@Hutan
@Andy
@Sly Saint
@Trish
@dave30th
@Brian Hughes
@Jonathan Edwards

Please share :-) and comment. I liked the format in this journal allowing extended correspondence so I could make as many points as possible.

Kind regards,
Joan Crawford
Counselling Psychologist
 
Joan Crawford said:
Hello there,

A wee update - I have had my Correspondence with Psychological Medicine about this paper published today. Yay. I can't see an authors response so far - perhaps that'll come along in time.

https://www.cambridge.org/core/jour...ycheva-et-al/F8AC978336EDA0E9AAFCEBBC8CA9641E

Let me know if you can't read/access and I can probably PM you with it.

@Michiel Tack
@Sean
@Amw66
@Hutan
@Andy
@Sly Saint
@Trish
@dave30th
@Brian Hughes
@Jonathan Edwards

Please share :) and comment. I liked the format in this journal allowing extended correspondence so I could make as many points as possible.

Kind regards,
Joan Crawford
Counselling Psychologist
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Thank you, a very helpful response.

I despair that so many papers like this are still being published without a basic understanding of experimental design, repeating basic logical failings that we were taught to avoid when I was a psychology undergraduate over forty years ago.

Real life clinical research is complex, but that is not a justification for shoddy thinking, rather the reverse.
 
Thanks @Joan Crawford

Some interesting highlights:
All the case−control studies included within the meta-analysis used interviews or questionnaires which elicited people's retrospective experiences and memories over their lifespan.
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One such study mentioned by Kaleycheva et al. (2021) was Raphael, Natelson, Janal, & Nayak's (2002) study of a large (N = 1312) community sample pre-surveyed for pain and psychiatric symptoms prior to the 9/11 terrorist attack in New York on 11 September 2001. The women included in this investigation were screened for presence of fibromyalgia 6 months later. No increased incidence of fibromyalgia was found.
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Joan also refers to this interesting paper by Raphael et al. which probably provides the most reliable info we have on this subject. The abstract reads:
Using a prospective cohort design, cases of early childhood abuse or neglect documented between 1967 and 1971 (n = 676) and demographically matched controls (n 520) were followed into young adulthood. The number of medically explained and unexplained pain complaints reported at follow-up (1989±1995) was examined. Assessed prospectively, physically and sexually abused and neglected individuals were not at risk for increased pain symptoms. The odds of reporting one or more unexplained pain symptoms was not associated with any childhood victimization or specific types (i.e. sexual abuse, physical abuse, or neglect). In contrast, the odds of one or more unexplained pain symptoms was signicantly associated with retrospective self-reports of all specific types of childhood victimization. These fndings indicate that the relationship between childhood victimization and pain symptoms in adulthood is more complex than previously thought. The common assumption that medically unexplained pain is of psychological origin should be questioned
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