Psychological factors driving the symptoms of Fibromyalgia

Aim: It has been reported that various psychological factors, including stress, associate with the clinical features of fibromyalgia. This project proposed that a top down process, comprising of a number of contributing psychological factors, plays a pivotal role in the establishment of fibromyalgia. The project specifically examined whether a number of psychological factors would contribute significantly to the core clinical features of fibromyalgia, and if so whether these psychological factors would modulate this relationship. Stress was also examined to see if it is the necessary link in the pathway between certain key fibromyalgia symptoms and these psychological factors.
 
   Finally, which are the key psychological factors that drive the proposed top down process and are the likely link between these psychological elements and the core clinical features of fibromyalgia.
 
   Methods: 98 females with ACR 1990 classified fibromyalgia, and 35 healthy control women were  identified. A battery of applied questionnaires including the Big 5 Personality Inventory, Fibromyalgia Impact Questionnaire [FIQ], Profile of Mood States [POMS], Perceived Control of Internal States scale [PCIOSS], Perceived Stress scale and Mastery scale were completed by all participants. Using statistical program, SPSS (PASW versions 18-22), tests including t tests, means, standard deviations, one-way ANOVA, bivariate correlations and multiple regression analysis were completed to explore differences between symptom characteristics, the phenotypic characteristics and potential mediating factors. Further analysis using structural equation modelling followed to examine the effect of stress on the relationships between psychological factors and the phenotype of fibromyalgia.
 
   Results: The results of the analyses, reported in seven published articles, showed significant relationships between the key psychological variables and the phenotype of fibromyalgia. Perceived stress was found to have the highest association between all examined psychological factors and also the components of fibromyalgia (p<0.05-0.001). The preferred top down model showed that the identified path clearly linked the psychological variables of anxiety, neuroticism and mastery, but not internal control, to the three key elements of fibromyalgia, namely pain, fatigue and sleep (p<0.001), via the person’s perceived stress. Confusion, however did not fit the preferred model.
 
   Conclusion: This combination of studies, confirms the following:
 
   1. That there are a number of psychological factors that contribute significantly to the core clinical features of fibromyalgia.
 
   2. That these psychological factors have the ability to modulate the relationship between stress and the core clinical features of the fibromyalgia phenotype.
 
   3. That stress is a necessary link in the pathway between certain identified, established and significant psychological factors and key fibromyalgia symptoms.
 
   4. This has implications for the understanding of contributing mechanisms and the clinical care of patients with fibromyalgia.