Fabrizio Colonna

Are fibromyalgia patients cognitively impaired? Objective and subjective neuropsychological evidence.

Patients with fibromyalgia (FM) syndrome often report a cluster of cognitive disorders that strongly interferes with their work and daily life, but the relationship between impaired cognitive function and self‐reported dysfunction remains unclear. We aimed to investigate the presence of cognitive impairments in patients with FM and to analyze the relationship between the impairments and their evaluation by the patients through a comparison with a group of healthy controls.

Theory of Mind and Emotional Functioning in Fibromyalgia Syndrome: An Investigation of the Relationship between Social Cognition and Executive Function

Background Fibromyalgia (FM) is a syndrome primarily characterised by chronic, widespread musculoskeletal pain. In the aetiology of this syndrome a crucial role is played by complex interactions among biological, genetic, psychological, and socio-cultural factors. Recently, researchers have started to explore emotional functioning in FM, with their attention focused on alexithymia, a personality construct that affects the regulation of a person’s own emotions. On the other hand, the detection and experience of emotional signals from other people have only been sparsely investigated in FM syndrome and no studies have investigated the ability to represent other people’s mental states (i.e. Theory of Mind, ToM) in these patients. Here we present the first study investigating a large set of social-cognitive abilities, and the possible relationships between these abilities and the performance on executive-function tasks, in a homogenous sample of patients with FM. Methodology Forty women with FM and forty-one healthy women matched for education and age were involved in the study. Social cognition was assessed with a set of validated experimental tasks. Measures of executive function were used to test the correlations between this dimension and the social-cognitive profile of patients with FM. Relationships between social-cognitive abilities and demographic, clinical and psychological variables were also investigated. Principal Findings Patients with FM have impairments both in the regulation of their own affect and in the recognition of other’s emotions, as well as in representing other people’s mental states. No significant correlations were found between social cognition tasks and the subcomponents of the executive function that were analysed. Conclusions The results show the presence of several impairments in social cognition skills in patients with FM, which are largely independent of both executive function deficits and symptoms of psychological distress. The impairments reported highlight the importance of adequately assessing ToM and emotional functioning in clinical practice.

Pain experience in Fibromyalgia Syndrome: The role of alexithymia and psychological distress

BACKGROUND Fibromyalgia (FM) is a chronic pain syndrome with a high prevalence of alexithymia, a personality disposition that affects emotional self-awareness. The present study aimed to investigate the relationship between alexithymia and pain, differentiating between the sensory and affective components of pain experience, in a sample of FM patients. METHODS One hundred and fifty-nine FM patients completed a battery of tests assessing pain experience, pain intensity, alexithymia and psychological distress. In order to characterize the clinical profile of alexithymic FM patients, alexithymic and non-alexithymic groups were compared on the different measures. Two regression analyses were performed on the total sample, in order to investigate the relationship between alexithymia and pain, controlling for psychological distress. RESULTS Alexithymic FM patients presented higher scores on all the clinical measures compared to non-alexithymic ones. Positive correlations were found between alexithymia and the affective, but not the sensory, dimension of pain experience variables. Regression analyses showed that alexithymia (difficulty identifying feelings factor) ceased to uniquely predict affective pain, after controlling for psychological distress, particularly anxiety. In addition, none of the alexithymia variables significantly explained pain intensity variance. Finally, a significant effect of anxiety in mediating the relationship between alexithymia and affective pain was found. LIMITATIONS No longitudinal data were included. CONCLUSIONS These findings show the presence of higher levels of pain and psychological distress in alexithymic vs. non-alexithymic FM patients, and a relevant association between alexithymia and the affective dimension of pain experience. Specifically, this relationship appears to be significantly mediated by anxiety.

Alexithymia and depression in patients with fibromyalgia: When the whole is greater than the sum of its parts

This study investigated the link between alexithymia and depressive symptoms in Fibromyalgia (FM). 181 FM women and 181 healthy controls (HC) were compared using the Hospital Anxiety and Depression Scale and the Toronto Alexithymia Scale. A moderation analysis was performed to examine the moderation effect of the group (FM vs. HC) on the relationship between alexithymia and depression. Group was a significant moderator, highlighting a stronger relationship between alexithymia and depressive symptoms in the FM compared to HC. The study highlighted that the association between alexithymia and depression is different when we consider FM patients rather than the healthy population.

Coping strategies and perceived social support in fibromyalgia syndrome: Relationship with alexithymia

Fibromyalgia (FM) is a chronic pain syndrome characterized by high levels of psychological distress and alexithymia, a personality disposition affecting emotional self-awareness. The main aim of the present study was to investigate for the first time the relationship between alexithymia and coping strategies on the one hand, and alexithymia and perceived social support on the other, in a sample of FM patients. To reach this aim, 153 FM patients completed a battery of tests assessing coping strategies, perceived social support, alexithymia, psychological distress and pain intensity. Four regression analyses were performed to assess whether alexithymia was still a significant predictor of coping strategies and perceived social support, after controlling for psychological distress. High levels of both psychological distress and alexithymia were found in our sample of FM patients. Regarding coping strategies, FM patients reported higher scores on problem-focused coping, with respect to the other two coping strategies. The regression analyses showed that the externally-oriented thinking factor of alexithymia significantly explained both problem- and emotion-focused coping, while the difficulty-describing feelings factor of alexithymia proved to be a significant predictor of perceived social support. Only the variance of dysfunctional coping ceased to be uniquely explained by alexithymia (difficulty identifying feelings factor), after controlling for psychological distress, particularly anxiety. These results highlight a negative relationship between alexithymia and both the use of effective coping strategies and the levels of perceived social support in FM patients. An adequate assessment of both alexithymia and psychological distress should therefore be included in clinical practice with these patients.

Harm Avoidance and Self-Directedness Characterize Fibromyalgic Patients and the Symptom Severity

Objective: Evidence in the literature suggests peculiar personality traits for fibromyalgic (FM) patients, and it has been suggested that personality characteristics may be involved in patients’ different symptomatic events and responses to treatment. The aim of the study is to investigate the personality characteristics of Italian FM patients and to explore the possibility of clustering them considering both personality traits and clinical characteristics. Design: The study used a cross-sectional methodology and involved a control group. A self-assessment procedure was used for data gathering. The study included 87 female FM patients and 83 healthy females. Patients were approached and interviewed in person during a psychiatric consultation. Healthy people were recruited from general practices with previous telephone contact. Main Outcome Measures: Participants responded to the Hospital Anxiety and Depression Scale, the Temperament and Character Inventory, the Fibromyalgia Impact Questionnaire and the Short-Form-36 Health Survey. Results: FM patients scored significantly different from healthy participants on the Harm avoidance (HA), Novelty seeking (NS) and Self-directedness (SD). Two clusters were identified: patients in Cluster1 (n = 37) had higher scores on HA and lower scores on RD, SD, and Cooperativeness and reported more serious fibromyalgia and more severe anxious–depressive symptomatology than did patients in Cluster2 (n = 46). Conclusion: This study confirms the presence of certain personality traits in the FM population. In particular, high levels of HA and low levels of SD characterize a subgroup of FM patients with more severe anxious–depressive symptomatology. According to these findings, personality assessment could be useful in the diagnostic process to tailor therapeutic interventions to the personality characteristics.

Alexithymia, not fibromyalgia, predicts the attribution of pain to anger-related facial expressions

BACKGROUND Fibromyalgia (FM) is a syndrome characterized by chronic, widespread musculoskeletal pain, occurring predominantly in women. Previous studies have shown that patients with FM display a pattern of selective processing or cognitive bias which fosters the encoding of pain-related information. The present study tested the hypothesis of an increased attribution of pain to facial expressions of emotions (FEE), in patients with FM. As previous studies have shown that alexithymia influences the processing of facial expressions, independent of specific clinical conditions, we also investigated whether alexithymia, rather than FM per se, influenced attribution of pain to FEE. METHODS One hundred and twenty-three women (41 with FM, 82 healthy controls, HC) were enrolled in this cross-sectional case-control study. We adopted two pain-attribution tasks, the Emotional Pain Estimation and the Emotional Pain Ascription, both using a modified version of the Ekman 60 Faces Test. Psychological distress was assessed using the Hospital Anxiety and Depression Scale, and alexithymia was assessed using the Toronto Alexithymia Scale. RESULTS Patients with FM did not report increased attribution of pain to FEE. Alexithymic individuals demonstrated no specific problem in the recognition of basic emotions, but attributed significantly more pain to angry facial expression. LIMITATIONS Our study involved a relatively small sample size. The use of self-reported instruments might have led to underestimation of the presence of frank alexithymia in individuals having borderline cut-off scores. CONCLUSIONS Alexithymia, rather than FM per se, plays a key role in explaining the observed differences in pain attribution to anger-related facial expressions.

Alexithymia and Depression Affect Quality of Life in Patients With Chronic Pain: A Study on 205 Patients With Fibromyalgia

Pain in fibromyalgia (FM) is accompanied by a heterogeneous series of other symptoms, which strongly affect patients’ quality of life and interfere with social and work performance. The present study aimed to evaluate the effects of alexithymia on both the physical and the psychosocial components of the health-related quality of life (HRQoL) of FM patients, controlling for the concomitant effects of depression, anxiety, and pain. In particular, given the strong interconnection between depression and alexithymia, the relationship between alexithymia and HRQoL as mediated by depressive symptoms was further investigated. Data were collected on a consecutive sample of 205 female patients with a main diagnosis of FM. The results showed that about 26% of the patients showed the presence of alexithymia, as assessed by the Toronto Alexithymia Scale (TAS-20). Clinically relevant levels of depressive and anxiety symptoms were present in 61 and 60% of the patients, respectively. The results of the hierarchical multiple regression analyses showed that pain intensity (PI) and depressive symptoms explained the 45% of the variance of the physical component of HRQoL (p < 0.001). Regarding the mental component of HRQoL, depressive and anxiety symptoms, alexithymia, and PI significantly explained 61% of the variance (p < 0.001). The mediation analyses confirmed that alexithymia had a direct effect on the mental component of HRQoL and showed a statistically significant indirect effect on both the physical and the mental components, through the mediation of depressive symptoms. In conclusion, the results of the present study suggested the presence of both a direct and an indirect effect of alexithymia, in particular of the difficulty identifying feeling, on the HRQoL of patients with FM. Indeed, even though the concomitant presence of depressive symptoms is responsible of an indirect effect, alexithymia per se seems to directly contribute to worsen the impact that this chronic pain pathology has on the patients’ quality of life, especially regarding the psychosocial functioning.

THU0589-HPR An Investigation of Emotional Processing Abilities in Fibromyalgia Syndrome

Background Fibromyalgia (FM) symptoms are not restricted to pain, but often comprise a heterogeneous series of other conditions, including emotional disorders (especially anxiety and depression)1. High levels of alexithymia have also repeatedly been reported2 suggesting that FM patients exhibit a lack of emotional self-awareness. Finally, functional alterations in brain areas responsible for emotional processing (EP) (amygdala and prefrontal cortex) were recently found3. Objectives The present study aimed at analyzing the three subcomponents of EP abilities in FM patients: (1) regulation of emotions, regulation of own emotions (i.e. alexithymia) and emphatic capacities; (2) recognition of others emotions; (3) representation of others affective mental states. The levels of anxiety and depression, and the general cognitive functioning were also assessed. Methods 22 FM patients were compared to 22 healthy controls (HC) on regulation of emotions (Toronto Alexithymia Scale – TAS-20 and Empathy Quotient – EQ), recognition of others emotions (Ekman 60 Faces), representation of others affective mental states (Reading the Mind in the Eyes – RME), psychological disorders (Hospital Anxiety and Depression Scale – HADS), and general cognitive functioning (Digit Span Forward-Backward – DS F-B, Rey auditory-verbal learning test, Trial making test A-B, verbal fluency, and Tower of London – ToL). Parametric tests such as the unpaired t-test, the chi-square test and the univariate ANOVA were used. Results Comparison between demographic variables of FM group and HC showed a significant difference for education (t(42)=-5,58, p<0.0001). For this reason, the analyses were corrected for educational level, as appropriate. T-test analyses showed a significant difference between the two groups on the TAS-20 total score (t(42)=3,89, p<0.0001), on the EQ (t(42)=2,76, p=.009), and on the Ekman 60 Faces (t(34,45)=-4,24, p<0.0001), for EP assessment; the univariate ANOVA on DS F (F(1,41)=8,02, p=.007) and B (F(1,41)=5,64, p=.022), and on ToL (F(1,41)=5,29, p=.027) for neuropsychological assessment. Instead, chi-square analyses showed a significant difference between the two groups on the HADS total score (χ2(1)=11,02, p=.001) and on the subscale HADS-D (χ2(1)=7,76, p=0.005). Conclusions The preliminary results showed that FM patients, compared with HC, had a general impairment of EP abilities, with higher difficulties in identifying and expressing their own feelings (i.e. alexithymia), lower empathic skills and lower capacities in recognizing others emotions. FM patients also exhibited higher levels of psychological disorders, especially depression, and some cognitive difficulties. References Mease P. (2005). Fibromyalgia syndrome: review of clinical presentation, pathogenesis, outcome measures, and treatment. J. Rheumatol. 75, 6–21. Di Tella M. and Castelli L. (2013). Alexithymia and fibromyalgia: clinical evidence. Front. Psychol. 4, 909. Lee S.J., Song H.J., Decety J., et al. (2013). Do patients with fibromyalgia show abnormal neural responses to observation of pain in others? Neurosci. Res. 75(4), 305–15. Disclosure of Interest : None declared DOI 10.1136/annrheumdis-2014-eular.4372