Cognitive Impairments in Fibromyalgia Syndrome: Associations With Positive & Negative Affect, Alexithymia, Pain Catastrophizing.., 2018, Duschek et al

Andy

Andy

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Cognitive Impairments in Fibromyalgia Syndrome: Associations With Positive and Negative Affect, Alexithymia, Pain Catastrophizing and Self-Esteem

Fibromyalgia syndrome (FMS) is a chronic condition characterized by widespread pain accompanied by symptoms like depression, anxiety, sleep disturbance and fatigue. In addition, affected patients frequently report cognitive disruption such as forgetfulness, concentration difficulties or mental slowness.

Though cognitive deficits in FMS have been confirmed in various studies, not much is known about the mechanisms involved in their origin. This study aimed to investigate the contribution of affect-related variables to cognitive impairments in FMS. For this purpose, 67 female FMS patients and 32 healthy control subjects completed a battery of cognitive tests measuring processing speed, attention, visuospatial and verbal memory, cognitive flexibility and planning abilities. In addition, participants completed self-report questionnaires pertaining to positive and negative affect, alexithymia, pain catastrophizing and self-esteem.

Clinical characteristics including pain severity, symptoms of depression and anxiety, insomnia and fatigue were also assessed. FMS patients showed markedly poorer performance than healthy controls in all of the cognitive domains assessed, in addition to greater levels of depression, anxiety, negative affect, alexithymia and pain catastrophizing, and lower self-esteem and positive affect. In exploratory correlation analysis in the FMS sample, lower cognitive performance was associated with higher pain severity, depression, anxiety, negative affect, alexithymia and pain catastrophizing, as well as lower self-esteem and positive affect. However, in regression analyses, pain, self-esteem, alexithymia, and pain catastrophizing explained the largest portion of the variance in performance.

While interference effects of clinical pain in cognition have been previously described, the present findings suggest that affective factors also substantially contribute to the genesis of cognitive impairments. They support the notion that affective disturbances form a crucial aspect of FMS pathology, whereas strategies aiming to improve emotional regulation may be a beneficial element of psychological therapy in the management of FMS.
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Open access at https://www.frontiersin.org/articles/10.3389/fpsyg.2018.00377/full
 
I've come across the concept of pain catastrophizing before. And it makes me bloody furious that patients are automatically blamed for suffering this.

Imagine a patient has a condition that doctors either don't believe in or assume that patients exaggerate the effect. Examples would be anything that is currently covered by the concept of medically unexplained symptoms.

If a patient goes to a doctor with (for example) fibromyalgia they will complain about being in pain. The doctor can't find anything visible wrong that they can treat so they offer anti-depressants, and tell the patient to get lost (but not in those precise terms). The patient's condition deteriorates, the pain gets worse, the ADs achieve nothing, and so the patient goes back to the doctor again. The reaction of the doctor is worse than before. They feel they are having their time wasted, and they become hostile. The hostility increases with every visit.

Years might pass with no diagnoses other than anxiety, depression, hypochondria, time-waster. The patient is unable to work to their full potential because of pain and other symptoms of their condition. They can't make much money as a result, and so they end up living in poverty. They may eventually get pain relief, but they may also fear that the pain relief will be taken away. So no wonder they catastrophize about pain. Their life has not been under their own control, it has been under the control of doctors who didn't believe a word they said. But doctors (and society and the DWP) blame the patient for being sick with something nobody believes in.
 
It's doubly infuriating bc what they don't realise is that we chronics are, on the whole, the opposite of pain catastrophizers.

I speak from direct experience when I say my pain threshold just gets higher over time. The only time I've been to Urgent Care ever was for a kidney stone, which is recognised to be some of the worst-ever pain, and that was mostly for the intractable vomiting, which was amplifying the pain with every heave-ho. I've rested alone through countless migraines that were soothed only by fantasies of trepanation and guillotines.

Seriously the people who believe this garbage need psychiatric help themselves.
 
The average number of years of education were 10.5 years for the patients and 12 years for the controls - with similar variability around the means for both. They suggest that this difference is not significant. However, if you think of the average intelligence of the people who have 10.5 years of education, versus the average intelligence of the people who have 12 years of education - well, where I come from, there's a big step-wise difference (say, dropping out of school at age 15 and a half, versus completing secondary school). (e.g. In my secondary school, we had around 300 students in the 10th year and only 25 students in the 12th year.)

(Just to be clear, I'm not saying that a person who drops out of school early isn't smart, just that the likelihood of them being smart is less than the person who completes secondary school).

That surely has to affect average performance on a number of their cognitive tests such as verbal memory and cognitive flexibility. I'd be wanting to control for that better before drawing conclusions about a whole lot of other things causing the reduced cognitive performance.

I'm sure that there are plenty of other issues with this study, but that was one that jumped out.
 
I thought about that, but this is fibromyalgia, not ME, and my sense is that it is not so common in the teen years. Maybe I'm wrong about that.

The average age of the participants was around 52 with a variation of about 7 years. So there was plenty of time for fibromyalgia to kick in.

And, even if it was true that that difference in years of education was wholly due to the people with fibromyalgia dropping out of school early for health reasons, that would suggest that they had a lot of years of compromised learning and lack of exposure to learning. That in itself might explain some differences in cognitive performance.

I don't believe that the authors have satisfactorily demonstrated that underlying intelligence and access to schooling can be ignored as significant causes of differences in cognitive performance. That's especially true in a study that is quite small.
 
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Arnie Pye said:
I've come across the concept of pain catastrophizing before. And it makes me bloody furious that patients are automatically blamed for suffering this.

Imagine a patient has a condition that doctors either don't believe in or assume that patients exaggerate the effect. Examples would be anything that is currently covered by the concept of medically unexplained symptoms.

If a patient goes to a doctor with (for example) fibromyalgia they will complain about being in pain. The doctor can't find anything visible wrong that they can treat so they offer anti-depressants, and tell the patient to get lost (but not in those precise terms). The patient's condition deteriorates, the pain gets worse, the ADs achieve nothing, and so the patient goes back to the doctor again. The reaction of the doctor is worse than before. They feel they are having their time wasted, and they become hostile. The hostility increases with every visit.

Years might pass with no diagnoses other than anxiety, depression, hypochondria, time-waster. The patient is unable to work to their full potential because of pain and other symptoms of their condition. They can't make much money as a result, and so they end up living in poverty. They may eventually get pain relief, but they may also fear that the pain relief will be taken away. So no wonder they catastrophize about pain. Their life has not been under their own control, it has been under the control of doctors who didn't believe a word they said. But doctors (and society and the DWP) blame the patient for being sick with something nobody believes in.
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Arnie
What you said is exactly me spot on:(
 
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I've experienced pain castastrophizing with fibro pain. During a severe flare up of pain, yes, pain dictates mood and the mood is rather extreme due to the pain being extreme.

But my mood brightens when the pain lessens and mood returns to baseline when the flare resolves (though a residual fear of what my body is able to wrought continues...each flare brings a new flavor of the illness, a new adjustment, slightly more fear based on experience.)

CBT self-talk ("you will be better in a few days") is okay for mild-moderate pain, but when a severe flare up occurs, I cannot think, cannot manage any reassuring platitudes as I am subsumed, consumed and battling the pain demon.



These psycho theories have reasoning fallacies. Take pain and its affect on mood. So the researchers look ass-backward from the mood and try to imput ITS affect on pain levels instead of the other way around. Deductive reasoning ?

It's getting harder and harder to read this non-science garbage.
 
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From my experience it seems to me that such a level of pain would reduce coping also because it is simply exhausting to deal with for anything but an acute short time period. When we're exhausted our normal ability to cope and function is compromised.
 
Came across this article in Journal of Practical Pain Management https://www.practicalpainmanagement...-catastrophizing-what-practitioners-need-know

Very fuzzy non-definition of what pain catastrophizing might be. Of course, the so-called professional (a health psychologist) can spot this phenomenon a mile off. I have no idea if my negativity about a huge pain bout is catastrophizing or not, but it seems to me to be a dire catastrophy at the time. Why not be more specific: instances of pure psychogenic pain or extreme exaggeration of what might come of leg pain (amputation?). Really, this is not science, but mush.

Has the internet turned the world into a slimey echo chamber of lies and rumor?
 
And to further catastrophize about pain catastrophizing, here is the wikipedia entryg https://en.wikipedia.org/wiki/Pain_catastrophizing

and interestingly it states:

"However, we cannot yet rule out the possibility that at least some aspects of catastrophization may actually be the product of an intense pain experience, rather than its cause. That is, the more intense the pain feels to the person, the more likely they are to have thoughts about it that fit the definition of catastrophization.[3] "

Amen. Psychs are irritated by something, therefore they blame the patient for their feelings by making some conceptual nonsense. All from a power differential and a lack of empathy. I rest my case...for now.
 
Catastrophization is a psych construct made to explain hysteria in other words. All the while the very least they could do is to quantify pain and brain inflammation via PET and MRI/MRS scans. We have the technology now.
 
This blog from Scienfic American is written by a Stanford psychologist who has been researching pain catastrophizing (PC). I think she is a major voice in the PC field. I don't see in any of her research an attempt to categorize pain levels as well as consider additional brain problems (fatigue, immune, etc.) that occur, for instance, in fibromyalgia.

I wonder though: if one is doing all sorts of methods to combat pain (including binge-watching Doc Martin), and yet the pain persists and tends to overwhelm the defenses, what then?

https://blogs.scientificamerican.com/observations/change-your-mind-set-reduce-your-chronic-pain/
 
Pain catastrophizing...Pain IS a catastrophe! I don't mean mild pain that can be easily ignored. I mean PAIN. Pain is draining. And if it's chronic, if you don't have pain meds or they don't work or whatever, it is only natural to get desperate over time. Because whenever you're awake, it's there. And if you wanna sleep, it doesn't let you. You can't function properly. Life quality is immensely reduced. This is not catastrophizing, it's reality for those with pain. And for those without pain - they should just shut up. Makes me so angry, sorry.
 
Inara said:
And for those without pain - they should just shut up
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I know how you feel. And agree with the whole post but highlighted the above. I suppose there are people somewhere who might have some degree of understanding but inevitably it's almost always the ideologues/those with not even secondary experience of people in chronic pain etc who decide this is a good area of research for them.

I suspect it's because they can hide behind the fact that the bar is set rather low for what qualifies in their research area.

What is it about Frontiers? They seem bent on publishing bird cage liner.
 
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