High reported levels of psychosocial stress involved in fibromyalgia triggers.

Abstract

Aim: Fibromyalgia is a common, chronic pain disorder seen by rheumatologists. Initial development of fibromyalgia symptoms occurs under conditions unique to each patient. Psychological and physical triggers are recognised, however their frequency and contribution to illness onset is poorly defined. Our aim was to examine fibromyalgia triggers and identify clinical features linked to specific triggering situations. Method(s): Fibromyalgia patients from a public outpatient clinic underwent a standardised interview regarding the circumstances of their symptom onset. Demographical and clinical data were collected, and patients completed the Fibromyalgia Impact Questionnaire. Patients were divided into groups based on whether they reported a trigger for their fibromyalgia, and if this involved increased psychosocial stress, physical illness or injury. These groups were then compared for differences regarding clinical and demographical features. Result(s): Information was collected on 230 consecutive patients. 204 (88.7%) patients reported a specific triggering situation corresponding to the onset of their symptoms. 67 (29.1%) described a triggering situation of purely increased psychosocial stress and a further 95 (41.3%) described a physical illness or injury combined with increased psychosocial stress. 42 (18.2%) described a trigger which was purely physical. Patients with a trigger involving increased psychosocial stress had a higher number of coexisting fibromyalgiaassociated conditions (e.g. irritable bowel syndrome, temporomandibular joint disorder, etc) (p < 0.005), were more likely to have multiple chemical sensitivities (p < 0.05) and higher levels of anxiety (p < 0.05) and depression (p < 0.05) than those patients who did not. The clinical profile of patients with a purely physical trigger was not significantly different to those without. Conclusion(s): Most patients reported a specific trigger for their fibromyalgia. The majority of these involved increased levels of psychosocial stress, including those with injury or illness. Prompt diagnosis and early management of psychosocial trigger factors may improve impact on the evolving fibromyalgia pathophysiology.