Fibromyalgia triggered by psychological stress presents different clinical profile.

Abstract

Aim. The onset of fibromyalgia is often triggered in situations of physical or psychological stress. We aimed to investigate the proportion of fibromy-algia patients reporting psychological stress triggers, and to compare their characteristics to those without reported psychological stress triggers in an Australian population. Method. Consecutive fibromyalgia patients seen in the Monash Fibromy-algia Clinic were assessed using standard interview, examination and questionnaires. Results. 719 patients were included (90.7% female, mean age 45.81 years, mean symptom duration 11.27 years). Of these, 72.3% reported an episode of significant emotional distress as a triggering factor at the onset of their illness. When compared to those patients who did not report this type of trigger, these patients had a higher number of associated central sensi-tivity conditions (eg. irritable bowel syndrome, migraine, temporomandib-ular joint disorder, multiple chemical sensitivities, etc) (p=0.000). They also had higher Fibromyalgia Impact Questionnaire (FIQ) scores (p=0.000), worse reported physical functioning (p=0.000), fatigue (p=0.004), anxiety (p=0.000), depression (p=0.000), Symptom Severity Score (SSS) (p=0.000) and Fibromyalgia Severity Scale (FSS) (p=0.005). A higher proportion of these patients were receiving pension support payments (43% vs 34.3% p<0.05). There was no significant difference between the groups in age, symptom duration, reported pain severity or level of sleep disturbance. When followed over time, those with psychological triggers had no significant difference in the change in FIQ and FSS measures when compared to those without. Conclusion. Fibromyalgia patients with psychological triggers have a higher burden of central sensitivity symptoms other than pain, which is reflected in worse illness impact measures, including increased reliance on pension payments. It may be particularly important to target these patients early with psychological strategies to avert poorer outcomes.