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Valentine TR, Kratz AL. Feasibility, reliability, and validity of ambulatory cognitive tests in fibromyalgia and matched controls. J Int Neuropsychol Soc 2023; 29:893-901. [PMID: 36762635 PMCID: PMC10412734 DOI: 10.1017/s1355617723000073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
OBJECTIVE This observational study examined the feasibility, reliability, and validity of repeated ambulatory cognitive tests in fibromyalgia (FM). METHOD Adults with FM (n = 50) and matched controls (n = 50) completed lab-based neuropsychological tests (NIH Toolbox) followed by eight days of smartphone-based ambulatory testing of processing speed (symbol search) and working memory (dot memory) five times daily. Feasibility was assessed based on response rates. Reliability was evaluated using overall average between-person reliabilities for the full assessment period and by determining the number of assessment days necessary to attain reliabilities of >.80 and >.90. To assess convergent validity, correlations were calculated between ambulatory test scores and NIH Toolbox scores. Test performance was contrasted between the FM and non-FM groups to examine known-groups validity. RESULTS Average rates of response to the ambulatory cognitive tests were 89.5% in FM and 90.0% in non-FM. Overall average between-person reliabilities were ≥.96. In FM, between-person reliability exceeded .90 after two days for symbol search and three days for dot memory. Symbol search scores correlated with NIH Toolbox processing speed scores in both groups, though there were no significant group differences in symbol search performance. Dot memory scores correlated with NIH Toolbox working memory scores in both groups. FM participants exhibited worse dot memory performance than did non-FM participants. CONCLUSIONS Repeated ambulatory tests of processing speed and working memory demonstrate feasibility and reliability in FM, though evidence for construct validity is mixed. The findings demonstrate promise for future research and clinical applications of this approach to assessing cognition in FM.
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Affiliation(s)
- Thomas R. Valentine
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA
| | - Anna L. Kratz
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA
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Dass R, Kalia M, Harris J, Packham T. Understanding the Experience and Impacts of Brain Fog in Chronic Pain: A Scoping Review. Can J Pain 2023; 7:2217865. [PMID: 37441085 PMCID: PMC10334862 DOI: 10.1080/24740527.2023.2217865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 05/10/2023] [Accepted: 05/22/2023] [Indexed: 07/15/2023]
Abstract
Introduction Approximately 15% to 40% of persons with chronic pain as a primary disorder experience brain fog. Prior research has investigated the etiology of "brain fog" in conditions in which pain presents as a key feature (e.g., fibromyalgia). However, it remains understudied in the context of chronic 10 musculoskeletal pain. Following current scoping review guidelines, we obtained stakeholder input from patient and health care professionals (HCPs) to define this phenomenon. Specific aims of this review were to (1) identify factors contributing to brain fog, (2) identify the functional correlates of brain fog and assessments used to measure them, and (3) establish a definition of brain fog that can be employed by researchers and HCPs to advance research and care. Methods A scoping review was conducted using recommendations of the Joanna Briggs Institute methodology of scoping reviews and the Levac et al methodology. Embase, Cinahl, PsycINFO, and Medline was searched to identify relevant sources. Findings were verified with patient and healthcare professionals. Results We identified four 15 key features of brain fog: perceived variability, subjective cognitive dysfunction, participation limitations, and changes in functional activities. We developed a model of brain fog illustrating the overlapping categories of contributors to brain fog in chronic musculoskeletal pain: (1) neuroanatomical and neurophysiological, (2) mental health/emotional, and (3) environmental/lifestyle. Conclusion The results of this scoping review conclude that the inconsistency in research regarding brain fog in 20 chronic musculoskeletal pain is obstructing a clear understanding of the phenomenon and therefore may be impeding persons with chronic pain and brain fog from receiving optimal care.
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Affiliation(s)
- Ronessa Dass
- School of Rehabilitation Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Mohini Kalia
- Faculty of Sciences, Carleton University, Ottawa, Ontario, Canada
| | - Jocelyn Harris
- School of Rehabilitation Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Tara Packham
- School of Rehabilitation Sciences, McMaster University, Hamilton, Ontario, Canada
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3
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Serrano PV, Zortea M, Alves RL, Beltran G, Deliberali CB, Maule A, Torres ILS, Fregni F, Caumo W. Association between descending pain modulatory system and cognitive impairment in fibromyalgia: A cross-sectional exploratory study. Front Behav Neurosci 2022; 16:917554. [PMID: 36248031 PMCID: PMC9559397 DOI: 10.3389/fnbeh.2022.917554] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 07/29/2022] [Indexed: 11/17/2022] Open
Abstract
Background The successful regulation of sensory input to the central nervous system depends on the descending pain modulatory system (DPMS). For the effective regulation of sensory input to the central nervous system and behavioral responses to pain, the DPMS is required. Its connection to fibromyalgia (FM)-related cognitive dysfunction has not yet been investigated. Therefore, this study tested whether measures of verbal fluency, sustained attention, and short-term and working memory could distinguish FM patients from healthy controls (HC). Additionally, it investigated, using a standardized paradigm, the link between cognitive ability and the function of the DPMS in responders and non-responders to the conditioned pain modulation test (CPM-test). Materials and methods We enrolled 21 HC women and 69 FM patients, all of whom ranged in age from 30 to 65. We employed scores from the Trail Making Test (TMTB-A) (sustained and divided attention), the Controlled Oral Word Association Test (COWAT) (orthographic and semantic fluency), and the Digits subtest of the Wechsler Adult Intelligence Scale (WAIS-III) as dependent variables. Results A generalized linear model (GLM) adjusted by educational level revealed significantly lower scores in FM than HC on the Span digits forward, COWAT-orthographic, and TMTB-A. For FM patients, multilevel MANCOVA revealed that the cognitive performance of non-responders compared to responders to CPM-test showed lower adjusted scores in Span digits forward (Partial-η2 = 0.358, P = 0.001), Span digits backward (Partial-η2 = 0.358, P = 0.001), COWAT-orthographic (Partial-η2 = 0.551, P = 0.001), COWAR-semantic (Partial-η2 = 0.355, P = 0.001), and TMTB-A (Partial-η2 = 0.360, P = 0.001). The association between the cognitive tests and the DPMS is moderated by the serum level of brain-derived neurotrophic factor (BDNF). Additionally, these cognitive assessments had a positive correlation with antidepressant use and pain threshold. The cognitive assessments, on the other hand, were conversely associated with a life of quality. Conclusion Based on these findings, it can be shown that HC performed substantially better on cognitive exams than FM did. They demonstrated a link between clinical complaints about attention and memory and decreased DPMS effectiveness. Additionally, they demonstrated that the BDNF is a moderating element in a potential relationship between the severity of cognitive impairment and DPMS dysfunction.
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Affiliation(s)
- Paul Vicuña Serrano
- Post-graduate Program in Medical Sciences, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
- Laboratory of Pain and Neuromodulation, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
| | - Maxciel Zortea
- Laboratory of Pain and Neuromodulation, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
- Department of Psychology, UNISINOS, São Leopoldo/Porto Alegre, Brazil
| | - Rael Lopes Alves
- Post-graduate Program in Medical Sciences, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
- Laboratory of Pain and Neuromodulation, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
| | - Gerardo Beltran
- Post-graduate Program in Medical Sciences, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
- Laboratory of Pain and Neuromodulation, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
- Institute of Neurosciences, Universidad Catolica de Cuenca (UCACUE), Cuenca, Ecuador
| | | | - Amanda Maule
- Laboratory of Pain and Neuromodulation, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
| | - Iraci L. S. Torres
- Post-graduate Program in Medical Sciences, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
- Laboratório de Farmacologia da Dor e Neuromodulação: Investigacoes Pre-clinicas, Centro de Pesquisa Experimental (CPE), Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
| | - Felipe Fregni
- Laboratory of Neuromodulation and Center for Clinical Research Learning, Department of Physics and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, MA, United States
| | - Wolnei Caumo
- Laboratory of Pain and Neuromodulation, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
- Laboratório de Farmacologia da Dor e Neuromodulação: Investigacoes Pre-clinicas, Centro de Pesquisa Experimental (CPE), Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
- Pain and Palliative Care Service, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
- Department of Surgery, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
- *Correspondence: Wolnei Caumo,
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Deumer US, Varesi A, Floris V, Savioli G, Mantovani E, López-Carrasco P, Rosati GM, Prasad S, Ricevuti G. Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS): An Overview. J Clin Med 2021; 10:jcm10204786. [PMID: 34682909 PMCID: PMC8538807 DOI: 10.3390/jcm10204786] [Citation(s) in RCA: 51] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 10/12/2021] [Accepted: 10/15/2021] [Indexed: 12/20/2022] Open
Abstract
Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a chronic systemic disease that manifests via various symptoms such as chronic fatigue, post-exertional malaise, and cognitive impairment described as “brain fog”. These symptoms often prevent patients from keeping up their pre-disease onset lifestyle, as extended periods of physical or mental activity become almost impossible. However, the disease presents heterogeneously with varying severity across patients. Therefore, consensus criteria have been designed to provide a diagnosis based on symptoms. To date, no biomarker-based tests or diagnoses are available, since the molecular changes observed also largely differ from patient to patient. In this review, we discuss the infectious, genetic, and hormonal components that may be involved in CFS pathogenesis, we scrutinize the role of gut microbiota in disease progression, we highlight the potential of non-coding RNA (ncRNA) for the development of diagnostic tools and briefly mention the possibility of SARS-CoV-2 infection causing CFS.
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Affiliation(s)
- Undine-Sophie Deumer
- Department of Biological Sciences, Faculty of Natural Sciences and Mathematics, University of Cologne, 50674 Cologne, Germany;
| | - Angelica Varesi
- Department of Biology and Biotechnology, University of Pavia, 27100 Pavia, Italy
- Almo Collegio Borromeo, 27100 Pavia, Italy
- Correspondence: (A.V.); (G.R.)
| | - Valentina Floris
- Department of Internal Medicine and Therapeutics, University of Pavia, 27100 Pavia, Italy;
| | - Gabriele Savioli
- Emergency Department, IRCCS Policlinico San Matteo, 27100 Pavia, Italy;
| | - Elisa Mantovani
- Department of Neurosciences, Biomedicine and Movement Sciences, Neurology Section, University of Verona, 37129 Verona, Italy;
| | - Paulina López-Carrasco
- División de Neurociencias, Instituto de Fisiología Celular, Universidad Nacional Autónoma de México (UNAM), Mexico City 04510, Mexico;
| | | | - Sakshi Prasad
- National Pirogov Memorial Medical University, 21018 Vinnytsya, Ukraine;
| | - Giovanni Ricevuti
- School of Pharmacy, Department of Drug Sciences, University of Pavia, 27100 Pavia, Italy
- Correspondence: (A.V.); (G.R.)
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Is clinical, musculoskeletal pain associated with poorer logical reasoning? Pain Rep 2021; 6:e929. [PMID: 33997585 PMCID: PMC8116037 DOI: 10.1097/pr9.0000000000000929] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Revised: 03/25/2021] [Accepted: 04/03/2021] [Indexed: 11/26/2022] Open
Abstract
Clinical pain does not seem to be considerably related to logical reasoning ability, which seems consistent with the effect of experimental pain on logical reasoning. Introduction: It has been hypothesized that pain disrupts system 2 processes (eg, working memory) presumed to underlie logical reasoning. A recent study examining the impact of experimentally induced pain on logical reasoning found no evidence of an effect. Objectives: The aim of this study was to examine whether clinical pain, which is qualitatively different from experimental pain, would lower the ability to reason logically. Methods: Ninety-six participants completed a questionnaire containing 3 different logical reasoning tasks (the cognitive reflection test, the belief bias syllogisms task, and the conditional inference task), questions about pain variables (present pain intensity, pain intensity during the last 24 hours, the influence of pain on daily activities, pain duration, and pain persistence), questions about other pain-related states (anxiety, depression, and fatigue), and pain-relieving medication. Correlations between the logical reasoning tasks and the pain variables were calculated. Results: For 2 of the 3 logical reasoning tasks (the cognitive reflection test and the belief bias syllogisms task), clinical pain was unrelated to logical reasoning. Performance on context-free logical reasoning showed a significant negative correlation with present pain intensity, but not with the other pain variables. Conclusion: This finding that logical reasoning ability is largely unrelated to clinical pain is highly consistent with previous research on experimentally induced pain. Pain should probably not constitute a significant barrier to logical reasoning in everyday life.
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6
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Pallanti S, Porta F, Salerno L. Adult attention deficit hyperactivity disorder in patients with fibromyalgia syndrome: Assessment and disabilities. J Psychiatr Res 2021; 136:537-542. [PMID: 33127072 DOI: 10.1016/j.jpsychires.2020.10.027] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 10/18/2020] [Accepted: 10/21/2020] [Indexed: 10/23/2022]
Abstract
In the broader list of cognitive concerns, neuropsychological testing has shown that attentional impairment may have a specific burden in Fibromyalgia Syndrome (FMS). Preliminary observations have reported a subset of FMS patient screened for attention disorders fulfilling the actual diagnosis of ADHD, a neurodevelopmental disorder characterized by developmentally inadequate levels of inattention, hyperactivity and impulsivity that might persist in adulthood. Yet, no study to date has systematically examined the history and the specific contribution of ADHD to FMS in terms of clinical impact and related specific disabilities. In this study, 106 individuals with a FMS diagnosis based on the 2010 criteria of the American College of Rheumatology have been assessed for (a) the presence of ADHD; (b) the burden of disability caused by ADHD versus FMS; (c) the presence of other psychiatric disorders. Results indicated that ADHD was present in 24.5% of FMS individuals, it was associated with higher FMS symptoms severity and a greater functional impairment, particularly in the work/school domain. Moreover, patients with both FMS and ADHD had higher frequency of substance use disorders than those with FMS only (38.5% versus 3.8%) and mainly opioids. Overall, results suggest that ADHD can increase burden adding specific disability in work and social activities, and it is associated with a trend for the excessive use of opioid painkillers. Detection of neurodevelopmental and actual symptoms of ADHD is highly recommended especially in patient prone to increase the dose of anti-pain medication.
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Affiliation(s)
- Stefano Pallanti
- INS, Istituto di Neuroscienze, Florence, Italy; Albert Einstein College of Medicine (New York), Department of Psychiatry and Behavioral Sciences, USA
| | - Francesco Porta
- INS, Istituto di Neuroscienze, Florence, Italy; MedCare, Pistoia, Italy
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7
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Castel A, Cascón-Pereira R, Boada S. Memory complaints and cognitive performance in fibromyalgia and chronic pain: The key role of depression. Scand J Psychol 2021; 62:328-338. [PMID: 33538343 DOI: 10.1111/sjop.12706] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 10/19/2020] [Accepted: 11/27/2020] [Indexed: 11/30/2022]
Abstract
To explore the relationship between perceived cognitive problems and cognitive performance in three different samples, taking into account the possible influence of depression, catastrophizing, pain intensity, or medication. Seventy individuals with fibromyalgia, 74 with non-malignant chronic pain and 40 pain-free controls, completed measures of verbal episodic memory, sustained attention, response inhibition, depression, catastrophizing, and pain intensity. Fibromyalgia and chronic pain patients performed worse than controls in verbal memory and sustained attention, but these differences disappeared when depressed participants were excluded from the analyses. Memory complaints were related with depression in all pain patients. However, in the case of fibromyalgia, memory complaints were also related by pain intensity and inversely related by short-term episodic memory. This case-control study shows the importance of jointly assessing cognitive performance and memory complaints and of controlling for variables such as depression, catastrophizing, pain intensity and medication in the studied samples. Accordingly, this study highlights the differences in memory complaints, between the patients with fibromyalgia and the patients with other chronic pain conditions. Finally, it has highlighted the important role played by depression in cognitive performance and memory complaints considering the Neurocognitive Model of Attention to pain.
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Affiliation(s)
- Antoni Castel
- Pain Clinic, Hospital Universitari de Tarragona Joan XXIII, Tarragona, Spain.,Multidimentional Pain Research Group, Institut d'Investigació Sanitària Pere Virgili, Reus, Spain
| | - Rosalia Cascón-Pereira
- Multidimentional Pain Research Group, Institut d'Investigació Sanitària Pere Virgili, Reus, Spain.,Business Management Unit, Universitat Rovira i Virgili, Reus, Spain
| | - Sergi Boada
- Pain Clinic, Hospital Universitari de Tarragona Joan XXIII, Tarragona, Spain
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8
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Gunnarsson H, Safipour J, Elmqvist C, Lindqvist G. Different pain variables could independently predict anxiety and depression in subjects with chronic musculoskeletal pain. Scand J Pain 2021; 21:274-282. [PMID: 34387962 DOI: 10.1515/sjpain-2020-0129] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 10/26/2020] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Chronic, clinical pain states are often accompanied by distress such as anxiety and depression. The aim of this study was to determine if certain clinical pain variables could predict the level of anxiety and depression in subjects with musculoskeletal pain. METHODS Two multiple linear regression analyses were conducted on a sample consisting of 189 subjects with clinical pain with the independent pain variables of pain intensity, the influence of pain on daily activities, pain persistence, pain duration, and the number of pain locations. The dependent variables measured anxiety and depression, respectively. RESULT Two statistically significant models were found, where the predicted variables accounted for 37.0% of the variability in the anxiety levels and 43.7% of the variability in the depression levels. The independent variable, the influence of pain on daily activities, significantly predicted the level of anxiety. The variables, the influence of pain on daily activities and the number of pain locations, significantly predicted the levels of anxiety and depression. CONCLUSIONS This study showed that two different independent variables, the influence of pain on daily activities and the number of pain locations, significantly predicted the levels of depression. The predictor, the influence of pain on daily activities, significantly predicted the levels of anxiety. The knowledge gained about which specific pain variables are more likely to coexist with anxiety and depression in clinical pain states could be important in implementing holistic treatment plans for chronic pain.
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Affiliation(s)
| | - Jalal Safipour
- Department of Health and Caring Sciences, Linnaeus University, Växjö, Sweden
| | - Carina Elmqvist
- Department of Health and Caring Sciences, Linnaeus University, Växjö, Sweden.,R&D Department, Region Kronoberg, Växjö, Sweden
| | - Gunilla Lindqvist
- Department of Health and Caring Sciences, Linnaeus University, Växjö, Sweden
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9
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Kratz AL, Whibley D, Kim S, Sliwinski M, Clauw D, Williams DA. Fibrofog in Daily Life: An Examination of Ambulatory Subjective and Objective Cognitive Function in Fibromyalgia. Arthritis Care Res (Hoboken) 2020; 72:1669-1677. [PMID: 31609548 PMCID: PMC7153985 DOI: 10.1002/acr.24089] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 10/08/2019] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Perceived cognitive dysfunction in fibromyalgia (FM), "fibrofog," is common. Prior laboratory-based studies have limited our understanding of cognitive function in FM in daily life. The objective of this study was to explore levels of subjective and objective cognitive functioning and the association between subjective and objective aspects of cognition in people with and without FM in the lived environment. METHODS Participants (n = 50 adults with FM; n = 50 adults without FM, matched for age, sex, and education) completed baseline measures of subjective and objective cognitive functioning (NIH Toolbox). They also completed ecological momentary assessments of cognitive clarity and speed and tests of processing speed and working memory, via a smart phone app, 5×/day for 8 days. RESULTS On baseline objective measures, the FM group demonstrated poorer cognitive functioning across 3 NIH Toolbox tests. There were no strong correlations between subjective and objective cognitive functioning in both the FM and control groups. In the lived environment, the FM group demonstrated poorer subjective cognition and objective working memory; groups did not differ on processing speed. Momentary ratings of subjective cognitive dysfunction were significantly related to changes in objective processing speed but not working memory, with no group differences. CONCLUSION Findings indicate worse laboratory-based and ambulatory subjective and objective cognitive function for those individuals with FM compared to those without FM. Similar associations between measures of subjective and objective cognitive functioning for the groups suggest that people with FM are not overstating cognitive difficulties. Future research examining contributors to ambulatory fibrofog is warranted.
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Affiliation(s)
- Anna L. Kratz
- Department of Physical Medicine & Rehabilitation, University of Michigan, Ann Arbor, MI
| | - Daniel Whibley
- Department of Physical Medicine & Rehabilitation, University of Michigan, Ann Arbor, MI
- Epidemiology Group, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
- Department of Anesthesiology, Chronic Pain & Fatigue Research Center, University of Michigan, Ann Arbor, MI
| | - Samsuk Kim
- Department of Psychology, University of Detroit Mercy, Detroit, MI
| | - Martin Sliwinski
- Center for Healthy Aging, Pennsylvania State University, University Park, PA
| | - Daniel Clauw
- Department of Anesthesiology, Chronic Pain & Fatigue Research Center, University of Michigan, Ann Arbor, MI
| | - David A. Williams
- Department of Anesthesiology, Chronic Pain & Fatigue Research Center, University of Michigan, Ann Arbor, MI
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10
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Effects of COMT Genotypes on Working Memory Performance in Fibromyalgia Patients. J Clin Med 2020; 9:jcm9082479. [PMID: 32752289 PMCID: PMC7464119 DOI: 10.3390/jcm9082479] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 07/28/2020] [Accepted: 07/29/2020] [Indexed: 12/23/2022] Open
Abstract
Growing research has reported the presence of a clear impairment of working memory functioning in fibromyalgia. Although different genetic factors involving dopamine availability (i.e, the COMT gene) have been associated with the more severe presentation of key symptoms in fibromyalgia, scientific evidence regarding the influence of COMT genotypes on cognitive impairment in these patients is still lacking. To this end, 167 participants took part in the present investigation. Working memory performance was assessed by the application of the SST (Spatial Span Test) and LNST (Letter and Number Sequence Test) belonging to the Weschler Memory Scale III. Significant working memory impairment was shown by the fibromyalgia patients. Remarkably, our results suggest that performance according to different working memory measures might be influenced by different genotypes of the COMT gene. Specifically, fibromyalgia patients carrying the Val/Val genotype exhibited significantly worse outcomes for the span of SST backward, SST backward score, SST total score and the Working Memory Index (WMI) than the Val/Val healthy carriers. Furthermore, the Val/Val patients performed worse on the SST backward and SST score than heterozygotes. Our findings are the first to show a link between the COMT gene and working memory dysfunction in fibromyalgia, supporting the idea that higher COMT enzyme activity would contribute to more severe working memory impairment in fibromyalgia.
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11
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Low Kapalu CM, Hall JJ, Wallace DP. Neuropsychological Functioning of Youth Receiving Intensive Interdisciplinary Pain Treatment. J Pediatr Psychol 2019; 43:870-881. [PMID: 29846679 DOI: 10.1093/jpepsy/jsy034] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Accepted: 04/30/2018] [Indexed: 12/29/2022] Open
Abstract
Objective Chronic pain is associated with school difficulties; however, there is limited published evidence on the cognitive or neuropsychological functioning of youth with chronic pain. Method When beginning intensive interdisciplinary pain treatment, 94 youth (age = 10-18) with chronic pain completed neuropsychological assessment (e.g., intelligence, academic skills, learning and recall, and attention) and clinical questionnaires (e.g., pain and physical and psychological functioning). We compared neuropsychological scores with test norms and with clinical questionnaires. Results Youth with chronic pain had higher verbal comprehension and full scale IQ scores than expected, below-average nondominant hand dexterity, and difficulty with visual recall. Self-reported difficulties with executive functioning were associated with small-to-moderate difficulties with objectively measured attention. Performance on neuropsychological measures was generally not associated with pain, impairment, anxiety, or depression, though catastrophizing was negatively correlated with perceptual reasoning. An expected number of these youth had learning disorders (14%); however, more than expected had an autism spectrum disorder (9%) or attention deficit hyperactivity disorder (18%), and nearly a quarter demonstrated characteristics of nonverbal learning disability (22%). Conclusions Some of these cognitive findings may be a consequence of chronic pain, and others may reflect subtle neurodevelopmental differences that may predate or be comorbid with pain. Regardless of etiology, with more than half the current sample experiencing some type of learning challenge, often undiagnosed, pediatric psychologists evaluating youth with chronic pain may wish to screen for comorbid learning difficulties.
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Affiliation(s)
| | - John J Hall
- Children's Mercy Kansas City.,School of Medicine, University of Missouri Kansas City
| | - Dustin P Wallace
- Children's Mercy Kansas City.,School of Medicine, University of Missouri Kansas City
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12
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Emotional Influences on Cognitive Processing in Fibromyalgia Patients With Different Depression Levels: An Event-related Potential Study. Clin J Pain 2019; 34:1106-1113. [PMID: 29975206 DOI: 10.1097/ajp.0000000000000637] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
OBJECTIVES Comorbid symptoms in fibromyalgia (FM) syndrome, such as mood disorders and cognitive dysfunction, may lead to greater functional impairment than pain itself. This study aimed to unravel the modulating role of depression in response execution and inhibition in FM using an emotional go/no-go task. MATERIALS AND METHODS In total, 17 FM patients with low depression, 18 FM patients with high depression, and 18 pain-free controls were included. Pain, happy, and neutral faces were pseudorandomly presented, and participants were asked to respond to male faces (go trials) by pressing a button, and to inhibit their responses if female faces were presented (no-go trials). RESULTS FM patients with high depression showed lower positive affect scores, higher negative affect and pain vigilance scores, and slower reaction times, than FM patients with low depression and pain-free controls. Both subgroups of FM patients also rated pain faces as more arousing than pain-free controls. The lack of group differences in our electrophysiological data, neither in N200 nor in P300 amplitudes, seems to indicate that there was no significant impairment in response execution in response inhibition due to pain. DISCUSSION Taken together, these results add evidence to the notion that depression is associated with higher affective dysregulation and deficit of information-processing speed in FM. Furthermore, our data suggest that pain induces a bias to pain-related information, but the absence of significant group differences in event-related potential amplitudes, calculated with analyses of covariance (ANCOVA) (with pain intensity), seem to show that pain intensity is not a predictor for cognitive dysfunctions.
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Kim JH. Effect of depressive disorder on cognitive decline. Arch Gerontol Geriatr 2019; 83:211-216. [PMID: 31096098 DOI: 10.1016/j.archger.2019.05.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 04/22/2019] [Accepted: 05/07/2019] [Indexed: 11/29/2022]
Abstract
This study longitudinally investigates the effect of depressive disorder on psychiatric disorder in middle aged and aged population from the Korean Longitudinal Study of Aging. Data from the Korean Longitudinal Study of Aging (KLoSA) from 2006 to 2016 was assessed using longitudinal data analysis and 7515 research samples were included after excluding those with cognitive decline and missing information at baseline (2006). To analyze the association between depressive disorder on cognitive decline in middle aged and aged population, generalized estimating equation (GEE) model and chi-square test were used. The association between depressive symptom during a week and center for epidemiological studies depression (CESD) on cognitive decline was statistically significant, respectively with the following Odds ratio (OR) predicting decreased MMSE score: OR = 0.89 (p < .0001) for 5-7 days vs. less than a day and B = 0.91 (p < .0001) for depression (8-10) vs. healthy (zero). In terms of cognitive decline, depressive symptom was higher for 5-7 days (OR = 3.79, p < .0001) compared to less than a day. This study shows a statistically significant association between depressive disorder and cognitive decline in a Korean middle aged and aged population. These findings suggest the importance of managing depressive disorder for incident cognitive decline.
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Affiliation(s)
- Jae-Hyun Kim
- Department of Health Administration, College of Health Science, Dankook University, Cheonan, Republic of Korea; Institute of Health Promotion and Policy, Dankook University, Cheonan, Republic of Korea.
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A comprehensive literature review of chronic pain and memory. Prog Neuropsychopharmacol Biol Psychiatry 2018; 87:183-192. [PMID: 28797640 DOI: 10.1016/j.pnpbp.2017.08.006] [Citation(s) in RCA: 77] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 07/29/2017] [Accepted: 08/05/2017] [Indexed: 12/22/2022]
Abstract
Chronic pain patients often complain of their "poor memory" and numerous studies objectively confirmed such difficulties in reporting working memory (WM) and long-term memory (LTM) dysfunctions. This paper provides a comprehensive review of the literature on memory impairment in chronic pain (CP) patients. Twenty-four observational studies evaluating WM or/and LTM in a chronic pain group and a control group were included in this review. Results showed that studies consistently reported a moderate decline, in both WM and LTM performances in CP patients. Even if CP patients complained about forgetfulness, objective measurements did not permit to conclude to a long-term storage impairment. CP patients exhibited more specifically encoding or retrieving difficulties compared to controls. Results showed that chronic pain selectively impacted the most attention-demanding memory processes, such as working memory and recollection in long-term memory. Results also demonstrated that CP patients exhibited a memory bias directed towards painful events compared to control subjects. Several authors have suggested that CP could be a maladaptive consequence of memory mechanisms. The long-lasting presence of pain continuously reinforces aversive emotional associations with incidental events. The inability to extinguish this painful memory trace could explain the chronic persistence of pain even when the original injury has disappeared. A major concern is the need to extricate pain-related cognitive effects from those resulting from all the co-morbidities associated with CP which both have a deleterious effect on cognitive function.
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Teodoro T, Edwards MJ, Isaacs JD. A unifying theory for cognitive abnormalities in functional neurological disorders, fibromyalgia and chronic fatigue syndrome: systematic review. J Neurol Neurosurg Psychiatry 2018; 89:1308-1319. [PMID: 29735513 PMCID: PMC6288708 DOI: 10.1136/jnnp-2017-317823] [Citation(s) in RCA: 124] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Revised: 03/24/2018] [Accepted: 04/10/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND Functional cognitive disorder (FCD) describes cognitive dysfunction in the absence of an organic cause. It is increasingly prevalent in healthcare settings yet its key neuropsychological features have not been reported in large patient cohorts. We hypothesised that cognitive profiles in fibromyalgia (FM), chronic fatigue syndrome (CFS) and functional neurological disorders (FNDs) would provide a template for characterising FCD. METHODS We conducted a systematic review of studies with cognition-related outcomes in FM, CFS and FND. RESULTS We selected 52 studies on FM, 95 on CFS and 39 on FND. We found a general discordance between high rates of subjective cognitive symptoms, including forgetfulness, distractibility and word-finding difficulties, and inconsistent objective neuropsychological deficits. Objective deficits were reported, including poor selective and divided attention, slow information processing and vulnerability to distraction. In some studies, cognitive performance was inversely correlated with pain, exertion and fatigue. Performance validity testing demonstrated poor effort in only a minority of subjects, and patients with CFS showed a heightened perception of effort. DISCUSSION The cognitive profiles of FM, CFS and non-cognitive FND are similar to the proposed features of FCD, suggesting common mechanistic underpinnings. Similar findings have been reported in patients with mild traumatic brain injury and whiplash. We hypothesise that pain, fatigue and excessive interoceptive monitoring produce a decrease in externally directed attention. This increases susceptibility to distraction and slows information processing, interfering with cognitive function, in particular multitasking. Routine cognitive processes are experienced as unduly effortful. This may reflect a switch from an automatic to a less efficient controlled or explicit cognitive mode, a mechanism that has also been proposed for impaired motor control in FND. These experiences might then be overinterpreted due to memory perfectionism and heightened self-monitoring of cognitive performance.
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Affiliation(s)
- Tiago Teodoro
- Neurosciences Research Centre, Molecular and Clinical Sciences Research Institute, St George's, University of London, London, UK.,Department of Neurology, St George's University Hospitals NHS Foundation Trust, London, UK.,Instituto de Medicina Molecular Faculdade de Medicina, Universidade de Lisboa & Serviço de Neurologia Hospital de Santa Maria, Lisboa, Portugal
| | - Mark J Edwards
- Neurosciences Research Centre, Molecular and Clinical Sciences Research Institute, St George's, University of London, London, UK.,Department of Neurology, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Jeremy D Isaacs
- Neurosciences Research Centre, Molecular and Clinical Sciences Research Institute, St George's, University of London, London, UK.,Department of Neurology, St George's University Hospitals NHS Foundation Trust, London, UK
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16
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Pidal-Miranda M, González-Villar AJ, Carrillo-de-la-Peña MT, Andrade E, Rodríguez-Salgado D. Broad cognitive complaints but subtle objective working memory impairment in fibromyalgia patients. PeerJ 2018; 6:e5907. [PMID: 30498630 PMCID: PMC6252063 DOI: 10.7717/peerj.5907] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 10/09/2018] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Cognitive dysfunction in fibromyalgia (FM) encompasses objective cognitive difficulties, as measured in neuropsychological tests, and self-reported cognitive complaints. Although it has been suggested that FM patients display problems in working memory, the data are inconsistent, and the overall working memory status of the patients is unclear. It is also not clear whether the working memory problems are related to cognitive complaints or how the dyscognition is affected by the characteristic clinical symptoms of FM. METHODS To clarify these aspects, we explored the neuropsychological performance for different components of working memory and the subjective self-perception of cognitive status in a sample of 38 women with FM. They were compared with a matched group of 32 healthy women. RESULTS Our findings suggested that the FM patients do not differ from healthy controls in their overall working memory functioning. Only a poor performance was found in a single task of visuospatial working memory, mediated by the presence of depressive symptoms, fatigue and pain. The FM patients also displayed a higher level of perception of cognitive difficulties than healthy controls, and this difference was mediated by depression and fatigue. Furthermore, cognitive complaints in FM patients were only associated with a lower verbal WM capacity. DISCUSSION FM patients have a subtle specific impairment in their working memory functioning, as well as elevated concern about their cognitive status. These findings suggest a disconnection between neuropsychological performance and subjective complaints. In FM patients, clinical variables such as pain, fatigue, and depression play an important role in dyscognition, as assessed by both objective and subjective measures, and should be taken into account in future research.
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Affiliation(s)
- Marina Pidal-Miranda
- Department of Clinical Psychology and Psychobiology, Universidad de Santiago de Compostela, Santiago de Compostela, Spain
| | - Alberto Jacobo González-Villar
- Department of Clinical Psychology and Psychobiology, Universidad de Santiago de Compostela, Santiago de Compostela, Spain
| | | | - Elena Andrade
- Department of Social, Basic and Methodological Psychology, Universidad de Santiago de Compostela, Santiago de Compostela, Spain
| | - Dolores Rodríguez-Salgado
- Department of Clinical Psychology and Psychobiology, Universidad de Santiago de Compostela, Santiago de Compostela, Spain
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17
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Gelonch O, Garolera M, Valls J, Castellà G, Varela O, Rosselló L, Pifarre J. The effect of depressive symptoms on cognition in patients with fibromyalgia. PLoS One 2018; 13:e0200057. [PMID: 29975749 PMCID: PMC6033429 DOI: 10.1371/journal.pone.0200057] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2016] [Accepted: 06/18/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Fibromyalgia (FM) patients frequently complain of cognitive problems, but it remains unclear whether these cognitive complaints can be attributed to a dysfunction of the central nervous system or if they can be explained by other factors associated with the disease, such as depression, anxiety and sleep dysfunction. METHODS One hundred and ten patients with FM were compared with thirty-three patients diagnosed with a depressive disorder (DD) and fifty healthy controls (HC). Several measures of attention and executive functions were used to make these comparisons and the patients were also asked to complete questionnaires on depression, anxiety and sleep quality. Univariate analyses of covariance (ANCOVA) were performed to identify and control confounders and multiple linear models were used to examine the effects of fibromyalgia and depression on cognitive measures. RESULTS FM and HC differed significantly with respect to depression, anxiety and sleep dysfunction, whereas FM and DD did not differ in terms of symptoms of depression and anxiety. However, FM was associated with a worse quality of sleep than DD. Comparisons of cognitive performance between groups showed that short-term and working memory and inattention measures were only associated with symptoms of depression, whereas selective attention was associated with both depression and fibromyalgia, and processing speed, cognitive flexibility and inhibitory control showed a significant interaction between depression and fibromyalgia. Moreover, cognitive flexibility and inhibition abilities were specifically associated with FM. CONCLUSION FM patients show a cluster of cognitive impairment in the attentional and executive domains, although some of the symptoms observed could be explained by the severity of the symptoms of depression, while others seem to depend on the effects of fibromyalgia. Implications of the findings for the understanding and management of cognitive impairment of FM patients are discussed.
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Affiliation(s)
- Olga Gelonch
- Universitat de Lleida, Lleida, Spain
- Brain, Cognition and Behavior: Clinical Research, Consorci Sanitari de Terrassa, Terrassa, Spain
| | - Maite Garolera
- Brain, Cognition and Behavior: Clinical Research, Consorci Sanitari de Terrassa, Terrassa, Spain
- Neuropsychology Unit, Hospital de Terrassa, Consorci Sanitari de Terrassa, Terrassa, Spain
| | - Joan Valls
- Lleida Institute for Biomedical Research, Dr. Pifarré Foundation, IRBLLEDA, Lleida, Spain
| | - Gerard Castellà
- Lleida Institute for Biomedical Research, Dr. Pifarré Foundation, IRBLLEDA, Lleida, Spain
| | - Olalla Varela
- Hospital Universitari Arnau de Vilanova, Lleida, Spain
| | - Lluís Rosselló
- Reumatology Section, Fibromyalgia and Chronic Fatigue Syndrome Unit, GSS-Hospital Universitari de Santa Maria, Lleida, Spain
| | - Josep Pifarre
- Universitat de Lleida, Lleida, Spain
- Lleida Institute for Biomedical Research, Dr. Pifarré Foundation, IRBLLEDA, Lleida, Spain
- GSS- Hospital Universitari de Santa Maria, Lleida, Spain
- Sant Joan de Deu Terres de Lleida, Lleida, Spain
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18
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Bell T, Trost Z, Buelow MT, Clay O, Younger J, Moore D, Crowe M. Meta-analysis of cognitive performance in fibromyalgia. J Clin Exp Neuropsychol 2018; 40:698-714. [PMID: 29388512 DOI: 10.1080/13803395.2017.1422699] [Citation(s) in RCA: 68] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Fibromyalgia is a condition with symptoms of pain, physical function difficulties, and emotional problems, but is also characterized by complaints of poor cognition (often called "FibroFog"). Over the last two decades, a number of studies have examined cognitive differences between individuals with and without fibromyalgia. The purpose of the current study was to conduct a quantitative synthesis of these differences across multiple cognitive domains. METHOD Following Cochrane guidelines, we identified 37 eligible studies for analysis where persons with fibromyalgia (total n = 964) were compared to participants from age-matched control groups without fibromyalgia (total n = 1025) on a range of neuropsychological measures. Group differences between persons with fibromyalgia and healthy controls were examined for cognitive domains including processing speed, long- and short-term memory, and executive functions (inhibitory control, set shifting, updating, and accessing). Random-effect meta-analyses were conducted to determine effect sizes for these differences in cognitive performance. RESULTS Fibromyalgia was significantly and negatively associated with performance on all domains of cognitive function. The largest effect size was found for inhibitory control (g = 0.61), followed by memory (g = 0.51 for short-term, 0.50 for long-term memory). The smallest cognitive difference between those with fibromyalgia and controls was for set shifting (g = 0.30). CONCLUSION These findings support the hypothesis that the self-reported cognitive impact of fibromyalgia is also found in objective neuropsychological measures. Routine screening for cognitive dysfunction in those with fibromyalgia may be warranted in addition to assessment of the traditional fibromyalgia symptoms.
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Affiliation(s)
- Tyler Bell
- a Psychology Department , University of Alabama at Birmingham , Birmingham , AL , USA
| | - Zina Trost
- a Psychology Department , University of Alabama at Birmingham , Birmingham , AL , USA
| | - Melissa T Buelow
- b Department of Psychology , The Ohio State University Newark, Newark, OH, USA
| | - Olivio Clay
- a Psychology Department , University of Alabama at Birmingham , Birmingham , AL , USA
| | - Jarred Younger
- c Department of Psychology and Department of Anesthesiology , University of Alabama at Birmingham , Birmingham , AL , USA
| | - David Moore
- d School of Natural Sciences and Psychology , Liverpool John Moores University, Liverpool, UK
| | - Michael Crowe
- a Psychology Department , University of Alabama at Birmingham , Birmingham , AL , USA
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Abstract
Approximately 30 % of Americans suffer from chronic pain disorders, such as fibromyalgia (FM), which can cause debilitating pain. Many pain-killing drugs prescribed for chronic pain disorders are highly addictive, have limited clinical efficacy, and do not treat the cognitive symptoms reported by many patients. The neurobiological substrates of chronic pain are largely unknown, but evidence points to altered dopaminergic transmission in aberrant pain perception. We sought to characterize the dopamine (DA) system in individuals with FM. Positron emission tomography (PET) with [(18)F]fallypride (FAL) was used to assess changes in DA during a working memory challenge relative to a baseline task, and to test for associations between baseline D2/D3 availability and experimental pain measures. Twelve female subjects with FM and 11 female controls completed study procedures. Subjects received one FAL PET scan while performing a "2-back" task, and one while performing a "0-back" (attentional control, "baseline") task. FM subjects had lower baseline FAL binding potential (BP) in several cortical regions relative to controls, including anterior cingulate cortex. In FM subjects, self-reported spontaneous pain negatively correlated with FAL BP in the left orbitofrontal cortex and parahippocampal gyrus. Baseline BP was significantly negatively correlated with experimental pain sensitivity and tolerance in both FM and CON subjects, although spatial patterns of these associations differed between groups. The data suggest that abnormal DA function may be associated with differential processing of pain perception in FM. Further studies are needed to explore the functional significance of DA in nociception and cognitive processing in chronic pain.
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Walitt B, Ceko M, Gracely JL, Gracely RH. Neuroimaging of Central Sensitivity Syndromes: Key Insights from the Scientific Literature. Curr Rheumatol Rev 2016; 12:55-87. [PMID: 26717948 DOI: 10.2174/1573397112666151231111104] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Revised: 06/24/2015] [Accepted: 12/29/2015] [Indexed: 12/14/2022]
Abstract
Central sensitivity syndromes are characterized by distressing symptoms, such as pain and fatigue, in the absence of clinically obvious pathology. The scientific underpinnings of these disorders are not currently known. Modern neuroimaging techniques promise new insights into mechanisms mediating these postulated syndromes. We review the results of neuroimaging applied to five central sensitivity syndromes: fibromyalgia, chronic fatigue syndrome, irritable bowel syndrome, temporomandibular joint disorder, and vulvodynia syndrome. Neuroimaging studies of basal metabolism, anatomic constitution, molecular constituents, evoked neural activity, and treatment effect are compared across all of these syndromes. Evoked sensory paradigms reveal sensory augmentation to both painful and nonpainful stimulation. This is a transformative observation for these syndromes, which were historically considered to be completely of hysterical or feigned in origin. However, whether sensory augmentation represents the cause of these syndromes, a predisposing factor, an endophenotype, or an epiphenomenon cannot be discerned from the current literature. Further, the result from cross-sectional neuroimaging studies of basal activity, anatomy, and molecular constituency are extremely heterogeneous within and between the syndromes. A defining neuroimaging "signature" cannot be discerned for any of the particular syndromes or for an over-arching central sensitization mechanism common to all of the syndromes. Several issues confound initial attempts to meaningfully measure treatment effects in these syndromes. At this time, the existence of "central sensitivity syndromes" is based more soundly on clinical and epidemiological evidence. A coherent picture of a "central sensitization" mechanism that bridges across all of these syndromes does not emerge from the existing scientific evidence.
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Affiliation(s)
- Brian Walitt
- National Center for Complementary and Integrative Health, National Institutes of Health, 10 Center Drive, Bethesda, MD 20814, USA.
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21
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Abstract
Fibromyalgia is a disorder that is part of a spectrum of syndromes that lack precise classification. It is often considered as part of the global overview of functional somatic syndromes that are otherwise medically unexplained or part of a somatization disorder. Patients with fibromyalgia share symptoms with other functional somatic problems, including issues of myalgias, arthralgias, fatigue and sleep disturbances. Indeed, there is often diagnostic and classification overlap for the case definitions of a variety of somatization disorders. Fibromyalgia, however, is a critically important syndrome for physicians and scientists to be aware of. Patients should be taken very seriously and provided optimal care. Although inflammatory, infectious, and autoimmune disorders have all been ascribed to be etiological events in the development of fibromyalgia, there is very little data to support such a thesis. Many of these disorders are associated with depression and anxiety and may even be part of what has been sometimes called affected spectrum disorders. There is no evidence that physical trauma, i.e., automobile accidents, is associated with the development or exacerbation of fibromyalgia. Treatment should be placed on education, patient support, physical therapy, nutrition, and exercise, including the use of drugs that are approved for the treatment of fibromyalgia. Treatment should not include opiates and patients should not become poly pharmacies in which the treatment itself can lead to significant morbidities. Patients with fibromyalgia are living and not dying of this disorder and positive outlooks and family support are key elements in the management of patients.
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Affiliation(s)
- Andrea T Borchers
- Division of Rheumatology, Allergy and Clinical Immunology, University of California at Davis School of Medicine, 451 Health Sciences Drive, Suite 6510, Davis, CA, 95616, USA
| | - M Eric Gershwin
- Division of Rheumatology, Allergy and Clinical Immunology, University of California at Davis School of Medicine, 451 Health Sciences Drive, Suite 6510, Davis, CA, 95616, USA.
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Bar-On Kalfon T, Gal G, Shorer R, Ablin JN. Cognitive functioning in fibromyalgia: The central role of effort. J Psychosom Res 2016; 87:30-6. [PMID: 27411749 DOI: 10.1016/j.jpsychores.2016.06.004] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Revised: 05/29/2016] [Accepted: 06/03/2016] [Indexed: 01/28/2023]
Abstract
OBJECTIVE Fibromyalgia syndrome (FM) patients demonstrate deficits in tests of attention, executive functioning and verbal memory. We assessed the role of effort in the cognitive impairment in FM patients, alongside common symptoms of pain, fatigue and depression. METHOD 50 FM patients underwent a computerized cognitive assessment battery including memory, executive function, attention and information processing speed (NeuroTrax Corp.). Age and education standardized scores were computed. Effort was assessed by the Test of Memory Malingering (TOMM). FM symptoms were assessed by the Fibromyalgia Impact Questionnaire (FIQ), Widespread Pain Index (WPI) and Symptom Severity Scale (SSS), a Visual Analog Scale (VAS) of clinical pain and the Beck Depression Inventory (BDI-2). RESULTS FM patients showed impaired performance on the memory, attention and information processing speed domains. According to the TOMM, sub-optimal effort was shown by 16% of patients. TOMM scores were not associated with pain, fatigue or depression. After controlling for effort, no significant impairment was found in memory scores; however attention and information processing speed scores remained significantly low. Multiple regressions analysis, performed in order to evaluate the contribution of effort, pain, fatigue and depression, found effort to be the only significant variable accounting for variance of cognitive scores on all domains. CONCLUSION The findings confirm impaired attention and processing speed in FM patients, independent of effort level. Nonetheless, the findings point to a general and strong effect of effort on neuropsychological performance in FM patients, especially in the domain of memory, emphasizes the importance of effort testing in this population.
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Affiliation(s)
- Tamar Bar-On Kalfon
- School of Behavioral Sciences, Tel Aviv-Jaffa Academic College, Jaffa, Israel
| | - Gilad Gal
- School of Behavioral Sciences, Tel Aviv-Jaffa Academic College, Jaffa, Israel
| | - Ran Shorer
- Institute of Rheumatology, Tel-Aviv Sourasky Medical Center, Israel
| | - Jacob N Ablin
- Institute of Rheumatology, Tel-Aviv Sourasky Medical Center, Israel
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Rathbone M, Parkinson W, Rehman Y, Jiang S, Bhandari M, Kumbhare D. Magnitude and variability of effect sizes for the associations between chronic pain and cognitive test performances: a meta-analysis. Br J Pain 2016; 10:141-55. [PMID: 27583141 DOI: 10.1177/2049463716642600] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVES AND METHODS A systematic review and meta-analysis were performed to estimate the size and variability of the association between chronic pain (CP) and poorer cognitive test performances as a function of individual tests, pain sub-types, and study sources on 22 studies having (1) a control group, (2) reported means and standard deviations (SDs) and (3) tests studied at least 3 times. RESULTS CP patients performed significantly poorer with small to moderate effects (d = -.31 to -.57) on Digit Span Backward; STROOP Word; Color and Color-Word; Digit Symbol; Trail Making A and B; Rey Auditory Learning Immediate and Delayed Recall and Recognition. For these 10 measures, single effects (no interaction) were supported (I(2) = 0%-8%) and Random and Fixed models yielded similar results. No group differences were found for Corsi Blocks Forward or Wisconsin Cart Sorting Test Categories Achieved, or Perseveration. Effects for the Rey Complex Figure Immediate and Delayed Recall were significant, but effect size was inconclusive, given moderate to high heterogeneity and lack of consistency between Random and Fixed models. For the Paced Auditory Serial Addition Test, there was a homogeneous (I(2) = 0%) and significantly lower performance in fibromyalgia (d = -.47), but no effect in diagnostically undifferentiated pain samples, and wide variability across studies of whiplash (d = -.15 to -1.04, I(2) = 60%). CONCLUSION The magnitude and consistency of the CP - cognition effect depended on the test, pain subgroup and study source. SUMMARY POINTS Among tests showing a chronic pain (CP) - cognition effect, the magnitude of this association was consistently small to moderate across tests.Effect size estimation was inconclusive for Digit Span Forwards, the Paced Auditory Serial Addition Test and the Rey Complex Figure Test.Variance was too heterogeneous for testing cognitive domain specificity of the CP - cognition effect.
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Affiliation(s)
- Michél Rathbone
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - William Parkinson
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
| | - Yasir Rehman
- Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Shucui Jiang
- Department of Biochemistry, McMaster University, Hamilton, ON, Canada
| | - Mohit Bhandari
- Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Dinesh Kumbhare
- Department of Medicine, University of Toronto, Toronto, ON, Canada
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Gelonch O, Garolera M, Valls J, Rosselló L, Pifarré J. Executive function in fibromyalgia: Comparing subjective and objective measures. Compr Psychiatry 2016; 66:113-22. [PMID: 26995244 DOI: 10.1016/j.comppsych.2016.01.002] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Revised: 01/06/2016] [Accepted: 01/10/2016] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND There is evidence to suggest the existence of an executive dysfunction in people diagnosed with fibromyalgia, although there are certain inconsistencies between studies. Here, we aim to compare executive performance between patients with fibromyalgia and a control group by using subjective and objective cognitive tests, analyzing the influence of patient mood on the results obtained, and studying associations between the two measures. METHOD 82 patients diagnosed with fibromyalgia and 42 healthy controls, matched by age and years of education, were assessed using the Behavioral Rating Inventory of Executive Function - Adult Version (BRIEF-A) as a subjective measure of executive functioning. A selection of objective cognitive tests were also used to measure a series of executive functions and to identify symptoms of depression and anxiety. RESULTS Patients with fibromyalgia perceived greater difficulties than the control group on all of the BRIEF-A scales. However, after adjustments were made for depression and anxiety the only differences that remained were those associated with the working memory scale and the Metacognition and Global Executive Composite index. In the case of the objective cognitive tests, a significantly worse overall performance was evidenced for the fibromyalgia patients. However, this also disappeared when adjustments were made for depression and anxiety. After this adjustment, fibromyalgia patients only performed significantly worse for the interference effect in the Stroop Test. Although there were no significant associations between most of the objective cognitive tests and the BRIEF-A scales, depression and anxiety exhibited strong associations with almost all of the BRIEF-A scales and with several of the objective cognitive tests. CONCLUSIONS Patients with fibromyalgia showed executive dysfunction in subjective and objective measures, although most of this impairment was associated with mood disturbances. Exceptions to this general rule were observed in the impairment of working memory evidenced on the BRIEF-A scale and the inhibition impairment exhibited by the interference effect from the Stroop Test. The two types of measurement provide different yet complementary information.
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Affiliation(s)
- Olga Gelonch
- Clinical Research Group for Brain, Cognition and Behavior, Consorci Sanitari de Terrassa, Terrassa, Spain; University of Lleida, Spain
| | - Maite Garolera
- Clinical Research Group for Brain, Cognition and Behavior, Consorci Sanitari de Terrassa, Terrassa, Spain; Neuropsychology Unit, Hospital de Terrassa, Consorci Sanitari de Terrassa, Terrassa, Spain
| | - Joan Valls
- Institute of Biomedical Research of Lleida, IRB-Lleida, Spain
| | - Lluís Rosselló
- Rheumatology Section, Fibromyalgia and Chronic Fatigue Syndrome Unit, Hospital Universitari de Santa Maria, Lleida, Spain
| | - Josep Pifarré
- University of Lleida, Spain; Institute of Biomedical Research of Lleida, IRB-Lleida, Spain.
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25
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Ojeda B, Failde I, Dueñas M, Salazar A, Eccleston C. Methods and Instruments to Evaluate Cognitive Function in Chronic Pain Patients: A Systematic Review. PAIN MEDICINE 2015; 17:1465-89. [PMID: 26814300 DOI: 10.1093/pm/pnv077] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Accepted: 10/30/2015] [Indexed: 12/13/2022]
Abstract
OBJECTIVE We aimed to systematically review the methods and instruments used to evaluate cognitive function in chronic pain (CP) patients. METHODS A sensitive search strategy was designed using five databases. Based on the objectives and methodology, we selected cross-sectional studies on adults with chronic non-cancer pain in which cognitive function was assessed using validated instruments. The characteristics of the subjects, control groups, and other variables that might affect cognitive function, and the instruments used, were extracted from each article. RESULTS In the 42 articles identified, 53 instruments were used to assess cognitive function. Chronic pain criteria were defined in 83.3% of the articles and more than half (57.1%) included single diagnosis samples, with fibromyalgia being the most frequent studied (75%). Patients with prior cognitive impairment were excluded in 61.9% of the studies, and a control group was included in 64.3% of the studies. In most cases potential confounding variables were evaluated. More than 14% of the studies used self-report measures, and 73.8% used neuropsychological instruments, particularly for assessing attention (30%) and memory (27.5%). None of the instruments were specifically validated for pain patients and only five studies analyzed the psychometric properties of the instruments. CONCLUSIONS Various instruments and methods were used to assess cognitive function in CP patients, particularly fibromyalgia patients, but also other cohorts with well-defined CP. The instruments used had been validated, but not for pain populations, thus they require specific adaptation and validation to be used in CP patients. Certain recommendations are made in order to improve the evaluation of cognitive function in these patients.
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Affiliation(s)
- Begoña Ojeda
- *Preventive Medicine and Public Health Area, The Observatory of Pain (External Chair of Pain), University of Cádiz, Cádiz, Spain
| | - Inmaculada Failde
- *Preventive Medicine and Public Health Area, The Observatory of Pain (External Chair of Pain), University of Cádiz, Cádiz, Spain
| | - María Dueñas
- Salus Infirmorum Faculty of Nursing, University of Cádiz, Spain
| | - Alejandro Salazar
- *Preventive Medicine and Public Health Area, The Observatory of Pain (External Chair of Pain), University of Cádiz, Cádiz, Spain
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Kravitz HM, Katz RS. Fibrofog and fibromyalgia: a narrative review and implications for clinical practice. Rheumatol Int 2015; 35:1115-25. [PMID: 25583051 DOI: 10.1007/s00296-014-3208-7] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2014] [Accepted: 12/30/2014] [Indexed: 01/26/2023]
Abstract
Patients with fibromyalgia often report forgetfulness as well as declines in cognitive function, memory, and mental alertness-symptoms that have been termed "fibrofog" in popular and electronic media as well as in professional literature. "Fibrofog" is the subjectively experienced cognitive dysfunction associated with fibromyalgia and is a clinically important yet comparatively less well-studied aspect of the disorder; it includes loss of mental clarity (mental fogginess) as well as attention and memory impairment. Although until recently cognitive symptoms have been largely ignored, these symptoms can be more disturbing than the widespread pain and can change these patients' lives, sometimes dramatically so. Whereas widespread musculoskeletal pain, tenderness, and fatigue may be the hallmark symptoms of fibromyalgia, patients rank cognitive dysfunction highly in terms of disease impact. This review addresses (1) the prevalence of self-reported cognitive disturbances in fibromyalgia, (2) the clinical presentation of fibrofog, (3) neuropsychological test performance, with particular attention to discrepancies between self-report and test results, (3) clinical correlates of impaired cognitive function in fibromyalgia, (4) neurobiology relevant to cognitive disturbances in fibromyalgia, and (5) clinical management of fibrofog. Although the pathophysiology of fibromyalgia remains an enigma, evidence suggests that it may be a brain disorder, with cognitive deficits ("fibrofog") reflecting disturbed centrally mediated processes.
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Affiliation(s)
- Howard M Kravitz
- Department of Psychiatry and Department of Preventive Medicine, Rush Medical College, Rush University Medical Center, Rush West Campus, 2150 West Harrison Street, Room 275, Chicago, IL, 60612, USA,
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Tesio V, Torta DME, Colonna F, Leombruni P, Ghiggia A, Fusaro E, Geminiani GC, Torta R, Castelli L. Are Fibromyalgia Patients Cognitively Impaired? Objective and Subjective Neuropsychological Evidence. Arthritis Care Res (Hoboken) 2014; 67:143-50. [PMID: 25047247 DOI: 10.1002/acr.22403] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Accepted: 07/08/2014] [Indexed: 12/31/2022]
Affiliation(s)
- Valentina Tesio
- Città della Salute e della Scienza Hospital and University of Turin; Turin Italy
| | | | | | - Paolo Leombruni
- Città della Salute e della Scienza Hospital and University of Turin; Turin Italy
| | | | - Enrico Fusaro
- Città della Salute e della Scienza Hospital; Turin Italy
| | | | - Riccardo Torta
- Città della Salute e della Scienza Hospital and University of Turin; Turin Italy
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Tapscott BE, Etherton J. The Effects of Cold Pressor-Induced Pain on PASAT Performance. APPLIED NEUROPSYCHOLOGY-ADULT 2014; 22:227-32. [DOI: 10.1080/23279095.2014.910213] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Brian E. Tapscott
- Department of Psychology, The University of Rhode Island, Kingston, Rhode Island
| | - Joseph Etherton
- Department of Psychology, Texas State University, San Marcos, Texas
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Memory impairment in chronic pain patients and the related neuropsychological mechanisms: a review. Acta Neuropsychiatr 2014; 26:195-201. [PMID: 25279415 DOI: 10.1017/neu.2013.47] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE This study provides a comprehensive review of the literature on memory impairment and the potential effective factors in patients with chronic pain. METHODS A literature search of databases PubMed, EMBASE, SpringerLink, and PsycINFO until September 2012 was conducted using the keywords ‘memory’ and ‘chronic pain’. The study emphasises on publications over the past 20 years. RESULTS Memory impairment in chronic pain patients is substantial, but the aspects of memory (e.g. working memory, long-term memory, and autobiographical memory) in chronic pain patients and the potentially related factors (e.g. age, level of education, pain conditions, emotion, neural network, and use of analgesics) are modest. Memory impairment is interpreted with the attention-narrowing hypothesis and the capacity-reduction hypothesis. CONCLUSIONS The currently available data and theory have explained memory impairment in chronic pain patients, but many controversies remain. Future research should focus on the subclinical characteristics of chronic pain, enlarging the sample size, and emphasise on the experimental intervention method and the cognitive neuroscience method.
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Mao CP, Zhang QL, Bao FX, Liao X, Yang XL, Zhang M. Decreased activation of cingulo-frontal-parietal cognitive/attention network during an attention-demanding task in patients with chronic low back pain. Neuroradiology 2014; 56:903-12. [PMID: 24986218 DOI: 10.1007/s00234-014-1391-6] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2014] [Accepted: 06/05/2014] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Attention deficits have been repeatedly reported via neuropsychological assessment in previous literature in patients with chronic low back pain (CLBP). However, there are few functional neuroimaging studies of patients with CLBP during attention processing, and the exact underlying neural mechanisms are yet to be elucidated. METHODS We used functional magnetic resonance imaging (fMRI) to measure the function of the cingulo-frontal-parietal (CFP) cognitive/attention network while performing a multi-source interference task (MSIT) in patients with CLBP. Thirty-six patients with CLBP and 36 healthy controls were included in this study. The fMRI data were analyzed with the FSL-FEAT software. RESULTS Our results indicated that patients with CLBP showed significantly less activation in the CFP network including the right dorsolateral prefrontal cortex, the dorsal anterior cingulate cortex, and bilateral superior parietal cortex during attention-demanding (MSITinterference > MSITcontrol) trials compared to the healthy controls. A significant negative correlation was found between the scores of the visual analog scale for pain and activation of the right prefrontal cortex during performing the MSIT in patients with CLBP. CONCLUSION Our study provides in vivo imaging evidence of abnormal CFP network function during attention-demanding condition in patients with CLBP, which might reflect partly an adaptation/maladaptation of the brain to the chronic pain states.
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Affiliation(s)
- Cui Ping Mao
- Department of Medical Imaging, First Affiliated Hospital of Xi'An Jiao Tong University College of Medicine, 277#, West YantaRoad, Xi'an, Shaan'Xi, 710061, People's Republic of China
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Fava A, Plastino M, Cristiano D, Spanò A, Cristofaro S, Opipari C, Chillà A, Casalinuovo F, Colica C, De Bartolo M, Pirritano D, Bosco D. Insulin resistance possible risk factor for cognitive impairment in fibromialgic patients. Metab Brain Dis 2013; 28:619-27. [PMID: 23892884 DOI: 10.1007/s11011-013-9421-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2013] [Accepted: 07/11/2013] [Indexed: 01/28/2023]
Abstract
To evaluate glucose metabolism and/or insulin resistance (IR) in 96 patients with Fibromyalgia (FM), associated or not to cognitive impairment. We investigated glucose metabolism in 96 FM patients. Enrolled patients were divided into two groups: 48 patients with memory deficit (group A) and 48 without memory deficit (control group). We evaluated glucose and insulin levels after a 2 h-Oral-Glucose-Tolerance-Test (2 h-OGTT) and insulin resistance (IR) by the homeostasis model assessment formula (HOMA). Body Mass Index (BMI), waist-to-hip-ratio (WHR), anxiety level, fasting plasma insulin and Non-Steroidal Anti-Inflammatory agents use were higher in patients with FM with memory impairment; while age, sex, waist circumference, education level, fasting plasma glucose, glycate hemoglobin, triglycerides, blood lipid profile, C- Reactivity-Protein (CRP), blood pressure and smoking habits were similar in both groups. Following OGTT the prevalence of glucose metabolism abnormalities was significantly higher in group A. IR was present in 79% patients, of whom 23% had also impaired glucose tolerance, 4% newly diagnosed diabetes mellitus and 52% IR only. Obesity and overweight prevailed in group A. IR, but not BMI or WHR was associated to an increased risk of memory impairment (OR = 2,6; 95% CI: 1,22-3,7). The results of this study suggest that IR may represent a risk factor for memory impairment in fibromialgic patients.
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Berryman C, Stanton TR, Bowering JK, Tabor A, McFarlane A, Moseley LG. Evidence for working memory deficits in chronic pain: A systematic review and meta-analysis. Pain 2013; 154:1181-96. [DOI: 10.1016/j.pain.2013.03.002] [Citation(s) in RCA: 211] [Impact Index Per Article: 19.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2012] [Revised: 02/05/2013] [Accepted: 03/01/2013] [Indexed: 12/19/2022]
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Abstract
The study investigated implicit memory function in fibromyalgia syndrome (FMS) and its association with clinical parameters. Implicit memory refers to the influence of past experience on current behavior without conscious awareness of these experiences. Eighteen FMS patients and 25 healthy individuals accomplished a word-stem completion task. As possible factors mediating the expected impairment, pain severity, emotional disorders, and medication were taken into account. The patients displayed markedly reduced task performance and higher levels of depression and anxiety. Among the clinical features, pain severity was most closely associated with performance, whereas depression, anxiety, and medication showed only a minor impact. The study documented reduced implicit memory function in FMS. In contrast to former findings on impaired performance of FMS patients on classical memory tests, lower implicit memory function cannot be ascribed to motivational deficits. Instead, the aberrances may relate to functional inference between central nervous nociceptive activity and cognitive processing.
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Affiliation(s)
- Stefan Duschek
- UMIT - University for Health Sciences, Medical Informatics and Technology, Eduard-Walln¨ofer-Zentrum 1, A-6060 Hall, Tirol, Austria.
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Akdoğan S, Ayhan FF, Yıldırım Ş, Borman P. Impact of Fatigue on Cognitive Functioning among Premenopausal Women with Fibromyalgia Syndrome and Rheumatoid Arthritis: The Controlled Study. ACTA ACUST UNITED AC 2013. [DOI: 10.3109/10582452.2013.806977] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Molina J, Dos Santos FH, Terreri MTRA, Fraga MM, Silva SG, Hilário MOE, Len CA. Sleep, stress, neurocognitive profile and health-related quality of life in adolescents with idiopathic musculoskeletal pain. Clinics (Sao Paulo) 2012; 67:1139-44. [PMID: 23070339 PMCID: PMC3460015 DOI: 10.6061/clinics/2012(10)04] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2012] [Accepted: 05/24/2012] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES The aims of this study were to measure levels of sleep, stress, and depression, as well as health-related quality of life, and to assess the neurocognitive profiles in a sample of adolescents with idiopathic musculoskeletal pain. METHODS Nineteen adolescents with idiopathic musculoskeletal pain and 20 age-matched healthy control subjects were evaluated regarding their levels of sleep and stress, as well as quality of life, and underwent neurocognitive testing. RESULTS The sample groups consisted predominantly of females (84%), and the socioeconomic status did not differ between the two groups. In addition, the occurrence of depressive symptoms was similar between the two groups; specifically, 26% of the idiopathic musculoskeletal pain patients and 30% of the control subjects had scores indicative of depression. Teenagers in the group with idiopathic musculoskeletal pain reported poorer quality of life and sleep scores than those in the control group. Regarding stress, patients had worse scores than the control group; whereas 79% of the adolescents with idiopathic musculoskeletal pain met the criteria for a diagnosis of stress, only 35% of the adolescents in the control group met the criteria. In both groups, we observed scores that classified adolescents as being in the resistance phase (intermediate) and exhaustion phase (pathological) of distress. However, the idiopathic musculoskeletal pain group more frequently reported symptomatic complaints of physical and emotional distress. The neurocognitive assessment showed no significant impairments in either group. CONCLUSION Adolescents with idiopathic musculoskeletal pain did not exhibit cognitive impairments. However, adolescents with idiopathic musculoskeletal pain did experience intermediate to advanced psychological distress and lower health-related quality of life, which may increase their risk of cognitive dysfunction in the future.
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Affiliation(s)
- Juliana Molina
- Pediatric Rheumatology Unit, Department of Pediatrics, Faculdade de Medicina, Universidade Federal de São Paulo, São Paulo/SP, Brazil
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Understanding fibromyalgia and its related disorders. PRIMARY CARE COMPANION TO THE JOURNAL OF CLINICAL PSYCHIATRY 2012; 10:133-44. [PMID: 18458727 DOI: 10.4088/pcc.v10n0208] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Lu W, Göder R. Does abnormal non-rapid eye movement sleep impair declarative memory consolidation? Sleep Med Rev 2012; 16:389-94. [DOI: 10.1016/j.smrv.2011.08.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2010] [Revised: 07/30/2011] [Accepted: 08/01/2011] [Indexed: 11/28/2022]
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Can SS, Gencay-Can AA. Assessment of Cognitive Function in Patients with Fibromyalgia using the Clock Drawing Test. ACTA ACUST UNITED AC 2012. [DOI: 10.3109/10582452.2012.704145] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Abstract
OBJECTIVES To determine the effect of duloxetine treatment on cognition in patients with fibromyalgia. METHODS Cognitive testing was conducted in a subset of adult patients in a randomized, double-blind, placebo-controlled trial of duloxetine. Patients met the American College of Rheumatology criteria for fibromyalgia and had a score of 4 or higher on the Brief Pain Inventory 24-hour average pain severity item. Patients who consented to cognitive testing were randomized to duloxetine (n = 80) or placebo (n = 76). The primary end point was at Week 12. Speed of processing on tasks requiring visual attention, working memory, and executive function was assessed with a Symbol Digit Substitution Test and Trail-Making Test A and B. Episodic memory was tested using the Verbal Learning and Recall Test. The change from baseline to end point (last-observation-carried-forward analysis) was analyzed by an analysis of covariance model, which included baseline, treatment, investigator, and treatment-by-investigator interaction. RESULTS Most of the patients were white (89%) women (92%), ranging in age from 21 to 88 years. Mean scores on the cognitive tests were within 2 SD of published scores for similar-aged participants in the general population, indicating no substantial impairment. Baseline-to-end point changes in cognitive scores did not differ significantly between duloxetine and placebo treatment groups. CONCLUSIONS Although scores differed somewhat from norms for age, substantial cognitive impairment was not evident in patients with fibromyalgia as assessed by the Symbol Digit Substitution Test, Trail-Making Test, and Verbal Learning and Recall Test. Overall, duloxetine treatment had neither positive nor negative effects on cognition. TRIAL REGISTRATION Clintrials.gov NCT00673452.
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Veldhuijzen DS, Sondaal SF, Oosterman JM. Intact Cognitive Inhibition in Patients With Fibromyalgia but Evidence of Declined Processing Speed. THE JOURNAL OF PAIN 2012; 13:507-15. [DOI: 10.1016/j.jpain.2012.02.011] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2011] [Revised: 01/27/2012] [Accepted: 02/29/2012] [Indexed: 01/12/2023]
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Burfield AH, Wan TT, Sole ML, Cooper JW. A study of longitudinal data examining concomitance of pain and cognition in an elderly long-term care population. J Pain Res 2012; 5:61-70. [PMID: 22536093 PMCID: PMC3333796 DOI: 10.2147/jpr.s29655] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose To examine if a concomitant relationship exists between cognition and pain in an elderly population residing in long-term care. Background/significance Prior research has found that cognitive load mediates interpretation of a stimulus. In the presence of decreased cognitive capacity as with dementia, the relationship between cognition and increasing pain is unknown in the elderly. Patients and methods Longitudinal cohort design. Data collected from the Minimum Data Set-Resident Assessment Instrument (MDS-RAI) from the 2001–2003 annual assessments of nursing home residents. A covariance model was used to evaluate the relationship between cognition and pain at three intervals. Results The sample included 56,494 subjects from nursing homes across the United States, with an average age of 83 ± 8.2 years. Analysis of variance scores (ANOVAs) indicated a significant effect (P < 0.01) for pain and cognition, with protected t test revealing scores decreasing significantly with these two measures. Relative stability was found for pain and cognition over time. Greater stability was found in the cognitive measure than the pain measure. Cross-legged effects observed between cognition and pain measures were inconsistent. A concomitant relationship was not found between cognition and pain. Even though the relationship was significant at the 0.01 level, the correlations were low (r ≤ 0.08), indicating a weak association between cognition and pain. Conclusion Understanding the concomitance of pain and cognition aids in defining additional frameworks to extend models to include secondary needs, contextual factors, and resident outcomes. Cognitive decline, as with organic brain diseases, is progressive. Pain is a symptom that can be treated and reduced to improve resident quality of life. However, cognition can be used to determine the most appropriate method to assess pain in the elderly, thereby improving accuracy of pain detection in this population.
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Affiliation(s)
- Allison H Burfield
- Gerontology Program, School of Nursing, College of Health and Human Services, University of North Carolina, Charlotte, NC, USA
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Caro XJ, Winter EF. EEG biofeedback treatment improves certain attention and somatic symptoms in fibromyalgia: a pilot study. Appl Psychophysiol Biofeedback 2011; 36:193-200. [PMID: 21656150 DOI: 10.1007/s10484-011-9159-9] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Fibromyalgia (FMS) is a chronic, painful disorder often associated with measurable deficiencies in attention. Since EEG biofeedback (EEG-BF) has been used successfully to treat attention problems, we reasoned that this modality might be helpful in the treatment of attention problems in FMS. We also speculated that improvement in central nervous system (CNS) function might be accompanied by improvement in FMS somatic symptoms. We studied fifteen FMS patients with attention problems, demonstrated by visual and auditory continuous performance testing (CPT), while completing 40 or more EEG-BF sessions. Training consisted of a "SMR protocol" that augmented 12-15 Hz brainwaves (sensory motor rhythm; SMR), while simultaneously inhibiting 4-7 Hz brainwaves (theta) and 22-30 Hz brainwaves (high beta). Serial measurements of pain, fatigue, psychological distress, morning stiffness, and tenderness were also obtained. Sixty-three FMS patients who received standard medical care, but who did not receive EEG-BF, served as controls. Visual, but not auditory, attention improved significantly (P < 0.008). EEG-BF treated subjects also showed improvement in tenderness, pain and fatigue. Somatic symptoms did not change significantly in controls. Visual attention parameters and certain somatic features of FMS appear to improve with an EEG-BF SMR protocol. EEG-BF training in FMS deserves further study.
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Affiliation(s)
- Xavier J Caro
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA.
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Reyes del Paso G, Pulgar Á, Duschek S, Garrido S. Cognitive impairment in fibromyalgia syndrome: The impact of cardiovascular regulation, pain, emotional disorders and medication. Eur J Pain 2011; 16:421-9. [DOI: 10.1002/j.1532-2149.2011.00032.x] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/27/2011] [Indexed: 11/11/2022]
Affiliation(s)
| | - Á. Pulgar
- Department of Psychology; University of Jaén; Jaen; Spain
| | - S. Duschek
- Department of Psychology; University of Munich; Munich; Germany
| | - S. Garrido
- Department of Psychology; University of Jaén; Jaen; Spain
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Prevalence and Overlap of Chronic Fatigue Syndrome and Fibromyalgia Syndrome Among 100 New Patients with Multiple Chemical Sensitivity Syndrome. ACTA ACUST UNITED AC 2011. [DOI: 10.1300/j092v05n03_06] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Hamilton NA, Atchley RA, Karlson CW, Taylor D, McCurdy D. The Role of Sleep and Attention in the Etiology and Maintenance of Fibromyalgia. COGNITIVE THERAPY AND RESEARCH 2011. [DOI: 10.1007/s10608-011-9390-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Sletvold H, Svendsen K, Aas O, Syversen T, Hilt B. Neuropsychological function and past exposure to metallic mercury in female dental workers. Scand J Psychol 2011; 53:136-43. [PMID: 22092046 PMCID: PMC3412222 DOI: 10.1111/j.1467-9450.2011.00929.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The aim of this study was to see if dental personnel with previous exposure to metallic mercury have later developed disturbances in cognitive function. Ninety-one female participants who had been selected from a previous health survey of dental personnel were investigated neuropsychologically within the following domains: motor function, short-term memory, working memory, executive function, mental flexibility, and visual and verbal long-term memory. The scores were mainly within normal ranges. Relationships between an exposure score, the duration of employment before 1990, and previously measured mercury in urine as independent variables and the neuropsychological findings as dependent variables, were analyzed by multiple linear regression controlling for age, general ability, length of education, alcohol consumption, and previous head injuries. The only relationship that was statistically significant in the hypothesized direction was between the previously measured urine mercury values and visual long-term memory, where the urine values explained 30% of the variability. As the study had a low statistical power and also some other methodological limitations, the results have to be interpreted with caution. Even so, we think it is right to conclude that neuropsychological findings indicative of subsequent cognitive injuries are difficult to find in groups of otherwise healthy dental personnel with previous occupational exposure to mercury.
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Affiliation(s)
- Helge Sletvold
- Department of Industrial Economics and Technology Management, Norwegian University of Science and Technology, Trondheim, Norway
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