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Serpas DG, Morton T, Zettel-Watson L, Cherry BJ. The role of pain intensity and depressive symptoms in the relationship between sleep quality and postural control among middle-aged and older adults with Fibromyalgia. Psychol Health 2024; 39:749-764. [PMID: 36134694 DOI: 10.1080/08870446.2022.2107644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 05/26/2022] [Accepted: 07/25/2022] [Indexed: 10/14/2022]
Abstract
OBJECTIVE Fibromyalgia (FM) is a chronic pain condition often accompanied by sleep problems and depression that are each associated with reduced physical ability including postural control. Research supports a sequential association between pain intensity and depression in FM, and poor sleep quality may play a key role in this relationship. This study aimed to verify a serial pattern of associations among sleep quality, pain intensity, and depressive symptoms and quantify these effects on objective postural control. DESIGN Community-residing adults diagnosed with FM (n = 155; Mage = 61.08, SD = 7.70; 93% female; 79% White) were included in this cross-sectional study. MAIN OUTCOMES Participants self-rated sleep quality (restorative sleep, sleep waking, and sleep latency), pain intensity, and depressive symptoms, and the Fullerton Advanced Balance (FAB) scale and 8-Foot Up and Go Test (8FUPGT) measured objective postural control. RESULTS Findings indicated that the serial association between pain intensity and depressive symptoms fully mediated the relationship between sleep quality and both FAB (95% CI [-.125, -.013]), and 8FUPGT (95% CI [.002, .033]) performance. CONCLUSION Findings highlight the serial association of pain intensity and depressive symptoms with objective postural control performance and the potential for sleep and depression interventions that may maximize functional outcomes in FM.
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Affiliation(s)
- Dylan G Serpas
- Department of Psychology, California State University, Fullerton, Fullerton, CA, USA
| | - Timothy Morton
- Department of Psychology, California State University, Fullerton, Fullerton, CA, USA
| | - Laura Zettel-Watson
- Department of Psychology, California State University, Fullerton, Fullerton, CA, USA
- Aging Studies Academic Program, California State University, Fullerton, Fullerton, CA, USA
| | - Barbara J Cherry
- Department of Psychology, California State University, Fullerton, Fullerton, CA, USA
- Aging Studies Academic Program, California State University, Fullerton, Fullerton, CA, USA
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Mun CJ, Davis MC, Campbell CM, Finan PH, Tennen H. Linking Nonrestorative Sleep and Activity Interference Through Pain Catastrophizing and Pain Severity: An Intraday Process Model Among Individuals With Fibromyalgia. THE JOURNAL OF PAIN 2020; 21:546-556. [PMID: 31526852 PMCID: PMC7069767 DOI: 10.1016/j.jpain.2019.09.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 07/12/2019] [Accepted: 09/12/2019] [Indexed: 12/29/2022]
Abstract
Nonrestorative sleep is a key diagnostic feature of the musculoskeletal pain disorder fibromyalgia and is robustly associated with poor physical functioning, including activity interference. However, the mechanisms through which nonrestorative sleep elicits activity interference among individuals with fibromyalgia at the within-person level remain unclear. The present study tested the following 3-path mediation model, using data gathered from a 21-day electronic daily diary in 220 individuals with fibromyalgia: previous night nonrestorative sleep → morning pain catastrophizing → afternoon pain severity → end-of-day activity interference. Results of multilevel structural equation modeling supported the 3-path mediation model. Previous night's nonrestorative sleep and morning pain catastrophizing were also directly related to end-of-day activity interference. Previous night nonrestorative sleep did not significantly predict afternoon pain severity while controlling for the effect of morning pain catastrophizing. Greater nonrestorative sleep during the previous night and a higher level of morning pain catastrophizing appear to serve as risk factors for experiencing greater daily pain and activity interference later in the day. These findings point to the potential utility of targeted interventions that improve both sleep quality and pain catastrophizing to help individuals with chronic pain engage in important daily activities despite experiencing pain. PERSPECTIVE: This study provides a better understanding of how nonrestorative sleep is associated with daily activity interference among individuals with fibromyalgia. An intervention that targets attenuating nonrestorative sleep and pain catastrophizing may help improve daily physical functioning of this population.
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Affiliation(s)
- Chung Jung Mun
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland.
| | - Mary C Davis
- Department of Psychology, Arizona State University, Tempe, Arizona
| | - Claudia M Campbell
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Patrick H Finan
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Howard Tennen
- Department of Community Medicine, University of Connecticut School of Medicine, Farmington, Connecticut
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Ojeda B, Salazar A, Calahorro MJ, Dueñas M, Mico JA, de Sola H, Failde I. Understanding the different relationships between mood and sleep disorders in several groups of non-oncological patients with chronic pain. Curr Med Res Opin 2018; 34:669-676. [PMID: 28945136 DOI: 10.1080/03007995.2017.1384372] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To compare sleep dimensions in patients suffering from chronic pain of different origins, and with a group of pain-free subjects. To analyze the relationship between depression and/or anxiety and sleep disorders in musculoskeletal, neuropathic, and fibromyalgia patients. METHODS This cross-sectional study included patients diagnosed with neuropathic pain (NP) (n = 104), musculoskeletal pain (MSK) (n = 99), or fibromyalgia (FM) (n = 51), and pain free subjects (n = 72). Information about sleep dimensions (MOS-sleep), duration and intensity of pain (Visual Analog Scale), and anxiety and depression (Hospital Anxiety and Depression scale) was collected. RESULTS Of the 254 patients with chronic pain (PCP) studied, the mean pain intensity was 6.6 (SD = 1.9), with an average duration of 9 years. The scores in all sleep dimensions of the MOS-sleep were higher in CPP (more disturbances) compared to pain free patients, and differences were observed among the three groups of PCP, with FM most severely affected. Anxiety (β = 1.3), depression (β = 1.1), intensity (β = 1.7), and duration of pain (β = 0.04) were associated with more sleep problems in MSK patients. In contrast, anxiety (β = 2.5) and duration of pain (β = 0.05) were negatively related to sleep in the NP patients, and only depression (β = 1.3) affected FM patients. CONCLUSIONS The sleep pattern differs among groups of PCP in the presence or absence of mood disorders. Understanding these disorders in each specific group of PCP is fundamental, and it can contribute to improve the clinical situation of the patients and better orientating therapeutic strategies.
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Affiliation(s)
- B Ojeda
- a Preventive Medicine and Public Health Area , University of Cádiz , Spain
- b The Observatory of Pain (External Chair of Pain), University of Cádiz , Spain
- c Institute of Research and Innovation in Biomedical Sciences of the Province of Cadiz (INiBICA) , Spain
| | - A Salazar
- a Preventive Medicine and Public Health Area , University of Cádiz , Spain
- b The Observatory of Pain (External Chair of Pain), University of Cádiz , Spain
- c Institute of Research and Innovation in Biomedical Sciences of the Province of Cadiz (INiBICA) , Spain
| | - M J Calahorro
- d Medical Care Center, Andalusian Health Service , Spain
| | - M Dueñas
- b The Observatory of Pain (External Chair of Pain), University of Cádiz , Spain
- c Institute of Research and Innovation in Biomedical Sciences of the Province of Cadiz (INiBICA) , Spain
- e Faculty of Nursing 'Salus Infirmorum' , University of Cádiz , Spain
| | - J A Mico
- f Department of Neuroscience , Pharmacology and Psychiatry, CIBER of Mental Health (CIBERSAM), Institute of Health Carlos III, University of Cádiz , Spain
| | - H de Sola
- a Preventive Medicine and Public Health Area , University of Cádiz , Spain
- b The Observatory of Pain (External Chair of Pain), University of Cádiz , Spain
- c Institute of Research and Innovation in Biomedical Sciences of the Province of Cadiz (INiBICA) , Spain
| | - I Failde
- a Preventive Medicine and Public Health Area , University of Cádiz , Spain
- b The Observatory of Pain (External Chair of Pain), University of Cádiz , Spain
- c Institute of Research and Innovation in Biomedical Sciences of the Province of Cadiz (INiBICA) , Spain
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Hamilton NA. Sleep and fibromyalgia: it is time to think big. Sleep Med 2015; 16:908-9. [DOI: 10.1016/j.sleep.2015.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Accepted: 05/01/2015] [Indexed: 10/23/2022]
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Avila LA, de Araujo Filho GM, Guimarães EFU, Gonçalves LCS, Paschoalin PN, Aleixo FB. [Characterization of the pain, sleep and alexithymia patterns of patients with fibromyalgia treated in a Brazilian tertiary center]. REVISTA BRASILEIRA DE REUMATOLOGIA 2015; 54:409-13. [PMID: 25627308 DOI: 10.1016/j.rbr.2014.03.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Revised: 03/14/2014] [Accepted: 03/26/2014] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVES Fibromyalgia (FM) is a complex syndrome that is characterized by lasting and diffuse chronic musculoskeletal pain, derived from non-inflammatory causes and classically associated with the presence of specific tender points. However, studies have highlighted other important symptoms associated with a lower quality of life (QOL) in FM, such as sleep disturbances and alexithymia. This study aimed to investigate the pain, sleep and alexithymia patterns of FM patients treated in a Brazilian tertiary center. METHODS 20 patients with FM who were followed-up in the Rheumatology outpatient clinic of a Brazilian tertiary center (Faculdade de Medicina de São José do Rio Preto - FAMERP, São Paulo, Brazil) and 20 patients without FM from other outpatient services of the FAMERP completed a clinical and socio-demographic questionnaire, the Fibromyalgia Impact Questionnaire (FIQ), the Pittsburgh Sleep Quality Index (PSQI), the Toronto Alexithymia Scale (TAS-20) and the SF-36 (WHOQOL). RESULTS The patients with FM presented worse performances in all QOL dimensions of the SF-36 and higher scores on the PSQI (p=0.01), and the TAS-20 (p=0.02). Patients with FM also scored significantly higher in all specific domains of PSQI and TAS-20. DISCUSSION The present data were in accordance with literature, disclosing a worse performance of patients with FM on pain impact, sleep complains and more presence of alexithymia. CONCLUSION Studies have disclosed the presence of important and frequently underdiagnosed symptoms beyond pain complaints in FM, such as sleep complaints and alexithymia, and a better knowledge of such disturbances might improve FM patients' approach and treatment.
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Affiliation(s)
- Lazslo A Avila
- Departamento de Psiquiatria e Psicologia Médica, Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto, SP, Brasil
| | - Gerardo M de Araujo Filho
- Departamento de Psiquiatria e Psicologia Médica, Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto, SP, Brasil.
| | - Estefano F U Guimarães
- Departamento de Psiquiatria e Psicologia Médica, Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto, SP, Brasil
| | - Lauro C S Gonçalves
- Departamento de Psiquiatria e Psicologia Médica, Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto, SP, Brasil
| | - Paola N Paschoalin
- Departamento de Psiquiatria e Psicologia Médica, Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto, SP, Brasil
| | - Fabia B Aleixo
- Departamento de Psiquiatria e Psicologia Médica, Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto, SP, Brasil
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Diaz-Piedra C, Di Stasi LL, Baldwin CM, Buela-Casal G, Catena A. Sleep disturbances of adult women suffering from fibromyalgia: a systematic review of observational studies. Sleep Med Rev 2014; 21:86-99. [PMID: 25456469 DOI: 10.1016/j.smrv.2014.09.001] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2014] [Revised: 09/10/2014] [Accepted: 09/12/2014] [Indexed: 11/15/2022]
Abstract
Although sleep complaints are often reported in patients with fibromyalgia syndrome (FMS), there is no conclusive evidence that these complaints represent symptomatic disorders of sleep physiology. Thus, the question of the role of sleep disturbances as an etiological or maintenance factor in FMS remains open. This study identifies the subjective and objective characteristics of sleep disturbances in adult women diagnosed with FMS. We carried out a systematic review of publications since 1990, the publication year of the American College of Rheumatology criteria of FMS. We selected empirical studies comparing sleep characteristics of adult women with FMS and healthy women or women with rheumatic diseases. We identified 42 articles. Patients with FMS were more likely to exhibit sleep complaints and also a less efficient, lighter and fragmented sleep. The evidence of a FMS signature on objective measures of sleep is inconsistent, however, as the majority of studies lacks statistical power. Current evidence cannot confirm the role played by sleep physiology in the pathogenesis or maintenance of FMS symptoms; nonetheless, it is clear that sleep disturbances are present in this syndrome.
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Affiliation(s)
- Carolina Diaz-Piedra
- Mind, Brain, and Behavior Research Center-CIMCYC, University of Granada, Spain; College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, USA.
| | - Leandro L Di Stasi
- Mind, Brain, and Behavior Research Center-CIMCYC, University of Granada, Spain; Department of Neurobiology, Barrow Neurological Institute, Phoenix, AZ, USA
| | - Carol M Baldwin
- College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, USA
| | | | - Andres Catena
- Mind, Brain, and Behavior Research Center-CIMCYC, University of Granada, Spain
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The Impact of Pain on Anxiety and Depression is Mediated by Objective and Subjective Sleep Characteristics in Fibromyalgia Patients. Clin J Pain 2014; 30:852-9. [DOI: 10.1097/ajp.0000000000000040] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Bernik M, Sampaio TPA, Gandarela L. Fibromyalgia comorbid with anxiety disorders and depression: combined medical and psychological treatment. Curr Pain Headache Rep 2014; 17:358. [PMID: 23904203 DOI: 10.1007/s11916-013-0358-3] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Fibromyalgia is associated with high level of pain and suffering. Lack of diagnosis leads to onerous indirect economic costs. Recent data indicate that fibromyalgia; anxiety disorders, and depression tend to occur as comorbid conditions. They also share some common neurochemical dysfunctions and central nervous system alterations such as hypofunctional serotonergic system and altered reactivity of the hypothalamic-pituitary-adrenal axis. Conversely, functional neuroimaging findings point to different patterns of altered pain processing mechanisms between fibromyalgia and depression. There is no cure for fibromyalgia, and treatment response effect size is usually small to moderate. Treatment should be based on drugs that also target the comorbid psychiatric condition. Combined pharmacotherapy and cognitive-behavior therapy should ideally be offered to all patients. Lifestyle changes, such as physical exercise should be encouraged. The message to patients should be that all forms of pain are true medical conditions and deserve proper care.
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Affiliation(s)
- Marcio Bernik
- Anxiety Disorders Program, Institute of Psychiatry FMUSP, R. Dr. Ovidio Pires de Campos, 785, Caixa Postal 3671, CEP 01060-970, Sao Paulo, SP, Brazil.
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