The FIBRO System: A Rapid Strategy for Assessment and Management of Fibromyalgia Syndrome

Characterizing "fibrofog": Subjective appraisal, objective performance, and task-related brain activity during a working memory task

The subjective experience of cognitive dysfunction ("fibrofog") is common in fibromyalgia. This study investigated the relation between subjective appraisal of cognitive function, objective cognitive task performance, and brain activity during a cognitive task using functional magnetic resonance imaging (fMRI). Sixteen fibromyalgia patients and 13 healthy pain-free controls completed a battery of questionnaires, including the Multiple Ability Self-Report Questionnaire (MASQ), a measure of self-perceived cognitive difficulties. Participants were evaluated for working memory performance using a modified N-back working memory task while undergoing Blood Oxygen Level Dependent (BOLD) fMRI measurements. Fibromyalgia patients and controls did not differ in working memory performance. Subjective appraisal of cognitive function was associated with better performance (accuracy) on the working memory task in healthy controls but not in fibromyalgia patients. In fibromyalgia patients, increased perceived cognitive difficulty was positively correlated with the severity of their symptoms. BOLD response during the working memory task did not differ between the groups. BOLD response correlated with task accuracy in control subjects but not in fibromyalgia patients. Increased subjective cognitive impairment correlated with decreased BOLD response in both groups but in different anatomic regions. In conclusion, "fibrofog" appears to be better characterized by subjective rather than objective impairment. Neurologic correlates of this subjective experience of impairment might be separate from those involved in the performance of cognitive tasks.

The Use of Polysymptomatic Distress Categories in the Evaluation of Fibromyalgia (FM) and FM Severity

OBJECTIVE

The polysymptomatic distress (PSD) scale is derived from variables used in the 2010 American College of Rheumatology (ACR) fibromyalgia (FM) criteria modified for survey and clinical research. The scale is useful in measuring the effect of PSD over the full range of pain-related clinical symptoms, not just in those who are FM criteria-positive. However, no PSD scale categories have been defined to distinguish severity of illness in FM or in those who do not satisfy the FM criteria. We analyzed the scale and multiple covariates to develop clinical categories and to further validate the scale.

METHODS

FM was diagnosed according to the research criteria modification of the 2010 ACR FM criteria. We investigated categories in a large database of patients with pain (2732 with rheumatoid arthritis) and developed categories by using germane clinic variables that had been previously studied for severity groupings. By definition, FM cannot be diagnosed unless PSD is at least 12.

RESULTS

Based on population categories, regression analysis, and inspections of curvilinear relationships, we established PSD severity categories of none (0-3), mild (4-7), moderate (8-11), severe (12-19), and very severe (20-31). Categories were statistically distinct, and a generally linear relationship between PSD categories and covariate severity was noted.

CONCLUSION

PSD categories are clinically relevant and demonstrate FM type symptoms over the full range of clinical illness. Although FM criteria can be clinically useful, there is no clear-cut symptom distinction between FM (+) and FM (-), and PSD categories can aid in more effectively classifying patients.

Simplifying Fibromyalgia Assessment: The VASFIQ Brief Symptom Scale

OBJECTIVES

We tested the ability of the VASFIQ, a seven-item scale composed of Fibromyalgia Impact Questionnaire (FIQ) visual analog scales (VASs), to quantify fibromyalgia global disease severity and identify fibromyalgia patients with significant symptoms of fatigue, poor sleep, depression or anxiety.

METHODS

Spearman rank correlations were used to compare global VASFIQ, FIQ and Patient Global Impression of Change (PGIC) scores and individual FIQ VAS scores with full-length, validated questionnaire scores for fatigue (Multidimensional Assessment of Fatigue-Global Fatigue Index [MAF-GFI]), poor sleep (Medical Outcomes Study Sleep Problems Index [SPI]) and depression and anxiety (Hospital Anxiety and Depression Scale [HADS]). Patient scores used in the analyses were derived from 2229 patients enrolled in three pregabalin fibromyalgia trials. Receiver operating characteristic analyses determined VASFIQ cutoff scores identifying patients with clinically significant symptom levels using full-length, validated symptom questionnaires to define cases.

RESULTS

Global VASFIQ and FIQ scores correlated highly at baseline and study endpoints (ρ = 0.94 and 0.97, respectively; both p<0.0001). Change in global VASFIQ and FIQ scores correlated similarly to PGIC scores at study endpoints (ρ = 0.58 and 0.61, respectively; both p<0.0001). Individual FIQ VAS scores correlated with corresponding full-length symptom questionnaire scores at baseline and study endpoints (VASfatigue with MAF-GFI, ρ = 0.64 and 0.76; VASsleep with SPI, ρ = 0.50 and 0.67; VASdepression with HADS-D, ρ = 0.43 and 0.62; VASanxiety with HADS-A, ρ = 0.47 and 0.67, respectively; p <0.0001 for all). Patients with significant symptoms of fatigue were identified by VASfatigue >7.5, poor sleep by VASsleep >7.9, depression by VASdepression >5.8 and anxiety by VASanxiety >6.0. VASFIQ global scores ≥31.4 and ≥45.0 identified patients with moderate and severe global fibromyalgia symptoms, respectively.

CONCLUSIONS

The VASFIQ scale accurately quantifies global fibromyalgia severity and identifies patients with significant symptoms of fatigue, poor sleep, depression or anxiety with brevity, enabling rapid patient assessment and informing treatment decisions in busy clinics.

A comprehensive evaluation of standardized assessment tools in the diagnosis of fibromyalgia and in the assessment of fibromyalgia severity

Standard assessments for fibromyalgia (FM) diagnosis and core FM symptom domains are needed for biomarker development and treatment trials. Diagnostic and symptom assessments are reviewed and recommendations are made for standards. Recommendations for existing assessments include the American College of Rheumatology FM classification criteria using the manual tender point Survey for diagnosis, the brief pain inventory average pain visual analogue scale for pain intensity, the function subscale of the revised fibromyalgia impact questionnaire (FIQR) for physical function, the patient global impression of change and FIQR for overall/global improvement, the hospital anxiety and depression scale depression subscale for depression, the multiple ability self-report questionnaire for cognitive dysfunction, the fatigue severity scale for fatigue, the FIQR for multidimensional function/health-related quality of life, the jenkins sleep scale for sleep disturbance, and the fibromyalgia intensity score for tenderness. Forthcoming assessments including the FIQR for diagnosis, NIH PROMIS, and FIBRO Change scales are discussed.