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Munsell EGS, Bui Q, Kaufman KJ, Tomazin SE, Regan BA, Lenze EJ, Lee JM, Mohr DC, Fong MWM, Metts CL, Pham V, Wong AWK. Intraindividual variability in post-stroke cognition and its relationship with activities of daily living and social functioning: an ecological momentary assessment approach. Top Stroke Rehabil 2024:1-12. [PMID: 38278142 DOI: 10.1080/10749357.2024.2307203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 01/12/2024] [Indexed: 01/28/2024]
Abstract
INTRODUCTION Ecological momentary assessment (EMA) is a methodological approach to studying intraindividual variation over time. This study aimed to use EMA to determine the variability of cognition in individuals with chronic stroke, identify the latent classes of cognitive variability, and examine any differences in daily activities, social functioning, and neuropsychological performance between these latent classes. METHODS Participants (N = 202) with mild-to-moderate stroke and over 3-month post-stroke completed a study protocol, including smartphone-based EMA and two lab visits. Participants responded to five EMA surveys daily for 14 days to assess cognition. They completed patient-reported measures and neuropsychological assessments during lab visits. Using latent class analysis, we derived four indicators to quantify cognitive variability and identified latent classes among participants. We used ANOVA and Chi-square to test differences between these latent classes in daily activities, social functioning, and neuropsychological performance. RESULTS The latent class analysis converged on a three-class model. The moderate and high variability classes demonstrated significantly greater problems in daily activities and social functioning than the low class. They had significantly higher proportions of participants with problems in daily activities and social functioning than the low class. Neuropsychological performance was not statistically different between the three classes, although a trend approaching statistically significant difference was observed in working memory and executive function domains. DISCUSSION EMA could capture intraindividual cognitive variability in stroke survivors. It offers a new approach to understanding the impact and mechanism of post-stroke cognitive problems in daily life and identifying individuals benefiting from self-regulation interventions.
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Affiliation(s)
- Elizabeth G S Munsell
- Center for Rehabilitation Outcomes Research, Shirley Ryan AbilityLab, Chicago, IL, USA
- Center for Education in Health Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Quoc Bui
- Division of Biostatistics, Washington University School of Medicine, St. Louis, MO, USA
| | - Katherine J Kaufman
- Center for Rehabilitation Outcomes Research, Shirley Ryan AbilityLab, Chicago, IL, USA
| | - Stephanie E Tomazin
- Center for Rehabilitation Outcomes Research, Shirley Ryan AbilityLab, Chicago, IL, USA
| | - Bridget A Regan
- Center for Rehabilitation Outcomes Research, Shirley Ryan AbilityLab, Chicago, IL, USA
| | - Eric J Lenze
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Jin-Moo Lee
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
| | - David C Mohr
- Center for Behavioral Intervention Technologies and Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | - Christopher L Metts
- Department of Pathology and Laboratory Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Vy Pham
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Alex W K Wong
- Center for Rehabilitation Outcomes Research, Shirley Ryan AbilityLab, Chicago, IL, USA
- Department of Physical Medicine and Rehabilitation and Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Kairys AE, Valentine TR, Whibley D, Kratz AL. Mind the Mood: Momentary Depression and Anxiety Moderate the Correspondence Between Subjective and Objective Cognitive Functioning in Fibromyalgia. Arthritis Care Res (Hoboken) 2023; 75:1967-1975. [PMID: 36601904 PMCID: PMC10319918 DOI: 10.1002/acr.25086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 12/21/2022] [Accepted: 01/03/2023] [Indexed: 01/06/2023]
Abstract
OBJECTIVE Subjective cognitive dysfunction (SCD) affects 55-75% of individuals with fibromyalgia (FM), but those reporting cognitive difficulties often lack corresponding objective deficits. Symptoms of depression and anxiety are prevalent in FM and may account for part of this discrepancy. This study was undertaken to investigate whether momentary (within-day, across 7 days) changes in mood moderate the relationship between within-the-moment SCD and mental processing speed performance. METHODS A total of 50 individuals with FM (mean age 44.8 years, mean education 15.7 years, 88% female, 86% White) completed momentary assessments of subjective cognitive functioning, depressive and anxious symptoms, and a test of processing speed. Assessments were completed 5 times per day for 8 consecutive days on a study-specific smartphone application. RESULTS Momentary ratings of SCD were positively associated with mean reaction time (P < 0.001) and variability of processing speed (P = 0.02). Depressive symptoms moderated the relationship between SCD and processing speed, with lower correspondence when depressive symptoms were higher (P = 0.03). A similar moderating effect was demonstrated for both depression (P = 0.02) and anxiety (P = 0.03) on the association between SCD and variability in processing speed performance. CONCLUSION Individuals with FM may have more accurate self-perception of momentary changes in mental processing speed during periods of less pronounced mood symptoms based on their corresponding objective processing speed performance. However, during moments of heightened depression and anxiety, we found increasingly less correspondence between SCD and objective performance, suggesting that psychological symptoms may play an important role in self-perception of cognitive dysfunction in FM as it relates to mental processing speed.
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Loreti EH, Freire AM, Alexandre da Silva A, Kakuta E, Martins Neto UR, Konkiewitz EC. Effects of Anodal Transcranial Direct Current Stimulation on the Primary Motor Cortex in Women With Fibromyalgia: A Randomized, Triple-Blind Clinical Trial. Neuromodulation 2023:S1094-7159(22)01370-8. [PMID: 36702675 DOI: 10.1016/j.neurom.2022.11.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 11/08/2022] [Accepted: 11/14/2022] [Indexed: 01/26/2023]
Abstract
OBJECTIVES The aim of this study was to analyze the effects of ten sessions of active transcranial direct current stimulation transcranial direct current stimulation (tDCS) (2 mA) with 13:20:13 stimulation at M1 in women with fibromyalgia (FM). To the best of our knowledge, this is the first article that uses this protocol in patients with FM. The main hypothesis is that the protocol would be effective in decreasing pain and that the results would last for up to 90 days. MATERIALS AND METHODS This study was a randomized clinical trial with 35 women with FM divided into two groups, active tDCS group and sham tDCS group. A conventional tDCS device was used to deliver 2 mA for 13 minutes, with a 20-minute break followed by a further 13 minutes of stimulation for ten sessions. The anodal stimulus was in the left primary motor cortex M1 region. The primary outcome was a change in the visual analog scale and the Survey of Pain Attitudes pain score at the end of treatment, after 30 days, and 90 days after the end of treatment. Secondary outcomes included changes in the Fibromyalgia Impact Questionnaire, Hamilton Anxiety Rating Scale, Hamilton Depression Rating Scale, World Health Organization's Quality of Life Questionnaire, and Fatigue Assessment Scale. The Research Ethics Committee of the Centro Universitário da Grande Dourados under registration number Certificado de Apresentação de Apreciação Ética approved this research: 36444920.5.0000.5159. The study was registered in The Brazilian Registry of Clinical Trials with the identifier RBR-8wc8rjq. RESULTS The active tDCS group showed improvement in pain after ten sessions (p < 0.001), after 30 days (p < 0.01), and after 90 days (p < 0.001) compared with sham tDCS. In addition, improvement in quality of life (QoL) and fatigue was observed in the active tDCS group. CONCLUSION The results of this study suggest that active tDCS with an intensity of 2 mA for ten sessions was effective in decreasing pain and fatigue and improving QoL in patients with FM.
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Affiliation(s)
| | - Ariana Mendes Freire
- Department of Physiotherapy, Grande Dourados University Center, Dourados, Brazil
| | | | - Elaine Kakuta
- Department of Health Sciences, Federal University of Grande Dourados, Dourados, Brazil
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4
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Altered recognition of fearful and angry facial expressions in women with fibromyalgia syndrome: an experimental case-control study. Sci Rep 2022; 12:21498. [PMID: 36513716 PMCID: PMC9747799 DOI: 10.1038/s41598-022-25824-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 12/04/2022] [Indexed: 12/15/2022] Open
Abstract
Evidence relative to facial emotion recognition and the role played by alexithymia in fibromyalgia syndrome is rare and heterogeneous. In this work, we investigated this ability in fibromyalgia investigating the implicit behaviour in the facial emotion recognition task, focusing on fear and anger. Twenty women with fibromyalgia and twenty healthy women as controls performed a facial emotion recognition of fearful and angry expressions. Their implicit behaviour was scored in accordance with the redundant target effect. The level of alexithymic traits through a standard psychological questionnaire and its effect on behavioral performance were also assessed. Participants affected by fibromyalgia reported a lower level of accuracy in recognizing fearful and angry expressions, in comparison with the controls. Crucially, such a difference was not explained by the different levels of alexithymic traits between groups. Our results agreed with some previous evidence suggesting an altered recognition of others' emotional facial expressions in fibromyalgia syndrome. Considering the role of emotion recognition on social cognition and psychological well-being in fibromyalgia, we underlined the crucial role of emotional difficulties in the onset and maintenance of the symptoms life-span.
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Muñoz Ladrón de Guevara C, Reyes del Paso GA, Fernández Serrano MJ, Montoro CI. Fibromyalgia Syndrome and Cognitive Decline: The Role of Body Mass Index and Clinical Symptoms. J Clin Med 2022; 11:jcm11123404. [PMID: 35743474 PMCID: PMC9224759 DOI: 10.3390/jcm11123404] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 06/10/2022] [Accepted: 06/11/2022] [Indexed: 01/27/2023] Open
Abstract
The high prevalence of obesity and overweight in fibromyalgia (FM) may be an important factor in the well-known cognitive deficits seen in the disorder. This study analyzed the influence of body mass index (BMI) and primary clinical symptoms of FM (pain, fatigue, insomnia, anxiety, and depression) on attention, memory, and processing speed in FM. Fifty-two FM patients and thirty-two healthy participants completed cognitive tasks assessing selective, sustained, and divided attention; visuospatial and verbal memory; and information processing speed. Furthermore, they were evaluated in terms of the main clinical symptoms of the disorder. FM patients showed a marked reduction of cognitive performance in terms of selective, sustained, and divided attention; visuospatial memory; and processing speed, but no group differences were observed in verbal memory. BMI negatively affects sustained and selective attention, verbal memory, and processing speed and is the main predictor of performance in these basic cognitive domains. Our findings confirm the presence of cognitive deficits with respect to attention and visual memory, as well as slower processing speed, in FM. Moreover, the results support a role of BMI in the observed cognitive deficits. Interventions increasing physical activity and promoting cognitive stimulation could be useful for strengthening cognitive function in FM patients.
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Affiliation(s)
| | | | | | - Casandra I. Montoro
- Department of Psychology, University of Jaén, 23071 Jaén, Spain;
- Correspondence: (C.M.L.d.G.); (C.I.M.)
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6
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Evaluation of visual reaction time in patients with fibromyalgia syndrome. Rheumatol Int 2022; 42:853-859. [DOI: 10.1007/s00296-022-05107-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 02/26/2022] [Indexed: 11/26/2022]
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7
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Bearden DJ, Waber DP, Schreiber J, Mrakotsky C. Functional abdominal pain symptom severity: Associations between cognition and emotion in a pediatric sample. APPLIED NEUROPSYCHOLOGY. CHILD 2022; 11:69-80. [PMID: 32538220 PMCID: PMC8589105 DOI: 10.1080/21622965.2020.1758106] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Functional abdominal pain (FAP) is a common physical complaint in children and adolescents. Prior research has documented associations between FAP symptoms and mood, especially internalizing behaviors. Limited research is available examining the association between symptom burden and cognitive function in this pediatric population. This study explored associations between FAP symptoms, internalizing behaviors, and cognitive and school function in children and adolescents. Twenty-seven participants (mean age = 12.6 years, range 8.8-16.5; 33% male) diagnosed with FAP completed assessments of cognitive, emotional, and behavioral function, as well as FAP symptom severity. Mean performances on cognitive tests were within age-expected ranges. Within this context, however, higher overall burden of FAP symptoms was associated with slower processing speed, more self-reported metacognitive problems and internalizing behaviors, and more school absences. Cognitive function was systematically associated with internalizing behaviors but not physical symptoms. Overall, findings revealed that FAP may be associated with cognitive inefficiencies in addition to internalizing problems. Cognitive symptoms may be linked to internalizing behaviors associated with FAP.
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Affiliation(s)
- Donald Jay Bearden
- Boston Children’s Hospital, Neuropsychology, Boston, 02115-5724 United States,Children’s Healthcare of Atlanta Inc, Neuropsychology, Atlanta, 30329-2303 United States
| | | | - Jane Schreiber
- Children’s Hospital of Philadelphia Pediatrics Residency Program, Philadelphia, 19104 United States
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8
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Korucu ZT, Onurlu İ, Korucu A, Günendi Z. The effect of supervised dynamic exercise program on somatosensory temporal discrimination in patients with fibromyalgia syndrome. Arch Rheumatol 2021; 36:409-418. [PMID: 34870173 PMCID: PMC8612498 DOI: 10.46497/archrheumatol.2021.8412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 12/22/2020] [Indexed: 11/04/2022] Open
Abstract
Objectives
This study aims to investigate the effect of a supervised dynamic exercise program on somatosensory temporal discrimination (STD) which indicates the central sensory processing ability. Patients and methods
Forty-eight patients (mean age: 43 years; range, 19 to 64 years) with fibromyalgia syndrome (FMS) were included in this prospective, randomized study between April 2018 and October 2018. Demographics and clinical measurements were recorded. The STD threshold was measured by a researcher blinded to the treatment groups. After baseline assessments, the patients were randomized into two groups: the supervised exercise group (SEG) and the home exercise group (HEG) as the control group. The SEG performed submaximal aerobic exercise and low-medium resistant isotonic exercises under the supervision of a physiotherapist, 1-h per day, three days in a week for four weeks. The HEG was given a home-based exercise program consisting of low-to-medium resistance isotonic exercises and aerobic exercises 1-h per day, three days in a week for four weeks. After exercise program, clinical assessments and STD threshold measurement were repeated. Results
Clinical and STD threshold measures improved significantly after four-week exercise program in both groups. The improvements in clinical measures were significantly higher in the SEG. However, there was no difference in the STD threshold improvement between the groups. No correlation was found between the STD threshold measure and clinical features in any patients. Conclusion
Although a significant improvement was achieved in impaired STD threshold with SEG, it was not found to be superior to the amelioration observed with HEG.
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Affiliation(s)
- Zübeyde Tuğçe Korucu
- Department of Physical Medicine and Rehabilitation, Ankara City Hospital, Ankara, Turkey
| | - İlknur Onurlu
- Department of Physical Medicine and Rehabilitation, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Alperen Korucu
- Department of Orthopedics and Traumatology, Ankara City Hospital, Ankara, Turkey
| | - Zafer Günendi
- Department of Physical Medicine and Rehabilitation, Gazi University Faculty of Medicine, Ankara, Turkey
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9
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Gil-Ugidos A, Rodríguez-Salgado D, Pidal-Miranda M, Samartin-Veiga N, Fernández-Prieto M, Carrillo-de-la-Peña MT. Working Memory Performance, Pain and Associated Clinical Variables in Women With Fibromyalgia. Front Psychol 2021; 12:747533. [PMID: 34744922 PMCID: PMC8566754 DOI: 10.3389/fpsyg.2021.747533] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 09/20/2021] [Indexed: 01/08/2023] Open
Abstract
Working memory (WM) is a critical process for cognitive functioning in which fibromyalgia (FM) patients could show cognitive disturbances. Dyscognition in FM has been explained by interference from pain processing, which shares the neural substrates involved in cognition and may capture neural resources required to perform cognitive tasks. However, there is not yet data about how pain is related to WM performance, neither the role that other clinical variables could have. The objectives of this study were (1) to clarify the WM status of patients with FM and its relationship with nociception, and (2) to determine the clinical variables associated to FM that best predict WM performance. To this end, 132 women with FM undertook a neuropsychological assessment of WM functioning (Digit span, Spatial span, ACT tests and a 2-Back task) and a complete clinical assessment (FSQ, FIQ-R, BDI-1A, HADS, PSQI, MFE-30 questionnaires), including determination of pain thresholds and tolerance by pressure algometry. Patients with FM seem to preserve their WM span and ability to maintain and manipulate information online for both visuospatial and verbal domains. However, up to one-third of patients showed impairment in tasks requiring more short-term memory load, divided attention, and information processing ability (measured by the ACT task). Cognitive performance was spuriously related to the level of pain experienced, finding only that pain measures are related to the ACT task. The results of the linear regression analyses suggest that sleep problems and fatigue were the variables that best predicted WM performance in FM patients. Future research should take these variables into account when evaluating dyscognition in FM and should include dynamic measures of pain modulation.
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Affiliation(s)
- Antonio Gil-Ugidos
- Brain and Pain (BaP) Laboratory, Department of Clinical Psychology and Psychobiology, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Dolores Rodríguez-Salgado
- Brain and Pain (BaP) Laboratory, Department of Clinical Psychology and Psychobiology, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Marina Pidal-Miranda
- Brain and Pain (BaP) Laboratory, Department of Clinical Psychology and Psychobiology, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Noelia Samartin-Veiga
- Brain and Pain (BaP) Laboratory, Department of Clinical Psychology and Psychobiology, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Montse Fernández-Prieto
- Genetics Group, GC05, Instituto de Investigación Sanitaria de Santiago (IDIS), Santiago de Compostela, Spain.,Grupo de Medicina Xenómica, Center for Research in Molecular Medicine and Chronic Diseases (CiMUS), Universidade de Santiago de Compostela (USC), Santiago de Compostela, Spain.,U711, Centro de Investigación en Red de Enfermedades Raras (CIBERER), Santiago de Compostela, Spain
| | - Maria Teresa Carrillo-de-la-Peña
- Brain and Pain (BaP) Laboratory, Department of Clinical Psychology and Psychobiology, University of Santiago de Compostela, Santiago de Compostela, Spain
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10
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Mercado F, Ferrera D, Fernandes-Magalhaes R, Peláez I, Barjola P. Altered sub-processes of working memory in fibromyalgia patients: An ERP study using N-back task. PAIN MEDICINE 2021; 23:475-487. [PMID: 34145889 DOI: 10.1093/pm/pnab190] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Cognitive dysfunction in fibromyalgia has become a key symptom considered by patients as more disabling than pain itself. Experimental evidence from neuropsychological and neuroimaging studies indicates that such cognitive impairments are especially robust when patients need to set in motion working memory processes, suggesting the existence of an altered functioning underlying the cerebral cortices of the frontoparietal memory network. However, the temporal dynamics of working memory sub-processes have not yet been explored in fibromyalgia. SUBJECTS Thirty-six right-handed women participated in the experiment: comprising eighteen patients with fibromyalgia and eighteen healthy controls. METHODS Event-related potentials (ERPs) and behavioural responses were recorded while participants were engaged in a 2-back working memory task. Principal Component Analyses (PCA) were used to define and quantify the ERP components associated with working memory processes. RESULTS Fibromyalgia patients exhibited worse performance than the control group, as revealed by their number of errors in the working memory task. Moreover, both scalp parieto-occipital P2 and parieto-occipital P3 amplitudes were lower for patients than for healthy control participants. Regression analyses revealed that lower P3 amplitudes were observed in those patients with fibromyalgia reporting higher pain ratings. CONCLUSIONS Current results suggest that both encoding of information (as reflected by P2) and subsequently, context updating and the replacement (as seen in lower P3 amplitudes), as a part of working memory sub-processes, are impaired in fibromyalgia. Studying the temporal dynamics of working memory using ERP methodology is a helpful approach to detect specific cognitive impaired mechanisms in this chronic pain syndrome. These new data could be used to develop more specific treatments adapted for each patient.
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Affiliation(s)
- Francisco Mercado
- Psychobiology Unit, School of Health Sciences, Rey Juan Carlos University, Madrid, Spain
| | - David Ferrera
- Psychobiology Unit, School of Health Sciences, Rey Juan Carlos University, Madrid, Spain
| | - Roberto Fernandes-Magalhaes
- Psychobiology Unit, School of Health Sciences, Rey Juan Carlos University, Madrid, Spain.,Clinical Foundation of the Rey Juan Carlos University, Madrid, Spain
| | - Irene Peláez
- Psychobiology Unit, School of Health Sciences, Rey Juan Carlos University, Madrid, Spain
| | - Paloma Barjola
- Psychobiology Unit, School of Health Sciences, Rey Juan Carlos University, Madrid, Spain
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Murasawa H, Pawlak A, Kobayashi H, Saeki K, Yasuda SI, Kitano Y. Mirogabalin, a novel ligand for α 2δ subunit of voltage-gated calcium channels, improves cognitive impairments in repeated intramuscular acidic saline injection model rats, an experimental model of fibromyalgia. Biomed Pharmacother 2021; 139:111647. [PMID: 33940507 DOI: 10.1016/j.biopha.2021.111647] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 04/13/2021] [Accepted: 04/19/2021] [Indexed: 11/17/2022] Open
Abstract
Mirogabalin is a novel potent and selective ligand for the α2δ subunit of voltage-gated calcium channels, and shows potent and sustained analgesic effects in neuropathic pain and fibromyalgia models. Fibromyalgia is often associated with multiple comorbid symptoms, such as anxiety, depression and cognitive impairment. In the present study, we investigated the effects of mirogabalin on cognitive impairments in an experimental animal model for fibromyalgia, repeated intramuscular acidic saline injection model (Sluka model) rats. Male rats received two repeated intramuscular injections of pH 4 acidic saline into their gastrocnemius muscle. After developing mechanical hypersensitivity as identified in the von Frey test, the animals received the test substance orally once daily for 13 days and were subjected to four cognitive function tests, (Y-maze, novel object recognition, Morris water maze and step-through passive avoidance). Sluka model rats showed cognitive impairments in all four tests. Oral administration of mirogabalin (3 and 10 mg/kg) improved the cognitive impairments in these rats. In conclusion, mirogabalin improved the impaired cognitive function in Sluka model rats. It may thus also alleviate cognitive impairments as well as painful symptoms in fibromyalgia patients.
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Affiliation(s)
- Hiroyasu Murasawa
- Hashima Laboratory, Nihon Bioresearch Inc., 6-104, Majima, Fukuju-cho, Hashima, Gifu 501-6251, Japan.
| | - Akiko Pawlak
- Hashima Laboratory, Nihon Bioresearch Inc., 6-104, Majima, Fukuju-cho, Hashima, Gifu 501-6251, Japan.
| | - Hiroyuki Kobayashi
- Hashima Laboratory, Nihon Bioresearch Inc., 6-104, Majima, Fukuju-cho, Hashima, Gifu 501-6251, Japan.
| | - Kensuke Saeki
- Hashima Laboratory, Nihon Bioresearch Inc., 6-104, Majima, Fukuju-cho, Hashima, Gifu 501-6251, Japan.
| | - Shun-Ichi Yasuda
- Hashima Laboratory, Nihon Bioresearch Inc., 6-104, Majima, Fukuju-cho, Hashima, Gifu 501-6251, Japan.
| | - Yutaka Kitano
- Specialty Medicine Research Laboratories I, Daiichi-Sankyo Co., Ltd., 1-2-58, Hiromachi, Shinagawa-ku, Tokyo 140-8710, Japan.
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12
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Pozhidaev KA, Parfenov VA. [Cognitive and emotional disorders in patients with migraine and signs of leukoencephalopathy]. Zh Nevrol Psikhiatr Im S S Korsakova 2021; 121:7-12. [PMID: 33834711 DOI: 10.17116/jnevro20211210317] [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] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To identify cognitive and emotional disorders and their correlation with neuroimaging parameters in patients with chronic migraine. MATERIAL AND METHODS We examined 50 patients (8 men and 42 women, mean age 41.9±11.9 years) with migraine, including 31 with chronic migraine, and signs of leukoencephalopathy according to magnetic resonance imaging (MRI). A control group comprised 40 healthy individuals (13 men and 27 women) aged 20 to 64 years (mean 42.6±12.0 years). A number of tests for neuropsychological examination and assessment of the emotional state, including a 12-word test, literal and categorical associations, Benton Test, the Montreal cognitive scale (MOCA), the Hospital Depression Scale, the Beck Depression Scale, the Center for Epidemiological Research scale, the Hospital Anxiety Scale and the Spielberger-Khanin scale, were administered at baseline and after 3 and 6 month of preventive therapy. RESULTS Patients with migraine had lower scores (p=0.004) on MOCA, memorization of 12 words (p=0.0003), test for literal (p=0.001) and categorical associations (p=0.0002) compared with the control group. No significant correlations were found between the volume of white matter lesions according to MRI and the severity of cognitive impairment. An inverse correlation of average strength was noted (correlation coefficient R=-0.41) between the number of days with headache per month and the MOCA score (p<0.05). In patients with migraine, signs of depression were found on the Hospital Depression Scale (p=0.04), Beck Depression Scale (p=0.003), the Center for Epidemiological Research scale (p=0.0001), and increased anxiety on the Hospital Anxiety Scale (p=0.0001) and the Spielberger-Khanin scale (p=0.0001). A significant relationship was found between the degree of depression and the MOCA score (p=0.007). The frequency of headaches decreased from 19.4±2.9 to 12.6±4.4 days per month (p<0.05). CONCLUSION There were a significant decrease of emotional disorders and improvement of cognitive functions compared with baseline scores during the 6 month therapy. Preventive treatment of migraine and concomitant emotional disorders seems to be the most effective way to improve cognitive functions.
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Affiliation(s)
- K A Pozhidaev
- Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation, Moscow, Russia
| | - V A Parfenov
- Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation, Moscow, Russia
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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: 4] [Impact Index Per Article: 1.3] [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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14
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van Ettinger-Veenstra H, Boehme R, Ghafouri B, Olausson H, Wicksell RK, Gerdle B. Exploration of Functional Connectivity Changes Previously Reported in Fibromyalgia and Their Relation to Psychological Distress and Pain Measures. J Clin Med 2020; 9:E3560. [PMID: 33167371 PMCID: PMC7694394 DOI: 10.3390/jcm9113560] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 10/27/2020] [Accepted: 11/03/2020] [Indexed: 11/18/2022] Open
Abstract
Neural functional connectivity changes in the default mode network (DMN), Central executive network (CEN), and insula have been implicated in fibromyalgia (FM) but stem from a sparse set of small-scale studies with limited power for the investigation of confounding effects. We investigated whether anxiety, depression, pain sensitivity, and pain intensity modulated functional connectivity related to DMN nodes, CEN nodes, and insula. Resting-state functional magnetic resonance imaging data were collected from 31 females with FM and 28 age-matched healthy controls. Connectivity was analysed with a region-based connectivity analysis between DMN nodes in ventromedial prefrontal cortex (vmPFC) and posterior cingulate cortex, CEN nodes in the intraparietal sulcus (IPS), and bilateral insula. FM patients displayed significantly higher levels of anxiety and depressive symptoms than controls. The right IPS node of the CEN showed a higher level of connectivity strength with right insula in FM with higher pain intensity compared to controls. More anxiety symptoms in FM correlated with higher levels of connectivity strength between the vmPFC DMN node and right sensorimotor cortex. These findings support the theory of altered insular connectivity in FM and also suggest altered IPS connectivity in FM. Interestingly, no change in insular connectivity with DMN was observed.
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Affiliation(s)
- Helene van Ettinger-Veenstra
- Department of Clinical Neuroscience, Karolinska Institute, S-171 77 Stockholm, Sweden;
- Center for Medical Image Science and Visualization (CMIV), Linköping University, S-581 85 Linköping, Sweden; (H.O.); (B.G.)
| | - Rebecca Boehme
- Center for Medical Image Science and Visualization (CMIV), Linköping University, S-581 85 Linköping, Sweden; (H.O.); (B.G.)
- Center for Social and Affective Neuroscience (CSAN), Linköping University, S-581 85 Linköping, Sweden
| | - Bijar Ghafouri
- Pain and Rehabilitation Centre, and Department of Health, Medicine and Caring Sciences, Linköping University, S-581 85 Linköping, Sweden;
| | - Håkan Olausson
- Center for Medical Image Science and Visualization (CMIV), Linköping University, S-581 85 Linköping, Sweden; (H.O.); (B.G.)
- Center for Social and Affective Neuroscience (CSAN), Linköping University, S-581 85 Linköping, Sweden
| | - Rikard K. Wicksell
- Department of Clinical Neuroscience, Karolinska Institute, S-171 77 Stockholm, Sweden;
| | - Björn Gerdle
- Center for Medical Image Science and Visualization (CMIV), Linköping University, S-581 85 Linköping, Sweden; (H.O.); (B.G.)
- Pain and Rehabilitation Centre, and Department of Health, Medicine and Caring Sciences, Linköping University, S-581 85 Linköping, Sweden;
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15
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Maffei ME. Fibromyalgia: Recent Advances in Diagnosis, Classification, Pharmacotherapy and Alternative Remedies. Int J Mol Sci 2020; 21:E7877. [PMID: 33114203 PMCID: PMC7660651 DOI: 10.3390/ijms21217877] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 10/22/2020] [Accepted: 10/22/2020] [Indexed: 02/07/2023] Open
Abstract
Fibromyalgia (FM) is a syndrome that does not present a well-defined underlying organic disease. FM is a condition which has been associated with diseases such as infections, diabetes, psychiatric or neurological disorders, rheumatic pathologies, and is a disorder that rather than diagnosis of exclusion requires positive diagnosis. A multidimensional approach is required for the management of FM, including pain management, pharmacological therapies, behavioral therapy, patient education, and exercise. The purpose of this review is to summarize the recent advances in classification criteria and diagnostic criteria for FM as well as to explore pharmacotherapy and the use of alternative therapies including the use of plant bioactive molecules.
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Affiliation(s)
- Massimo E Maffei
- Department of Life Sciences and Systems Biology, University of Turin, 10135 Turin, Italy
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16
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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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17
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Attachment style and parental bonding: Relationships with fibromyalgia and alexithymia. PLoS One 2020; 15:e0231674. [PMID: 32287311 PMCID: PMC7156042 DOI: 10.1371/journal.pone.0231674] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 03/28/2020] [Indexed: 12/26/2022] Open
Abstract
Objectives Fibromyalgia (FM) is a chronic pain syndrome, and alexithymia, which is a condition that is characterised by deficits in emotional self-awareness, is highly prevalent among individuals with FM. Insecure attachment styles and inadequate parental care appear to play an important role in the onset and maintenance of both alexithymia and chronic pain. Therefore, the present study aimed to examine the associations between attachment styles, parental bonding, and alexithymia among patients with FM and healthy controls (HC). Methods All participants completed a battery of tests that assessed alexithymia, attachment styles, and parental bonding. Two logistic regression models were tested to examine whether these variables predict (a) group membership (i.e. patients with FM vs. HC) and (b) the likelihood of having alexithymia (i.e. among patients with FM and HC). Results Alexithymia (i.e. difficulty identifying and describing feelings subscales of the 20-item Toronto Alexithymia Scale) significantly predicted group membership (i.e. the likelihood of having FM). On the other hand, educational level and dismissive attachment (i.e. the discomfort with closeness and relationships as secondary subscales of the Attachment Style Questionnaire) were the only significant predictors of the likelihood of having alexithymia. Conclusions These findings highlight both the relevance of alexithymic traits to the definition of FM and centrality of an insecure attachment style to the manifestation of alexithymia.
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18
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Kratz AL, Whibley D, Kim S, Williams DA, Clauw DJ, Sliwinski M. The Role of Environmental Distractions in the Experience of Fibrofog in Real-World Settings. ACR Open Rheumatol 2020; 2:214-221. [PMID: 32237225 PMCID: PMC7164629 DOI: 10.1002/acr2.11130] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 02/14/2020] [Indexed: 12/20/2022] Open
Abstract
Objective Perceived cognitive dysfunction in people with fibromyalgia (FM), “fibrofog,” is commonly reported and has been demonstrated in neurocognitive testing. Distractibility and inattention have been implicated as potential contributors to fibrofog, but the role of environmental distractions has not been explored. In this study, ambulatory assessment methods were used to examine whether FM is related to more environmental distractions and to examine the impact of distractions on subjective and objective cognitive functioning. Methods Fifty people with FM and 50 age‐, sex‐, and education‐matched controls without FM completed 8 consecutive days of ambulatory assessments. Five times per day, participants reported perceived cognitive functioning and environmental distractions and completed validated tests of processing speed and working memory. Results The FM group reported distractions in a higher proportion of the ambulatory cognitive testing sessions (40.5%) compared with the group without FM (29.8%; P < 0.001) and more often reported multiple simultaneous distractions. For both groups, sound was the most common distraction. The group with FM reported more distractions caused by light, and the group without FM reported more social distractions. Group differences in subjective and objective cognitive functioning were not augmented during distraction relative to during periods of no distraction. There were no group differences in within‐person changes in cognitive functioning as a function of distraction. Conclusion The group with FM reported more distractions than the group without FM; both groups reported poorer processing speed when distracted, and the effects of distraction on test performance did not differ significantly by group. Findings suggest that sensitivity to environmental distractions may play a role in the experience of cognitive dysfunction in FM.
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Affiliation(s)
| | - Daniel Whibley
- University of Michigan, Ann Arbor, and School of Medicine, Medical Sciences, and Nutrition, University of Aberdeen, Aberdeen, United Kingdom
| | - Samsuk Kim
- University of Detroit Mercy, Detroit, Michigan
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19
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Latysheva N, Filatova E, Osipova D, Danilov AB. Cognitive impairment in chronic migraine: a cross-sectional study in a clinic-based sample. ARQUIVOS DE NEURO-PSIQUIATRIA 2020; 78:133-138. [PMID: 32236328 DOI: 10.1590/0004-282x20190159] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 09/30/2019] [Indexed: 11/22/2022]
Abstract
Cognitive impairment has been described in all phases of a migraine attack and interictally. However, the prevalence and phenotype of such impairment in chronic migraine (CM) have not yet been studied. OBJECTIVES The aim of this study was to evaluate both the prevalence of the objective cognitive deficit in patients with CM and the factors underlying its etiology. METHODS 144 patients with CM and 44 age-matched patients with low-frequency episodic migraine (EM) (a maximum of 4 headache days per month) participated in this study. Neuropsychiatric characteristics were measured with the HADS Hospital Anxiety and Depression Scale. Cognitive function was assessed with the Montreal Cognitive Assessment (MoCA), Digit Symbol Substitution Test (DSST), Rey Auditory Verbal Learning Test (RAVLT), and the Perceived Deficits Questionnaire (PDQ-20). RESULTS Compared to EM, CM subjects demonstrated higher subjective and objective cognitive impairment across all tests. CM patients had 4 times higher odds of achieving a RAVLT score in the lower quartile range compared to EM (Odds Ratio [OR] 3.8; 95% confidence interval [95%CI] 1.5‒9.6; р=0.005). In the MoCA, CM patients demonstrated the most striking impairment in memory/delayed recall (65.3%), attention (46.5%), abstraction (30.6%), and language (27.1%). Chronic headache and level of education, but not gender, depression or anxiety, were independent predictors of cognitive impairment. CONCLUSIONS Cognitive impairment is prevalent in the CM population during their mildest possible pain and may be caused by a central sensitization. Timely preventive treatment of EM is warranted.
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Affiliation(s)
- Nina Latysheva
- Department of Neurology, Institute for Professional Education, Sechenov University, Moscow, Russia
| | - Elena Filatova
- Department of Neurology, Institute for Professional Education, Sechenov University, Moscow, Russia
| | - Diana Osipova
- Department of Neurology, Institute for Professional Education, Sechenov University, Moscow, Russia
| | - Alexey B Danilov
- Department of Neurology, Institute for Professional Education, Sechenov University, Moscow, Russia
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20
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Abstract
BACKGROUND Fibromyalgia (FM) is a chronic pain syndrome with a controversial etiopathogenesis. Patients with FM usually complain of cognitive symptoms, which are described as "fibrofog." These cognitive complaints might be caused partially by dissociative disorders (DD). The aim of this research is to determine the association between FM and DD. METHODS The authors conducted a case-control study for this purpose, integrated by 3 groups: control (C), patients with rheumatic disorders (R), and patients with FM (FM), who were compared through the Dissociative Experiences Scale (DES).The findings are as follows: 42% were taking medications in the FM group, and their differences in scores with those who were not under medications were then considered. In terms of the results, the FM group showed higher scores than both C and R groups (p < 0.05). Patients with FM who were taking antidepressants had lower scores than those who were not (Z-score -8.03; p < 0.05); and finally, 5.71% had a score over 30 (χ2 = 3.73, p = 0.15). CONCLUSION Patients with FM had higher scores, which might be related to the association of dissociative experiences, lifetime trauma, and victimization. Antidepressants might have some role on dissociative symptoms as well.
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21
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Rates of Neuropsychological Dysfunction in Fibromyalgia and Rheumatoid Arthritis. J Clin Rheumatol 2019; 25:252-257. [DOI: 10.1097/rhu.0000000000000837] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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22
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van Rensburg R, Meyer HP, Hitchcock SA, Schuler CE. Screening for Adult ADHD in Patients with Fibromyalgia Syndrome. PAIN MEDICINE 2019; 19:1825-1831. [PMID: 29099955 DOI: 10.1093/pm/pnx275] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Objective Fibromyalgia syndrome (FMS) is a common chronic pain disorder associated with altered activity of neurotransmitters involved in pain sensitivity such as dopamine, serotonin, and noradrenaline. FMS may significantly impact an individual's functioning due to the presence of chronic pain, fatigue, and cognitive impairment. Dyscognition may be more disabling than the chronic pain but is mostly under-recognized. This study aimed to assess the potential co-occurrence of FMS and adult attention deficit hyperactivity disorder (ADHD), a chronic neurodevelopmental disorder also associated with impaired cognition and dopaminergic function. Methods In a cross-sectional observational study, 123 previously confirmed FMS patients were screened for adult ADHD using the World Health Organization Adult ADHD Self Report scale v1.1. The Revised Fibromyalgia Impact Questionnaire (FIQ-R) was used to assess the impact of FMS. Cognitive assessment was based on self-report in accordance with the 2011 modified American College of Rheumatology criteria and the FIQ-R, respectively. Results Of the 123 participants, 44.72% (N = 55) screened positive for adult ADHD. Participants with both FMS and a positive adult ADHD screening test scored higher on the FIQ-R score (64.74, SD = 17.66, vs 54.10, SD = 17.10). Self-reported cognitive impairment was rated higher in the combined group (odds ratio = 10.61, 95% confidence interval; 3.77-29.86, P < 0.01). Conclusions These results indicate that the co-occurrence of adult ADHD in FMS may be highly prevalent and may also significantly impact the morbidity of FMS. Patients with FMS should be assessed for the presence of adult ADHD.
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Affiliation(s)
- Roland van Rensburg
- Department of Family Medicine, University of Pretoria, Pretoria, South Africa
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23
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Arnold LM, Bennett RM, Crofford LJ, Dean LE, Clauw DJ, Goldenberg DL, Fitzcharles MA, Paiva ES, Staud R, Sarzi-Puttini P, Buskila D, Macfarlane GJ. AAPT Diagnostic Criteria for Fibromyalgia. THE JOURNAL OF PAIN 2019; 20:611-628. [DOI: 10.1016/j.jpain.2018.10.008] [Citation(s) in RCA: 148] [Impact Index Per Article: 29.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 09/28/2018] [Accepted: 10/15/2018] [Indexed: 01/08/2023]
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24
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Brain Electrical Activity Associated With Visual Attention and Reactive Motor Inhibition in Patients With Fibromyalgia. Psychosom Med 2019; 81:380-388. [PMID: 31048636 DOI: 10.1097/psy.0000000000000677] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Fibromyalgia (FM) is a generalized chronic pain condition associated with multiple cognitive impairments, including altered inhibitory processes. Inhibition is a key component of human executive functions and shares neural substrate with pain processing, which may explain the inhibitory deficits in FM. Here, we investigated the integrity of brain inhibitory mechanisms in these patients. METHODS We recorded the electroencephalographic activity of 27 patients with FM and 27 healthy controls (HCs) (all women) while they performed a reactive motor inhibition task (the stop-signal paradigm). We analyzed task-induced modulations in electrophysiological markers related to inhibition (N2, P3, and midfrontal theta oscillations) and visual attention (posterior alpha oscillations). RESULTS The FM group performed the task correctly, with no differences relative to HCs at the behavioral level. We did not find any between-group differences in N2 amplitude (F(1,52) = 0.01, p = .93), P3 amplitude (F(1,52) = 3.46; p = .068), or theta power (F(1,52) = 0.05; p = .82). However, modulation of posterior alpha power after presentation of either the go or stop stimuli was lower in patients than in HCs (F(1,52) = 7.98; p = .007). CONCLUSIONS N2, P3, theta power, and behavioral results indicate that the mechanisms of motor inhibition are sufficiently preserved to enable correct performance of the stop-signal task in patients with FM. Nevertheless, the lower modulation of alpha suggests greater difficulty in mobilizing and maintaining visual attentional resources, a result that may explain the cognitive dysfunction observed in FM.
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25
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Samartin-Veiga N, González-Villar AJ, Carrillo-de-la-Peña MT. Neural correlates of cognitive dysfunction in fibromyalgia patients: Reduced brain electrical activity during the execution of a cognitive control task. NEUROIMAGE-CLINICAL 2019; 23:101817. [PMID: 30999252 PMCID: PMC6468193 DOI: 10.1016/j.nicl.2019.101817] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 04/04/2019] [Accepted: 04/07/2019] [Indexed: 12/17/2022]
Abstract
OBJECTIVES Fibromyalgia (FM) is a generalized chronic pain syndrome of unknown aetiology. Although FM patients frequently complain of cognitive dysfunction, this is one of the least studied symptoms. Research on brain activity associated with the perceived cognitive impairment is particularly scarce. To address this gap, we recorded the brain electrical activity in participants during a cognitive control task. METHODS Electroencephalograms (EEGs) were recorded in 19 FM patients and 22 healthy controls (all women) while they performed the Multi-Source Interference Task (MSIT). We analyzed the amplitude of the frontal N2 and parietal P3 components elicited in control and interference trials and their relation with reaction times. We also explored the relationship of perceived cognitive dysfunction, assessed using visual analogue scales (VAS) and the Memory Failures of Everyday (MFE-30) test, with N2 and P3 amplitudes. RESULTS The N2 amplitudes were smaller in FM patients than in controls and were negatively associated with cognitive complaints. Unlike patients, healthy controls showed significant differences in the amplitude of P3 obtained from control vs. interference trials of the MSIT. Smaller N2 and P3 amplitudes were associated to longer reaction times. CONCLUSIONS The findings suggest a reduction in frontal brain activity during performance of an interference task, which was associated with the patients' cognitive complaints. Findings on P3 suggest altered modulation of attention according to the task demands in FM patients. Deficits in flexibility in the allocation of attentional resources and cognitive control during complex tasks may explain the dyscognition reported by chronic pain patients.
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Affiliation(s)
- N Samartin-Veiga
- Departamento de Psicoloxía Clínica e Psicobioloxía, Facultade de Psicoloxía, Universidade de Santiago de Compostela, Santiago de Compostela, Spain.
| | - A J González-Villar
- Departamento de Psicoloxía Clínica e Psicobioloxía, Facultade de Psicoloxía, Universidade de Santiago de Compostela, Santiago de Compostela, Spain; Psychological Neuroscience Lab, Research Center in Psychology, School of Psychology, University of Minho, Braga, Portugal
| | - M T Carrillo-de-la-Peña
- Departamento de Psicoloxía Clínica e Psicobioloxía, Facultade de Psicoloxía, Universidade de Santiago de Compostela, Santiago de Compostela, Spain
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26
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Ghavidel-Parsa B, Bidari A, Hajiabbasi A, Shenavar I, Ghalehbaghi B, Sanaei O. Fibromyalgia diagnostic model derived from combination of American College of Rheumatology 1990 and 2011 criteria. Korean J Pain 2019; 32:120-128. [PMID: 31091511 PMCID: PMC6549593 DOI: 10.3344/kjp.2019.32.2.120] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 03/02/2019] [Accepted: 03/04/2019] [Indexed: 12/03/2022] Open
Abstract
Background We aimed to explore the American College of Rheumatology (ACR) 1990 and 2011 fibromyalgia (FM) classification criteria’s items and the components of Fibromyalgia Impact Questionnaire (FIQ) to identify features best discriminating FM features. Finally, we developed a combined FM diagnostic (C-FM) model using the FM’s key features. Methods The means and frequency on tender points (TPs), ACR 2011 components and FIQ items were calculated in the FM and non-FM (osteoarthritis [OA] and non-OA) patients. Then, two-step multiple logistic regression analysis was performed to order these variables according to their maximal statistical contribution in predicting group membership. Partial correlations assessed their unique contribution, and two-group discriminant analysis provided a classification table. Using receiver operator characteristic analyses, we determined the sensitivity and specificity of the final model. Results A total of 172 patients with FM, 75 with OA and 21 with periarthritis or regional pain syndromes were enrolled. Two steps multiple logistic regression analysis identified 8 key features of FM which accounted for 64.8% of variance associated with FM group membership: lateral epicondyle TP with variance percentages (36.9%), neck pain (14.5%), fatigue (4.7%), insomnia (3%), upper back pain (2.2%), shoulder pain (1.5%), gluteal TP (1.2%), and FIQ fatigue (0.9%). The C-FM model demonstrated a 91.4% correct classification rate, 91.9% for sensitivity and 91.7% for specificity. Conclusions The C-FM model can accurately detect FM patients among other pain disorders. Re-inclusion of TPs along with saving of FM main symptoms in the C-FM model is a unique feature of this model.
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Affiliation(s)
- Banafsheh Ghavidel-Parsa
- Rheumatology Research Center, Razi Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Ali Bidari
- Department of Rheumatology, Iran University of Medical Sciences, Tehran, Iran
| | - Asghar Hajiabbasi
- Rheumatology Research Center, Razi Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Irandokht Shenavar
- Rheumatology Research Center, Razi Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Babak Ghalehbaghi
- ENT and Head and Neck Research Center and Department, Iran University of Medical Sciences, Tehran, Iran
| | - Omid Sanaei
- Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, MD, USA
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27
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Fang SC, Wu YL, Chen SC, Teng HW, Tsai PS. Subjective sleep quality as a mediator in the relationship between pain severity and sustained attention performance in patients with fibromyalgia. J Sleep Res 2019; 28:e12843. [PMID: 30920084 DOI: 10.1111/jsr.12843] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 02/12/2019] [Accepted: 02/14/2019] [Indexed: 01/17/2023]
Abstract
Pain severity and sleep are associated with cognitive performance in patients with fibromyalgia. This study examined whether sleep mediates the relationships of pain severity with psychomotor vigilance and attention in patients with fibromyalgia by analysing 80 patients with fibromyalgia. Cognitive performance, pain severity and sleep parameters were determined using the Psychomotor Vigilance Task, Brief Pain Inventory-Short Form and sleep diaries of seven consecutive nights, respectively. The patients' demographic data were analysed for potential confounding factors. After adjustment for these confounders, a series of regression analyses was performed to examine the mediating role of sleep. The results indicated that higher pain severity was strongly associated with poorer sustained attention and lower sleep quality, the total effects of pain severity on psychomotor vigilance and attention were significant (c path: β = 0.23, p = 0.04), and pain severity was a significant sleep quality predictor (a path: β = -0.33, p < 0.01). When sleep quality was entered into the regression model (a × b path), the effects of pain severity on psychomotor vigilance and attention became non-significant (c' path: β = 0.15, p = 0.20) after adjustment of age, indicating a complete mediating effect of sleep quality in the pain severity-cognitive performance relationship. In conclusion, sleep quality mediates the pain severity-cognitive performance relationship: pain affects sleep quality, which in turn impairs sustained attention. Our findings provide further insight into the processes underlying the relationship between pain and poor cognitive function. Improved sleep quality may offset the detrimental effects of pain on sustained attention.
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Affiliation(s)
- Su-Chen Fang
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Yu-Lin Wu
- Institute of Population Health Sciences, National Health Research Institutes, Miaoli, Taiwan
| | - Shih-Ching Chen
- Department of Physical Medicine and Rehabilitation, College of Medicine, Taipei Medical University, Taipei, Taiwan.,Department of Physical Medicine and Rehabilitation, Taipei Medical University Hospital, Taipei, Taiwan
| | - Hao-Wen Teng
- Department of Neurology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Pei-Shan Tsai
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan.,Department of Nursing, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.,Sleep Research Center, Taipei Medical University Hospital, Taipei, Taiwan
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28
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Brighina F, Curatolo M, Cosentino G, De Tommaso M, Battaglia G, Sarzi-Puttini PC, Guggino G, Fierro B. Brain Modulation by Electric Currents in Fibromyalgia: A Structured Review on Non-invasive Approach With Transcranial Electrical Stimulation. Front Hum Neurosci 2019; 13:40. [PMID: 30804771 PMCID: PMC6378756 DOI: 10.3389/fnhum.2019.00040] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Accepted: 01/24/2019] [Indexed: 01/13/2023] Open
Abstract
Fibromyalgia syndrome (FMS) is a complex disorder where widespread musculoskeletal pain is associated with many heterogenous symptoms ranging from affective disturbances to cognitive dysfunction and central fatigue. FMS is currently underdiagnosed and often very poorly responsive to pharmacological treatment. Pathophysiology of the disease remains still obscure even if in the last years fine structural and functional cerebral abnormalities have been identified, principally by neurophysiological and imaging studies delineating disfunctions in pain perception, processing and control systems. On such basis, recently, neurostimulation of brain areas involved in mechanism of pain processing and control (primary motor cortex: M1 and dorsolateral prefrontal cortex: DLPFC) has been explored by means of different approaches and particularly through non-invasive brain stimulation techniques (transcranial magnetic and electric stimulation: TMS and tES). Here we summarize studies on tES application in FMS. The great majority of reports, based on direct currents (transcranial direct currents stimulation: tDCS) and targeting M1, showed efficacy on pain measures and less on cognitive and affective symptoms, even if several aspects as maintenance of therapeutical effects and optimal stimulation parameters remain to be established. Differently, stimulation of DLPFC, explored in a few studies, was ineffective on pain and showed limited effects on cognitive and affective symptoms. Very recently new tES techniques as high-density tDCS (HD-tDCS), transcranial random noise stimulation (tRNS) and tDCS devices for home-based treatment have been explored in FMS with interesting even if very preliminary results opening interesting perspectives for more effective, well tolerated, cheap and easy therapeutic approaches.
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Affiliation(s)
- Filippo Brighina
- Dipartimento di Biomedicina, Neuroscienze e Diagnostica Avanzata (BIND), Università degli Studi di Palermo, Palermo, Italy
| | - Massimiliano Curatolo
- Dipartimento di Biomedicina, Neuroscienze e Diagnostica Avanzata (BIND), Università degli Studi di Palermo, Palermo, Italy
| | - Giuseppe Cosentino
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.,IRCCS Mondino Foundation, Pavia, Italy
| | - Marina De Tommaso
- Unità di Neurofisiopatologia del Dolore, Dipartimento di Scienze Mediche di Base, Neuroscienze e Organi di Senso (SMBNOS), Università degli Studi di Bari Aldo Moro, Bari, Italy
| | - Giuseppe Battaglia
- Dipartimento di Scienze Psicologiche, Pedagogiche, dell'Esercizio Fisico e della Formazione, Università degli Studi di Palermo, Palermo, Italy
| | | | - Giuliana Guggino
- Dipartimento Biomedico di Medicina Interna e Specialistica (DIBIMIS), Università degli Studi di Palermo, Palermo, Italy
| | - Brigida Fierro
- Dipartimento di Biomedicina, Neuroscienze e Diagnostica Avanzata (BIND), Università degli Studi di Palermo, Palermo, Italy
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Latysheva NV, Filatova EG, Osipova DV. Depression is not the only cause of cognitive impairment in chronic migraine. ACTA ACUST UNITED AC 2019. [DOI: 10.17650/2222-8721-2018-8-4-35-42] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Background. Patients with the chronic migraine frequently present with memory and attention complaints. However, the prevalence and phenotype of such impairment in chronic migraine have not been studied.Objective – to evaluate the prevalence of the objective cognitive deficit in patients with chronic migraine and factors underlying its etiology. Materials and methods. We recruited 62 subjects with chronic migraine and 36 genderand age-matched controls with low-frequency episodic migraine (not more, then 4 headache days per month) aged 18–59. All patients filled in the Hospital Anxiety and Depression Scale (HADS) and Sheehan Disability Scale. Cognitive function was assessed with the Montreal Cognitive Assessment (MoCA), Digital Symbol Substitution Test (DSST), Rey Auditory Verbal Learning Test (RAVLT), and the Perceived Deficits Questionnaire (PDQ-20).Results. In this study 58 % of patients with chronic migraine complained of memory loss. Cognitive impairment was also found with PDQ-20. Objectively, we found a significant decrease in 90-second DSST results and RAVLT total recall and learning rate. In 40 % of subjects with chronic migraine scored lower than 26 points on MoCA. Patients with chronic migraine more frequently had lower DSST rates as compared to episodic migraine (odds ratio 5.07 (95 % confidence interval – 1.59–16.17); p = 0.003). Depression and anxiety did not correlate with performance on cognitive tests. Chronic migraine (frequent headache) and longer headache history, but not depression, anxiety or medication overuse were independent predictors of cognitive impairment.Conclusion. Subjective and objective cognitive deficits are prevalent in the chronic migraine population. Most often memory and attention are impaired. Longer headache history and presence of chronic migraine are independent risk factors for cognitive impairment in patients with chronic migraine.
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Affiliation(s)
- N. V. Latysheva
- I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia;
Alexander Vein Headache Clinic
| | - E. G. Filatova
- I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia;
Alexander Vein Headache Clinic
| | - D. V. Osipova
- I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia
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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: 91] [Impact Index Per Article: 15.2] [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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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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Blanco S, Sanromán L, Pérez-Calvo S, Velasco L, Peñacoba C. Olfactory and cognitive functioning in patients with fibromyalgia. PSYCHOL HEALTH MED 2018; 24:530-541. [PMID: 30453770 DOI: 10.1080/13548506.2018.1549741] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Fibromyalgia is a complex syndrome characterized by chronic musculoskeletal pain. Previous research has found impaired olfactory function and cognitive deficits in patients with fibromyalgia. In non-clinical population (middle-aged and elderly populations) an association has been found between olfactory function and cognitive impairment. Therefore, olfactory impairment identification could be considered as a reliable and early marker predicting the decline of cognitive function in mild cognitive impairment, Alzheimer's disease and Parkinson's disease. Nevertheless, the relationship between cognitive and olfactory functioning has not been studied in fibromyalgia patients. The aims of the study have been to analyze the cognitive and olfactory functioning and their association in a sample of women with fibromyalgia in comparison to women without a chronic pain disease. A transversal study was conducted with fibromyalgia patients (n = 146) and women without a chronic pain disease (n = 122). Data were collected using the WAIS-III (cognitive functioning) and the CCCRC test (olfactory functioning). Descriptive analysis, Student's t test and chi-square tests were conducted. There were significant differences in perceptive organization and processing speed, and in odour identification, odour threshold and total CCCRC score; the lower scores were for fibromyalgia patients. Among the fibromyalgia patients there were significant differences in the verbal scale, the manipulative scale, the total scale and processing speed between normosmic and hyposmic patients, the lowest scores were for hyposmic patients. Although previous literature has shown that self-reports by fibromyalgia patients inform about an enhanced olfactory acuity, the current study suggests that there are deficits in olfactory functioning in these patients. Also, the relationship between olfactory and cognitive functioning in fibromyalgia patients, due to the lack of previous studies, suggests a new line of research. Taken together, these results suggest that olfactory functioning could be included in a bio-psycho-social approach of fibromyalgia patients, because of the association with cognitive functioning.
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Affiliation(s)
- Sheila Blanco
- a Department of Medicine and Surgery, Public Health, Psychology and Immunology and Medical Microbiology, Odontology and Nursing , Rey Juan Carlos University , Alcorcón (Madrid) , Spain
| | - Lucía Sanromán
- a Department of Medicine and Surgery, Public Health, Psychology and Immunology and Medical Microbiology, Odontology and Nursing , Rey Juan Carlos University , Alcorcón (Madrid) , Spain
| | - Soledad Pérez-Calvo
- a Department of Medicine and Surgery, Public Health, Psychology and Immunology and Medical Microbiology, Odontology and Nursing , Rey Juan Carlos University , Alcorcón (Madrid) , Spain
| | - Lilian Velasco
- a Department of Medicine and Surgery, Public Health, Psychology and Immunology and Medical Microbiology, Odontology and Nursing , Rey Juan Carlos University , Alcorcón (Madrid) , Spain
| | - Cecilia Peñacoba
- a Department of Medicine and Surgery, Public Health, Psychology and Immunology and Medical Microbiology, Odontology and Nursing , Rey Juan Carlos University , Alcorcón (Madrid) , Spain
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Latysheva NV, Filatova EG, Osipova DV. Chronic pain, depression and cognitive impairment: a close relationship. ACTA ACUST UNITED AC 2018. [DOI: 10.17650/2222-8721-2018-8-3-34-42] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Over a half of chronic pain (CP) patients present with cognitive complaints, which increase their disability and impact quality of life. The paper reviews objective impairments in memory, attention, processing speed and executive function demonstrated in the CP population. The paper also reviews common pathology underlying cognitive impairment and CP: neuroplasticity in the shared brain areas, neurotransmitter and other molecular mechanisms. Common mechanisms in CP and depression precipitating cognitive impairment are also discussed. The paper also compares the potential of different antidepressants to improve cognitive functions in depression and CP.
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Affiliation(s)
- N. V. Latysheva
- I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia; Alexander Vein Headache Clinic
| | - E. G. Filatova
- I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia; Alexander Vein Headache Clinic
| | - D. V. Osipova
- I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia
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Gomides APM, Bezerra JC, do Rosário E Souza EJ, da Mota LMH, Santos-Neto LL. Work disability in fibromyalgia and other soft tissue disorders: analysis of preventive benefits in Brazil from 2006 to 2015. Adv Rheumatol 2018; 58:13. [PMID: 30657072 DOI: 10.1186/s42358-018-0015-y] [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: 03/24/2018] [Accepted: 06/15/2018] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Fibromyalgia is a common chronic disease characterized by persistent diffuse pain, fatigue, sleep disorders and functional symptoms. The disease can have negative consequences in personal and social life, in addition to significant public health expenses caused by treatment and work leave. The purpose of this article is to evaluate the number of social security benefits granted due to incapacity for work in Brazil in patients with ICD M79 and variants in the period 2006-2015. There has been no previous study with data referring to work withdrawals caused by fibromyalgia in Brazil. METHODS Data for this study were obtained through an official Social Security platform. The disability and retirement benefits were analyzed. RESULTS A total of 95,882 social security disability benefits were granted to ICD M79 and variants in the period from 2006 to 2015. Regarding gender, 69,420 benefits (72.3%) were granted to women and 26,562 (27.7%) to men. Regarding the types of benefits, we found 93,556 (97.5%) temporary withdrawals from work and 2426 (2.5%) permanent withdrawals. When comparing the initial and final years, we observed a significant reduction in the number of awards: 15,562 in 2006 to 6163 in 2015. CONCLUSION Fibromyalgia was an important cause of withdrawal due to incapacity for work in Brazil, with consequent public health expenditure. These data may serve as a basis for new studies and can alert professionals of the need for adequate management of fibromyalgia to reduce work withdrawal and its consequences.
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Affiliation(s)
- Ana Paula Monteiro Gomides
- Programa de Pós-Graduação em Ciências Médicas, Faculdade de Medicina, Universidade de Brasília, UnB, CEP, Brasília, DF, 70910-900, Brazil.
| | | | | | - Licia Maria Henrique da Mota
- Programa de Pós-Graduação em Ciências Médicas, Faculdade de Medicina, Universidade de Brasília, UnB, CEP, Brasília, DF, 70910-900, Brazil
| | - Leopoldo Luiz Santos-Neto
- Programa de Pós-Graduação em Ciências Médicas, Faculdade de Medicina, Universidade de Brasília, UnB, CEP, Brasília, DF, 70910-900, Brazil
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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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Abstract
OBJECTIVE Cognitive dysfunction has been reported in individuals with fibromyalgia. However, findings regarding cognitive function examined using neuropsychological tests have been inconsistent. The aim of the study was to determine domain-specific cognitive impairment in patients with fibromyalgia compared with healthy controls. METHODS We conducted a meta-analysis that systematically searched six databases (PubMed, Ovid MEDLINE, Embase, CINAHL, PsycINFO, and Web of Science) for articles published before September 2017. RESULTS Twenty-three case-control studies with a total of 2096 participants were included in the meta-analysis. Cognitive function was significantly lower (g = 0.87, 95% confidence interval [CI] = 0.60-1.15) in individuals with fibromyalgia than in healthy controls. Large effect sizes were found in learning/memory and attention/psychomotor speed (g = 0.94, p = .013; g = 1.22, p < .001, respectively); medium effect sizes were reported in executive function and working memory (g = 0.72, p < .001; g = 0.75, p < .001, respectively). Depression and anxiety scores were associated with the effect size of group differences in cognitive function (B = 0.11, p < .001, 95% CI = 0.09-0.13; B = 0.02, p < .001, 95% CI = 0.01-0.02, respectively). CONCLUSIONS Cognitive impairment across different cognitive domains was found in individuals with fibromyalgia compared with healthy controls. Mood states (depression and anxiety) may explain the heterogeneity across studies.
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Feliu-Soler A, Pérez-Aranda A, Andrés-Rodríguez L, Butjosa A, Díaz NS, Trujols J, Núñez C, Stephan-Otto C, Rozadilla-Sacanell A, Serrano-Blanco A, Kratz AL, Luciano JV. Digging into the construct of fibrofog: Psychometric properties of the Spanish version of the Multidimensional Inventory of Subjective Cognitive Impairment in patients with fibromyalgia. ACTA ACUST UNITED AC 2018. [DOI: 10.1111/jabr.12134] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Albert Feliu-Soler
- Institut de Recerca Sant Joan de Déu; Esplugues de Llobregat Spain
- Teaching Research & Innovation Unit; Parc Sanitari Sant Joan de Déu; St. Boi de Llobregat Spain
- Primary Care Prevention and Health Promotion Research Network; RedIAPP; Madrid Spain
| | - Adrián Pérez-Aranda
- Institut de Recerca Sant Joan de Déu; Esplugues de Llobregat Spain
- Teaching Research & Innovation Unit; Parc Sanitari Sant Joan de Déu; St. Boi de Llobregat Spain
- Primary Care Prevention and Health Promotion Research Network; RedIAPP; Madrid Spain
| | - Laura Andrés-Rodríguez
- Institut de Recerca Sant Joan de Déu; Esplugues de Llobregat Spain
- Teaching Research & Innovation Unit; Parc Sanitari Sant Joan de Déu; St. Boi de Llobregat Spain
- Primary Care Prevention and Health Promotion Research Network; RedIAPP; Madrid Spain
| | - Anna Butjosa
- Institut de Recerca Sant Joan de Déu; Esplugues de Llobregat Spain
- Teaching Research & Innovation Unit; Parc Sanitari Sant Joan de Déu; St. Boi de Llobregat Spain
| | | | - Joan Trujols
- Centre for Biomedical Research in Mental Health; CIBERSAM; Madrid Spain
- Addictive Behaviors Unit; Department of Psychiatry; Hospital de la Santa Creu i Sant Pau; Barcelona Spain
| | - Christian Núñez
- Teaching Research & Innovation Unit; Parc Sanitari Sant Joan de Déu; St. Boi de Llobregat Spain
| | - Christian Stephan-Otto
- Teaching Research & Innovation Unit; Parc Sanitari Sant Joan de Déu; St. Boi de Llobregat Spain
- Centre for Biomedical Research in Mental Health; CIBERSAM; Madrid Spain
| | | | - Antoni Serrano-Blanco
- Institut de Recerca Sant Joan de Déu; Esplugues de Llobregat Spain
- Teaching Research & Innovation Unit; Parc Sanitari Sant Joan de Déu; St. Boi de Llobregat Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública, CIBERESP; Madrid Spain
| | - Anna L. Kratz
- Department of Physical Medicine and Rehabilitation; University of Michigan; Ann Arbor MI USA
| | - Juan V. Luciano
- Institut de Recerca Sant Joan de Déu; Esplugues de Llobregat Spain
- Teaching Research & Innovation Unit; Parc Sanitari Sant Joan de Déu; St. Boi de Llobregat Spain
- Primary Care Prevention and Health Promotion Research Network; RedIAPP; Madrid Spain
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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: 67] [Impact Index Per Article: 11.2] [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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Andrade A, Vilarino GT, Sieczkowska SM, Coimbra DR, Bevilacqua GG, Steffens RDAK. The relationship between sleep quality and fibromyalgia symptoms. J Health Psychol 2018; 25:1176-1186. [DOI: 10.1177/1359105317751615] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
This study investigated the relationship between sleep quality and fibromyalgia symptoms in 326 patients. The Pittsburgh Sleep Quality Index was used to assess the presence of sleep disorders. Multivariate analysis of variance was performed to determine the influence of fibromyalgia symptoms on sleep quality. The prevalence of sleep disorders was 92.9 percent. Patients reported generalized pain (88.3%), memory failure (78.5%), moodiness (59%), excessive anxiety (77.5%), and concentration difficulties (69.1%). Patients with more symptoms reported poor sleep quality ( p < .05; d = .74), and the total Pittsburgh Sleep Quality Index score correlated with the number of symptoms ( p < .01). Sleep quality has an important association with fibromyalgia symptoms.
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Abstract
OBJECTIVES Cognitive functioning is commonly disrupted in people living with chronic pain, yet it is an aspect of pain that is often not routinely assessed in pain management settings, and there is a paucity of research on treatments or strategies to alleviate the problem. The purpose of this review is to outline recent research on cognitive deficits seen in chronic pain, to give an overview of the mechanisms involved, advocate cognitive functioning as an important target for treatment in pain populations, and discuss ways in which it may be assessed and potentially remediated. METHODS A narrative review. RESULTS There are several options for remediation, including compensatory, restorative, and neuromodulatory approaches to directly modify cognitive functioning, as well as physical, psychological, and medication optimization methods to target secondary factors (mood, sleep, and medications) that may interfere with cognition. DISCUSSION We highlight the potential to enhance cognitive functions and identify the major gaps in the research literature.
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Baker KS, Gibson SJ, Georgiou-Karistianis N, Giummarra MJ. Relationship between self-reported cognitive difficulties, objective neuropsychological test performance and psychological distress in chronic pain. Eur J Pain 2017; 22:601-613. [PMID: 29160603 DOI: 10.1002/ejp.1151] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2017] [Indexed: 12/31/2022]
Abstract
BACKGROUND Persons with chronic pain often report problems with cognitive abilities, such as memory or attention. There is limited understanding of whether objective performance is consistent with subjective reports, and how psychological factors contribute. We aimed to investigate these relationships in a group of patients expressing cognitive concerns, and evaluate the utility of self-report tools for pain management settings. METHOD Participants with chronic pain (n = 41) completed standardized neuropsychological tests, and self-report measures of cognitive functioning, pain, mood and sleep, as part of a broader study investigating cognitive performance in pain. RESULTS Average neuropsychological test performance was subtly below normative means (within one standard deviation). Twenty-five percent of the sample scored substantially below age-adjusted norms on one or more objective tests. There were moderate-to-large associations between objective performance (e.g. Trail-Making B) and subjective cognitive complaints (e.g. Everyday Memory Questionnaire - Revised), controlling for age and education level. This was moderated by anxiety, such that subjective-objective relationships were particularly strong in those with higher anxiety. Poorer test performance was associated with higher pain intensity and catastrophizing. Subjective-objective cognition relationships remained after controlling for catastrophizing. CONCLUSION Patients' self-reported cognitive concerns concurred with objectively measured performance, independent of age, education and catastrophizing. Moreover, those with severe anxiety were more accurate in predicting their cognitive performance. The findings highlight some interesting cognition-mood relationships, and suggest that easy-to-administer questionnaires, such as the Everyday Memory Questionnaire - Revised and the Behavior Rating Inventory of Executive Function - Adult Version, may be useful to capture cognitive concerns in clinical settings. SIGNIFICANCE Cognitive concerns in chronic pain reflected objective neurocognitive performance. This was moderated by anxiety, such that self-reported cognition was more consistent with objective performance in those with high anxiety. Our findings suggest that reported cognitive concerns should be heeded, and self-report measures may be used clinically to facilitate dialogue about cognitive functioning.
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Affiliation(s)
- K S Baker
- Caulfield Pain Management and Research Centre, Caulfield, Vic., Australia.,School of Psychological Sciences and Monash Institute for Cognitive and Clinical Neurosciences, Monash University, Clayton, Vic., Australia
| | - S J Gibson
- Caulfield Pain Management and Research Centre, Caulfield, Vic., Australia.,National Ageing Research Institute, Parkville, Vic., Australia
| | - N Georgiou-Karistianis
- School of Psychological Sciences and Monash Institute for Cognitive and Clinical Neurosciences, Monash University, Clayton, Vic., Australia
| | - M J Giummarra
- Caulfield Pain Management and Research Centre, Caulfield, Vic., Australia.,School of Public Health & Preventive Medicine, Monash University, Melbourne, Vic., Australia.,Institute for Safety, Compensation & Recovery Research, Monash University, Melbourne, Vic., Australia
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González-Villar AJ, Samartin-Veiga N, Arias M, Carrillo-de-la-Peña MT. Increased neural noise and impaired brain synchronization in fibromyalgia patients during cognitive interference. Sci Rep 2017; 7:5841. [PMID: 28724985 PMCID: PMC5517506 DOI: 10.1038/s41598-017-06103-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Accepted: 06/07/2017] [Indexed: 12/12/2022] Open
Abstract
Fibromyalgia (FM) and other chronic pain syndromes are associated with cognitive dysfunction and attentional deficits, but the neural basis of such alterations is poorly understood. Dyscognition may be related to high levels of neural noise, understood as increased random electrical fluctuations that impair neural communication; however, this hypothesis has not yet been tested in any chronic pain condition. Here we compared electroencephalographic activity (EEG) in 18 FM patients -with high self-reported levels of cognitive dysfunction- and 22 controls during a cognitive control task. We considered the slope of the Power Spectrum Density (PSD) as an indicator of neural noise. As the PSD slope is flatter in noisier systems, we expected to see shallower slopes in the EEG of FM patients. Higher levels of neural noise should be accompanied by reduced power modulation and reduced synchronization between distant brain locations after stimulus presentation. As expected, FM patients showed flatter PSD slopes. After applying a Laplacian spatial filter, we found reduced theta and alpha power modulation and reduced midfrontal-posterior theta phase synchronization. Results suggest higher neural noise and impaired local and distant neural coordination in the patients and support the neural noise hypothesis to explain dyscognition in FM.
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Affiliation(s)
- A J González-Villar
- Departamento de Psicoloxía Clínica e Psicobioloxía, Facultade de Psicoloxía, Universidade de Santiago de Compostela, Santiago de Compostela, Spain.
| | - N Samartin-Veiga
- Departamento de Psicoloxía Clínica e Psicobioloxía, Facultade de Psicoloxía, Universidade de Santiago de Compostela, Santiago de Compostela, Spain
| | - M Arias
- Departamento de Neurología, Complexo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain
| | - M T Carrillo-de-la-Peña
- Departamento de Psicoloxía Clínica e Psicobioloxía, Facultade de Psicoloxía, Universidade de Santiago de Compostela, Santiago de Compostela, Spain
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Electroencephalographic Evidence of Altered Top–Down Attentional Modulation in Fibromyalgia Patients During a Working Memory Task. Brain Topogr 2017; 30:539-547. [DOI: 10.1007/s10548-017-0561-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Accepted: 04/01/2017] [Indexed: 10/19/2022]
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Aasvik JK, Woodhouse A, Stiles TC, Jacobsen HB, Landmark T, Glette M, Borchgrevink PC, Landrø NI. Effectiveness of Working Memory Training among Subjects Currently on Sick Leave Due to Complex Symptoms. Front Psychol 2017; 7:2003. [PMID: 28111555 PMCID: PMC5216020 DOI: 10.3389/fpsyg.2016.02003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Accepted: 12/12/2016] [Indexed: 11/21/2022] Open
Abstract
Introduction: The current study examined if adaptive working memory training (Cogmed QM) has the potential to improve inhibitory control, working memory capacity, and perceptions of memory functioning in a group of patients currently on sick leave due to symptoms of pain, insomnia, fatigue, depression and anxiety. Participants who were referred to a vocational rehabilitation center volunteered to take part in the study. Methods: Participants were randomly assigned to either a training condition (N = 25) or a control condition (N = 29). Participants in the training condition received working memory training in addition to the clinical intervention offered as part of the rehabilitation program, while participants in the control condition received treatment as usual i.e., the rehabilitation program only. Inhibitory control was measured by The Stop Signal Task, working memory was assessed by the Spatial Working Memory Test, while perceptions of memory functioning were assessed by The Everyday Memory Questionnaire-Revised. Results: Participants in the training group showed a significant improvement on the post-tests of inhibitory control when compared with the comparison group (p = 0.025). The groups did not differ on the post-tests of working memory. Both groups reported less memory problems at post-testing, but there was no sizeable difference between the two groups. Conclusions: Results indicate that working memory training does not improve general working memory capacity per se. Nor does it seem to give any added effects in terms of targeting and improving self-perceived memory functioning. Results do, however, provide evidence to suggest that inhibitory control is accessible and susceptible to modification by adaptive working memory training.
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Affiliation(s)
- Julie K. Aasvik
- Department of Circulation and Medical Imaging, Faculty of Medicine, Norwegian University of Science and TechnologyTrondheim, Norway
| | - Astrid Woodhouse
- Hysnes Rehabilitation Center, St. Olav's University HospitalTrondheim, Norway
- National Competence Centre for Complex Disorders, St. Olav's University HospitalTrondheim, Norway
- Department of Public Health and General Practice, Norwegian University of Science of TechnologyTrondheim, Norway
| | - Tore C. Stiles
- Hysnes Rehabilitation Center, St. Olav's University HospitalTrondheim, Norway
- National Competence Centre for Complex Disorders, St. Olav's University HospitalTrondheim, Norway
- Department of Psychology, Norwegian University of Science and TechnologyTrondheim, Norway
| | - Henrik B. Jacobsen
- Hysnes Rehabilitation Center, St. Olav's University HospitalTrondheim, Norway
- National Competence Centre for Complex Disorders, St. Olav's University HospitalTrondheim, Norway
| | - Tormod Landmark
- National Competence Centre for Complex Disorders, St. Olav's University HospitalTrondheim, Norway
| | - Mari Glette
- Department of Circulation and Medical Imaging, Faculty of Medicine, Norwegian University of Science and TechnologyTrondheim, Norway
| | - Petter C. Borchgrevink
- Department of Circulation and Medical Imaging, Faculty of Medicine, Norwegian University of Science and TechnologyTrondheim, Norway
- Hysnes Rehabilitation Center, St. Olav's University HospitalTrondheim, Norway
- National Competence Centre for Complex Disorders, St. Olav's University HospitalTrondheim, Norway
| | - Nils I. Landrø
- Department of Circulation and Medical Imaging, Faculty of Medicine, Norwegian University of Science and TechnologyTrondheim, Norway
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Coyne KS, Currie BM, Donevan S, Cappelleri JC, Hegeman-Dingle R, Abraham L, Thompson C, Sadosky A, Brodsky M. Discriminating between neuropathic pain and sensory hypersensitivity using the Chronic Pain Questions (CPQ). Postgrad Med 2016; 129:22-31. [DOI: 10.1080/00325481.2017.1267538] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
| | | | - Sean Donevan
- Global Medical Affairs, Pfizer Inc, New York, NY, USA
| | | | | | - Lucy Abraham
- Outcomes & Evidence, Global Health & Value, Pfizer Ltd, Tadworth, UK
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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: 41] [Impact Index Per Article: 5.1] [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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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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Castelli L, Tesio V. Commentary: Mindfulness training for reducing anger, anxiety, and depression in fibromyalgia patients. Front Psychol 2016; 7:740. [PMID: 27242640 PMCID: PMC4871879 DOI: 10.3389/fpsyg.2016.00740] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Accepted: 05/04/2016] [Indexed: 12/02/2022] Open
Affiliation(s)
- Lorys Castelli
- Department of Psychology, University of Turin Turin, Italy
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50
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Walitt B, Čeko M, Khatiwada M, Gracely JL, Rayhan R, VanMeter JW, Gracely RH. Characterizing "fibrofog": Subjective appraisal, objective performance, and task-related brain activity during a working memory task. NEUROIMAGE-CLINICAL 2016; 11:173-180. [PMID: 26955513 PMCID: PMC4761650 DOI: 10.1016/j.nicl.2016.01.021] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Revised: 01/27/2016] [Accepted: 01/31/2016] [Indexed: 02/09/2023]
Abstract
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.
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Affiliation(s)
- Brian Walitt
- National Center for Complementary and Integrative Health (NCCIH), NIH, Bethesda, MD, United States; MedStar Washington Hospital Center, Division of Rheumatology, Washington, DC, United States.
| | - Marta Čeko
- National Center for Complementary and Integrative Health (NCCIH), NIH, Bethesda, MD, United States
| | - Manish Khatiwada
- Georgetown University Medical Center, Department of Neurology, Center for Functional and Molecular Imaging, Washington, DC, United States
| | - John L Gracely
- National Center for Complementary and Integrative Health (NCCIH), NIH, Bethesda, MD, United States
| | - Rakib Rayhan
- Georgetown University Medical Center, Department of Medicine, Division of Rheumatology, Immunology and Allergy, Washington, DC, United States
| | - John W VanMeter
- Georgetown University Medical Center, Department of Neurology, Center for Functional and Molecular Imaging, Washington, DC, United States
| | - Richard H Gracely
- Center for Pain Research and Innovation, University of North Carolina, School of Dentistry, Chapel Hill, NC, United States
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