Background & Aims

Fibromyalgia (FM) is a chronic pain condition marked by persistent diffuse pain, fatigue and mood disturbances, and cognitive difficulties. Major Depressive Disorder (MDD) is a psychiatric condition marked by depressed mood, anhedonia, and poor concentration. FM and MDD often co-occur leading to greater disease burden than each alone (Arnow et al., 2009). Moreover, the most prevalent comorbidity in adults with FM is MDD, and chronic pain is also highly prevalent in MDD (Yepez et al., 2022). In previous studies (López-Solà et al., 2014; 2017; Wilbarger and Cook, 2011; Wang and Frey-Law, 2022) FM patients showed greater sensory sensitivities to non-painful sensory stimuli than healthy peers and more localized chronic pain conditions. In MDD, evidence showed enhanced sensory perception thresholds for non-painful sensory stimulation (Engel-Yeger et al., 2016; Serafini et al., 2017). Here, we investigate the differences between FM and MDD patients based on non-painful sensory sensitivities.

Methods

Thirty-seven FM patients (48.15 ± 11.05 years), sixteen MDD patients (49.31 ± 10.96 years) and thirty-nine healthy controls (46.44 ± 16.16 years) completed a multisensory task involving four trials of alternating 30 seconds of simultaneous multisensory/motor stimulation (visual, auditory, and tactile-motor finger opposition task) and rest periods ranging from 20-30 seconds during fMRI. After each trial participants rated their level of unpleasantness associated with the stimuli. At the end of the task, participants rated the intensity and extension of bodily pain experienced during the multisensory task. Anova and two-sample t-tests were used to compare the differences between groups regarding unpleasantness, bodily pain, and extensiveness of bodily pain during the multisensory task.

Results

Compared to MDD patients and healthy participants, FM patients reported augmented unpleasantness during the multisensory task (FM vs. Healthy controls: t=7.53 P<0.001, FM vs MDD: t=3.91 P<0.001). Furthermore, FM patients reported higher bodily pain (FM vs. Healthy controls: t=4.89 P<0.001, FM vs MDD: t=3.54 P<0.001) and greater extensiveness of bodily pain during the task (FM vs. Healthy controls: t=6.52 P<0.001, FM vs MDD: t=2.15 P=0.03). There were no significant differences between MDD patients and healthy participants in unpleasantness (MDD vs. Healthy controls: t=-1.57 P=0.11) and bodily pain (MDD vs. Healthy controls: t=0.71 P=0.47) during the multisensory task, yet there were significant differences in bodily pain extension; MDD patients reported more extensiveness of the bodily pain during the multisensory task compared to healthy peers (MDD vs. Healthy controls: t=2.28 P=0.03).

Conclusions

The findings strengthen the association between augmented unpleasantness to multisensory stimuli and FM disease, even when compared with major depression. Sensory sensitivities involving a multisensory integration component may be characteristic of FM, even in comparison with other partially related diseases. This study highlights the potential role of multisensory integration pathophysiology as critical to identify FM patients and distinguish such pathophysiology from such characteristic of major affective disorders, which may help tailoring treatment. The results call for a better understanding of the brain mechanisms supporting these behavioral differences between fibromyalgia and major depression.

References

Arnow, B. A., Blasey, C. M., Lee, J., Fireman, B., Hunkeler, E. M., Dea, R., … & Hayward, C. (2009). Relationships among depression, chronic pain, chronic disabling pain, and medical costs. Psychiatric Services, 60(3), 344-350.

Engel-Yeger, B., Muzio, C., Rinosi, G., Solano, P., Geoffroy, P. A., Pompili, M., … & Serafini, G. (2016). Extreme sensory processing patterns and their relation with clinical conditions among individuals with major affective disorders. Psychiatry research, 236, 112-118.

López?Solà, M., Pujol, J., Wager, T. D., Garcia?Fontanals, A., Blanco?Hinojo, L., Garcia?Blanco, S., … & Deus, J. (2014). Altered functional magnetic resonance imaging responses to nonpainful sensory stimulation in fibromyalgia patients. Arthritis & rheumatology, 66(11), 3200-3209.

López-Solà, M., Woo, C. W., Pujol, J., Deus, J., Harrison, B. J., Monfort, J., & Wager, T. D. (2017). Towards a neurophysiological signature for fibromyalgia. Pain, 158(1), 34.

Serafini, G., Gonda, X., Canepa, G., Pompili, M., Rihmer, Z., Amore, M., & Engel-Yeger, B. (2017). Extreme sensory processing patterns show a complex association with depression, and impulsivity, alexithymia, and hopelessness. Journal of affective disorders, 210, 249-257.

Wang, D., & Frey-Law, L. A. (2022). Multisensory sensitivity differentiates between multiple chronic pain conditions and pain-free individuals. Pain, 10-1097.

Wilbarger, J. L., & Cook, D. B. (2011). Multisensory hypersensitivity in women with fibromyalgia: implications for well being and intervention. Archives of physical medicine and rehabilitation, 92(4), 653-656.

Yepez D, Grandes XA, Talanki Manjunatha R, Habib S, Sangaraju SL. Fibromyalgia and Depression: A Literature Review of Their Shared Aspects. Cureus 2022 2022.

Presenting Author

Laura Martin-Herrero

Poster Authors

Laura Martín Herrero

MSc

University of Barcelona

Lead Author

E-mail

Maria Suñol

PhD

University of Barcelona

Lead Author

E-mail

Lucia Blanc

BSc

University of Barcelona

Lead Author

E-mail

Ana Arias

BSc

Hospital Clinic de Barcelona

Lead Author

E-mail

Xavier Torres

PhD

Hospital Clinic de Barcelona

Lead Author

E-mail

Tamara Rodríguez

MD

Hospital Clinic de Barcelona

Lead Author

E-mail

Myriam Cavero

MD

Hospital Clinic de Barcelona

Lead Author

E-mail

Marc Valentí

MD

Hospital Clinic de Barcelona

Lead Author

E-mail

Luciano Polino

MD

Hospital Clinic de Barcelona

Lead Author

E-mail

Miguel Montero

University of Barcelona

Lead Author

E-mail

Marina López-Sola

Phd

University of Barcelona

Lead Author

E-mail

Topics

  • Specific Pain Conditions/Pain in Specific Populations: Fibromyalgia