Background & Aims

Fibromyalgia (FM) is a chronic, widespread pain syndrome characterized by pain in at least 4 of 5 body regions, sleep disorders, cognitive dysfunction, and somatic symptoms.
Maladaptive coping styles play a significant role in FM, as they can dysfunctionally modulate pain and affect the intensity of subjective pain and general health. Accordingly, positive coping strategies such as Cognitive Self-Efficacy (CSE) – the confidence in one’s cognitive capacities, may influence the performance of actions necessary for managing or controlling pain, thus contributing to better clinical outcomes and quality of life.
This study aimed to test the level of CSE in FM compared to Rheumatoid Arthritis (RA) participants and to explore the association of CSE to FM clinical characteristics: disease severity, pain intensity, sensory responsiveness, attachment style, and self-rated health.

Methods

Data were collected via an online survey. After signing an online informed consent, all participants completed a socio-demographic and health information questionnaire, the Fibromyalgia Impact Questionnaire (FIQ) testing symptom severity, Brief Pain Inventory (BPI) testing pain intensity and interference, Cognitive Self-Efficacy Questionnaire (CSEQ) testing confidence in cognitive capacities, Sensory Responsiveness Questionnaire (SRQ) testing responsiveness to daily non-painful sensory stimuli, Attachment Questionnaire (AQ) testing attachment pattern- avoidance or anxiety, and Self-Rated Health (SRH) testing perceived health. First, we used descriptive and discriminative statistics to compare the level of cognitive self-efficacy between FM and RA subjects. Further, we used cluster analysis to classify the FM sample based on CSEQ score. Last, an analysis of variance was performed to test the influence of CSE on the clinical characteristics of FM based on the derived cluster model.

Results

118 FM, ages 43.8±13.48 yrs. (92.8% females) and 19 RA (100% females) ages 48.26 ±18.05 yrs. participated. The FM group demonstrated a significantly lower CSE score (M= 6.87 ± 1.89) compared to the RA group (M=8.59 ±1.37; [t (127) =3.09], p<.001). The Cluster analysis procedure performed selectively on the FM group derived 2 cluster groups: ‘Low’ (n=74, M=5.81±1.3) and ‘High’ CSE score (n=44, M=8.65± 0.83), with good model quality (Silhouette index= 0.7).
Correspondingly to the two cluster groups, significant differences were found in FIQ (F1,99=11.9, p<.001), BPI interference (F1,99=21.84, p<.001), Attachment styles- anxiety (F1,99=7.68, p<.001) and avoidance (F1,99=6.19, p<.001), and self-rated health (F1,99=3.95, p<.001) scores. The differences in sensory responsiveness and BPI-pain intensity scores were not significant (p>.05).

Conclusions

While demonstrating lower CSE scores compared to the RA group, a cluster analysis model within the FM group revealed heterogeneity in this measure, creating ‘High’ and ‘Low’ CSE cluster groups. Importantly, this cluster model has found clinical relevance, discriminating between high and low pain interference, perceived health, and attachment style levels. Moreover, the cluster model discriminated between high and low disease severity, suggesting its potential predictive value.
Interestingly, pain intensity and sensory responsiveness were unrelated to the CSE cluster groups, implying that both may be associated with a pronociceptive predisposition. Overall, findings highlight the potential influence of disease management-based cognitive strategy on FM state but not trait-related factors. This may suggest that therapeutic interventions focusing on improving cognitive confidence and proactivity may be of value in ameliorating the lived experience of FM patients.

References

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Miró, E., Martínez, M. P., Sánchez, A. I., Prados, G., & Medina, A. (2011). When is pain related to emotional distress and daily functioning in fibromyalgia syndrome? The mediating roles of self?efficacy and sleep quality. British journal of health psychology, 16(4), 799-814.?

Nicholas, M., Vlaeyen, J. W. S., Rief, W., Barke, A., Aziz, Q., Benoliel, R., Cohen, M., Evers, S., Giamberardino, M. A., Goebel, A., Korwisi, B., Perrot, S., Svensson, P., Wang, S. J., & Treede, R. D. (2019). The IASP classification of chronic pain for ICD-11: Chronic primary pain. Pain, 160(1), 28–37.

Sarzi-Puttini, P., Giorgi, V., Marotto, D., & Atzeni, F. (2020). Fibromyalgia: an update on clinical characteristics, aetiopathogenesis and treatment. Nature Reviews Rheumatology, 16(11), 645-660.?

Toglia, J., Otr, L., Foster, E., Otr, L., Jethani, P., Otr, L., College, M., Ferry, D., & Louis, S. (2020). Cognitive Self-Efficacy in Parkinson’s Disease ( PD ). The American Journal of Occupational Therapy, 74(4).

Presenting Author

Tami Bar-Shalita

Poster Authors

ronnie deutsch

MScOT

Tel-Aviv University

Lead Author

Hana Karpin

Tel Aviv University

Lead Author

Yael Lahav Phd

Tel Aviv University

Lead Author

Tami Bar-Shalita

Tel-Aviv University

Lead Author

Topics

  • Specific Pain Conditions/Pain in Specific Populations: Fibromyalgia