Background & Aims

Fibromyalgia is the most common widespread pain syndrome and enacts a significant burden on individuals living with that condition. Frequently, the perception that other people can’t understand their pain contributes to social isolation and loneliness. Recently, loneliness has been found to be a major risk factor for cardiovascular disease, equivalent to smoking 15 cigarettes/day, and to worsen the prognosis of several chronic illnesses. However, the association between loneliness, pain levels, and the overall impact of fibromyalgia has been the focus of few studies and remains unclear. Hence, this study sought to investigate the relationship between loneliness with these outcomes among people living with fibromyalgia.

Methods

This cross-sectional online survey was disseminated through social media networks to groups of PLwF. Inclusion criteria involved age ? 18 years and a diagnosis of fibromyalgia made by a doctor. The survey instrument comprised the UCLA three-item Loneliness Scale (LS), the Fibromyalgia Impact Questionnaire (FIQ), the short Lubben Social Network Scale (LSNS), the International Physical Activity Questionnaire (IPAC), several sociodemographic characteristics, and the presence of comorbidities. We operationalized loneliness as both continuous and categorical variables (occasional loneliness: 0 < LS < 4; frequent loneliness: LS ? 4). We evaluated the association of loneliness with the total impact of fibromyalgia, and the level of pain of participants by means of robust multivariable linear regression. All analyses were adjusted by sex, age, race, marital status, education, level of income, physical activity, LSNS, smoking, alcohol consumption, and nine comorbidities.

Results

In total, 1501 individuals were included in this study. Among que responders, 1467 (97.7%) were female and their mean  (SD) age was 43 (9.5 years). The median (IQR) pain score was 8 ( 7-9). The median (IQR) loneliness score was 4 (3-4) out of 6 ( higher values mean worse loneliness), and the FIQ score had a median (IQR) of 52 ( 42-59). out of 100 ( higher values mean worse impact of fibromyalgia). The LNSN score for social engagement had mean (SD) of 11.7 pints (5.1) out of 30 ( higher values mean stronger social engagement). The multivariable regression analyses showed that occasional and frequent loneliness were associated with an increase in 3.8 ( 95%CI: 1.6-6.0, p< 0.001) and 4.7 (95%CI: 2.4-7.1, p<0,001) pints in the FIQ score, respectively. Loneliness as a continuous variable was associated with increased levels of pain 0,10 ( 95%CI: 0,03-0,17, p <0,001), however, as a categorical variable, the occasional and frequent loneliness categories were not associated with pain levels.

Conclusions

Despite limitations related to the cross-sectional design of this study, its results signal the relevance of studying and evaluating loneliness among PLwF. Because loneliness, pain, and functional impairment due to the symptoms are all clinically negative outcomes in their own right, our results are relevant regardless of whether loneliness causes worsened levels of pain and higher functional impairment, or if increased levels of pain and functional impairment lead to higher levels of loneliness. Our findings emphasize the intricate interplay between emotional well-being, particularly loneliness, and the overall impact of fibromyalgia on the lives of PLwF, and highlight the importance of addressing psychological aspects alongside physical symptoms in the comprehensive management of fibromyalgia. Further research and interventions targeting social support and mental health may contribute to more effective strategies for improving the overall well-being and functionality of PLwF.

References

1. Sarzi-Puttini P, Giorgi V, Marotto D, Atzeni F. Fibromyalgia: an update on clinical characteristics, aetiopathogenesis and treatment. Vol. 16, Nature Reviews Rheumatology. Nature Research; 2020. p. 645–60.
2. Wolfe F, Smythe HA, Yunus MB, Bennett RM, Bombardier C, Goldenberg DL, et al. THE AMERICAN COLLEGE OF RHEUMATOLOGY 1990 CRITERIA FOR THE CLASSIFICATION OF FIBROMYALGIA Report of the Multicenter Criteria Committee.
3. Arnold LM, Bennett RM, Crofford LJ, Dean LE, Clauw DJ, Goldenberg DL, et al. AAPT Diagnostic Criteria for Fibromyalgia. Vol. 20, Journal of Pain. Churchill Livingstone Inc.; 2019. p. 611–28.
4. Powell VD, Abedini NC, Galecki AT, Kabeto M, Kumar N, Silveira MJ. Unwelcome Companions: Loneliness Associates with the Cluster of Pain, Fatigue, and Depression in Older Adults. Gerontology and Geriatric Medicine. 2021;7.

Presenting Author

Lizandra de Oliveira d'Afonseca Correia

Poster Authors

Lizandra Correia

L de O Silva

Lead Author

Edison Iglesias de Oliveira VIdal

MD PhD

UNESP

Lead Author

Mariana Ruy

UNESP SÃO PAULO

Lead Author

Fernanda Fukushima

MD, PhD

UNESP

Lead Author

Livia Agostinho Teixeira

UNESP

Lead Author

Topics

  • Epidemiology