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The association between tender points, psychological distress, and adverse childhood experiences: A community‐based study
Abstract
Objective
To examine the hypothesis that characteristics of somatization and illness behavior, and their childhood antecedents, are associated with the presence of multiple tender points.Methods
Two hundred eighty-nine subjects who had demonstrated psychological distress (General Health Questionnaire score ≥2) had a tender point examination and in-depth psychological evaluation. In addition, subjects were interviewed about a number of adverse childhood experiences. The 99 subjects with 5 or more tender points were compared with the remaining 190 subjects.ResultsA high tender point count (≥5) was associated with low levels of self-care (odds ratio [OR] 2.4, 95% confidence interval [95% CI] 1.1–5.0), reports of a greater number of somatic symptoms (OR 2.2, 95% CI 1.0–4.9), high levels of fatigue (OR 3.3, 95% CI 1.7–6.3), and a pattern of illness behavior characterized by increased medical care usage (OR 4.2, 95% CI 2.1–8.4). Those with high tender point counts were substantially more likely to report adverse childhood experiences, including loss of parents (OR 2.1, 95% CI 1.1–3.9) and abuse (OR 6.9, 95% CI 2.0–24.6). These results were not explained by the presence of chronic pain.Conclusion
These data add further weight to the hypothesis that tender points, as part of the fibromyalgia syndrome, are strongly associated with specific components of psychological distress as well as characteristics of somatization and its antecedents. It is possible that these features contribute to the development of the syndrome of fibromyalgia.
... This leads to the finding, that critical life events modulate the symtomatology of fibromyalgia. Thus, traumatized fibromyalgia patients demonstrate a heightened sensitivity to pain (Alexander et al., 1998; McBeth et al., 1999), more accessory symptoms (McBeth et al., 1999; Taylor et al., 1995), and a greater consumption of analgesics (Alexander et al., 1998; Boisset-Pioro et al., 1995). The primarily genetically determined stress-coping system, which determines the stress threshold, dampening , and reactivation (Lewis, 1992), is individually shaped in terms of its functional ability through psychosocial influencing factors. ...
... This leads to the finding, that critical life events modulate the symtomatology of fibromyalgia. Thus, traumatized fibromyalgia patients demonstrate a heightened sensitivity to pain (Alexander et al., 1998; McBeth et al., 1999), more accessory symptoms (McBeth et al., 1999; Taylor et al., 1995), and a greater consumption of analgesics (Alexander et al., 1998; Boisset-Pioro et al., 1995). The primarily genetically determined stress-coping system, which determines the stress threshold, dampening , and reactivation (Lewis, 1992), is individually shaped in terms of its functional ability through psychosocial influencing factors. ...
... In fibromyalgia patients these early stressors were found as well. The patients have a higher lifetime prevalence rate for psychosocial victimization during childhood and adolescence (Walker et al., 1997), even though the details about sexual abuse and physical maltreatment vary widely (Alexander et al., 1998; Boisset-Pioro et al., 1995; Goldberg et al., 1999; McBeth et al., 1999; Taylor et al., 1995; Walker et al., 1997). In contrast, van Houdenhove et al. (2001) found no increased frequency of sexual abuse in a European (Belgian) fibromyalgia population sample. ...
Prospective studies already prove, that those who were afflicted with distinct psychosocial childhood risk factors could have an impairment of mental health in their adulthood. Using a structural biographical interview (Mainz Structured Biographical Interview, MSBI) we examined systematically the relevance of 14 childhood risk factors, which already showed a great body of evidence, in two different kinds of somatization disorder (ICD-10: F45.0), patients with a persistent somatoform pain disorder (ICD-10: F45.4; n = 70) and patients (n = 47) with somatoform autonomic dysfunction (ICD-10: F45.3; n = 25) or undifferentiated somatoform disorder or other somatoform disorders (ICD-10: F45.0/.1/.8; n = 22) in the second somatoform group. As comparison groups we selected patients with dysthymia (ICD-10: F34.1; n = 42) and patients with a somatic pain complaint (n = 70). Our results show, that the patients in both groups with somatization disorders have a considerable higher total risk score than patients with a somatic pain disorders, however a considerable lower risk score than those with dysthymia. With regard to the single risk factors we found, that patients with a somatization disorder compared to those with a somatic pain complaint have a significant higher frequency of chronically ill or disabled parents, and a less sound relationship to their parents, a chronic familial disharmony (their parents were frequently entangled in difficulties and verbal or physical quarrel with themselves), and a history of sexual or physical abuse during their childhood (until age 14); those kinds of childhood risk factors were even more frequent in patients with dysthymia. Also between the two groups with somatization disorders differences were found: while in patients with a persistent somatoform pain disorder sexual and physical abuse (43% vs. 21%) and occupationally highly engaged parents (66% vs. 34%) were significant more frequent, patients with other somatization disorders have more often a chronic ill parent (53% vs. 29%).
... [11][12][13][14] However, patients reporting CTEs tend to experience more psychological distress, more severe physical symptoms, poorer functioning and more consumption of health care services. [15,16] It is especially important to study the role of childhood trauma in the etiology of FMS since psychiatric comorbidities are well known to accompany many chronic pain syndromes. ...
... The presence of an abuse history in patients with FMS not only correlates with the severity of FMS, but also with treatment resistance. [15,42] Therefore, in the PMR outpatient clinics, particularly in the presence of the two specific symptoms mentioned above and treatment resistance, patients should be referred to the psychiatric outpatient clinic for further investigation. ...
Objectives:
In this study, we aimed to compare patients with fibromyalgia syndrome (FMS) and those with myofascial pain syndrome (MPS) and healthy women and to investigate the prevalence of childhood traumatic experiences (CTEs) in relation to comorbid mood and anxiety disorders.
Patients and methods:
Between February 2014 and May 2014, a total of 136 women including 52 with FMS, 35 with MPS, and 49 healthy controls were included in the study. The Sociodemographic Data Form, Mood and Anxiety Disorders Modules of Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders fourth edition (DSM-IV) Axis I Disorders (SCID-I), Fibromyalgia- related Symptom Scale (FSS), Hamilton Depression Rating Scale (HDRS), Hamilton Anxiety Rating Scale (HARS), and Childhood Trauma Questionnaire-28 (CTQ-28) were applied to participants.
Results:
As a result of the semi-structured clinical interview conducted by a psychiatrist experienced in psychological trauma, the prevalence of any mood or anxiety disorder were found to be significantly more common in the FMS group. Childhood traumatic experiences, not only in general, but also with all subtypes, were also reported to be significantly more in FMS patients. Besides, only in patients with FMS, a significant relationship was found between the psychiatric diagnoses and the presence of CTEs. Furthermore, the CTQ-28 scores were correlated positively with the FSS scores as well as HDRS and HARS. Among the symptoms screened by the FSS, only crying and over-reacting to incidents were significantly associated with CTEs in FMS group.
Conclusion:
Based on our study results, CTEs may play a critical role in the development of fibromyalgia and may be related with comorbid mood and anxiety disorders in FMS patients. Associating psychological symptoms such as crying or over-reacting to incidents in FMS patients should be, therefore, alerting for psychiatric consultation.
... A meta-analysis of 18 studies has revealed significant associations between FM and self-reported physical and sexual abuse in childhood, but not between FM and childhood emotional abuse (7) and, consistently, a significant association has been observed between rape and a lifetime diagnosis of FM (8). Finally, patients with FM who self-report childhood traumas have more severe physical symptoms (9) and high tender point counts (10), show a greater loss of function (11), and make greater use of healthcare services and pain medications (12). Retrospective investigations (13,14) and prospective longitudinal studies (15) have shown that childhood trauma is also a known risk factor for adult major depression disorder (MDD). ...
... Childhood parental loss due to death or separation has hardly been investigated in patients with FM, although animal studies suggest that maternal separation in infancy lead increases affective pain processing (38) and visceral hyperalgesia (39) in adult rats. In a preliminary study, FM patients had higher childhood adversity rates (including parental separation) than a control group with medically explained chronic pain; in addition, the loss of parents during childhood as a result of parental divorce or death, or separation from parents was associated with higher tender point counts regardless of the presence of chronic pain (10). Our findings suggest that childhood adversities are related to FM itself and not to comorbid lifetime bipolar spectrum disorders, which contrasts with the sizeable literature describing a relationship between childhood adversities and mood disorders. ...
Objectives:
Fibromyalgia (FM) is a syndrome of unknown aetiology that is frequently associated with depressive disorders, and childhood adversities (including maltreatment and parental loss) are frequently described in subjects with FM and depression. The aim of this study was to investigate the extent to which the high percentage of childhood adversities reported by patients with FM is related to FM itself or to a comorbid lifetime depressive disorder.
Methods:
Ninety-four consecutive FM patients were assessed for lifetime major depression using the DSM-IVSCID-CV interview. Childhood maltreatment was investigated using the Childhood Trauma Questionnaire, and information relating to parental death or separation before the age of 18 years was collected by means of a semi-structured interview. The Zung Self-Rating Depression Scale, used as a quantitative measure of depressive symptoms, and the childhood adversity assessment were recorded at the same time.
Results:
Sixty of the 94 FM patients (63.8%) were diagnosed as having a lifetime major depressive disorder. There were no significant associations between childhood parental loss, the presence/level of maltreatment, the occurrence of a lifetime major depression episode, and the Zung Self-Rating Depression Scale scores.
Conclusions:
The results of this study suggest that there is no association between childhood adversities and comorbid lifetime major depression in patients with FM. As it would be helpful to prevent the development of FM because of the high cost and limited efficacy of therapeutic interventions, childhood adversities may offer targets for primary prevention.
... Although it is not definite; it has been concluded in recent years that the Fibromyalgia Syndrome (FMS) may be associated with the autonomic nervous system (ANS) [2] [13]. In a study reviewing the relationship between sensitive points in fibromyalgia and psychological status, it has been identified that there is a relation between psychological distress and particularly somatization [20]. In addition to these studies; Ozhan et al examined in detail the relationship between FMS and SSR in their study in 2012 and it was reported that SSR could be used for the diagnosis of FMS [2]. ...
... Disadvantages: Close relationship with the severity of pain measurements. However, the relationship between the personal factors that affect pain is weak [20] [23]. ...
... Frühe traumatische Bindungserfahrungen (Brisch, 2005;Corbin, 2007;Gunnar & Donzella, 2002menhängen (Walker et al., 1997).lane, Benjamin,Morris & Silman, 2000;Fillingim, Wilkinson & Powell, 1999;Waller & Scheidt, 2002;Walker, et al., 1997). Unsichere Bindung wurde weiter mit einer erhöhten ...
... BindungssicherheitRisikofaktor darstellen (z.B.McBeth et al., 2000;Fillingim et al., 1999;Waller & Scheidt, 2002;Walker, et al., 1997)(2) Besteht zwischen bindungsbezogener Angst und der körperlichen Belastung ein stärkerer Zusammenhang als zwischen bindungsbezogener Vermeidung und der körperlichen Belastung? ...
Bindungsunsicherheit wurde in diversen Studien als unspezifischer Vulnerabilitätsfaktor mit systematischen Auffälligkeiten im Wahrnehmen und Beurteilung von Belastung in Verbin-dung gebracht (z.B. Maunder & Hunter, 2001). Inwieweit bindungsbezogene Angst und Vermeidung mit dem psychosomatischen Beschwerdedruck zusammenhängen, wurde bei 166 ambulanten Patienten, die im Mittel 41 (41.13) Jahre alt (SD=12.38) und zu 66.9% weiblich waren, vor dem Erstgespräch in einer Institutsambulanz mit dem Experiences in Close Relations-Revised (ECR-RD: Ehrenthal, Dinger, Lamla, Funken & Schauenburg, 2009) sowie der Symptom-Checkliste (SCL-90-R: Franke, 2002) untersucht. Den beiden Skalen des 36-Items-Fragebogen ECR-RD liegt ein Partnerschaftsmodell der latenten Bindungsdimensionen Angst (BANG) und Vermeidung (BVER) zugrunde. Für die Operationalisierung des psychosomatischen Beschwerdedrucks wurde der GSI (Global Severity Index) als ein globaler Kennwert der SCL-90-R gewählt. Zusätzlich wurde das Mitwirken körperlicher Belastung mit dem Gießener Beschwerdebogen (GBB-24: Brähler, Schumacher & Scheer, 2004) und wahrgenommener, zwischenmenschlicher Konflikte mit dem Inventar interpersonaler Probleme (IIP-C: Horowitz, Strauß & Kordy, 2000) einbezo-gen.
Die Auswertung ergab zwischen BANG und dem GSI starke sowie zwischen BVER und dem GSI moderate, linear positive Zusammenhänge. Beide Bindungsdimensionen konnten einen signifikanten Anteil am GSI in einer simultanen Regressionsanalyse vorhersagen, wobei der Anteil von BANG der maßgebliche war. Die Korrelationen von BANG mit der körperlichen Gesamtbelastung und weiteren Symptomen fielen schwach, wenn doch signifikant aus, wo-hingegen bei BVER nur mit „Herzbeschwerden“ ein bedeutender Zusammenhang bestand. Beide Bindungsdimensionen korrelierten zudem unterschiedlich stark mit verschiedenen Arten interpersonaler Probleme. Allerdings stellten interpersonale Probleme keine Mediatorvariable beim Zusammenhang zwischen den Bindungsdimensionen mit dem GSI dar.
So konnte mit dieser Feldstudie eine in der klinischen Bindungsliteratur benannte, besondere Beziehung zwischen unsicheren Bindungsrepräsentationen und dem Beschwerdedruck unter-mauert werden. Der ECR-RD könnte somit additiv zum diagnostischen Screening in der klinischen Praxis zum Einsatz kommen, um Beschwerden mithilfe bindungsrelevanter Persönlichkeitsmerkmale umfassender begreifen und somit gezielter behandeln zu können.
... [5] Studies on twins have shown that heredity is only responsible for half of the risk of developing FM or one of the other central sensitivity disorders. [6] It would appear that psychiatric conditions have a significant impact on fibromyalgia. Patients diagnosed with fibromyalgia are more likely to suffer from psychological disorders compared to patients diagnosed with other rheumatic illnesses. ...
A chronic condition known as fibromyalgia syndrome (FM) is characterised by widespread body pain, sensitivity , exhaustion, sleep disorder, and cognitive dysfunc-tion. [1] In addition, certain symptoms or syndromes, such as irritable bowel syndrome, chronic headache, depression, anxiety, restless leg syndrome, temporomandibular dys-Objectives: Long-term fibromyalgia syndrome (FM) causes widespread pain, sensitivity, fatigue, trouble sleeping, and cognitive issues. FM has no known cause despite extensive research. In this study, we looked at how bad fibromyalgia was in mothers of children with autism spectrum disorder (ASD). Methods: Gülhane Training and Research Hospital conducted this study. In the study, 40 children aged 6-10 were diagnosed with ASD in the child psychiatry department. The paediatric and outpatient clinic had 40 healthy controls without psychiatric disorders. The Beck Depression Scale, the Beck Anxiety Scale, the Fibromyalgia Effect Survey, and the Autism-Spectrum Questionnaire (ASQ) were used to test the mothers of the children in the study for depression, anxiety, the severity of their fibromyalgia, and autistic symptoms. Results: The clinical severity of ASD symptoms has been measured (CARS) using the Childhood Autism Rating Scale. ASD, fibromyalgia, ASQ, and CARS patients score higher than healthy people. There were no statistically important differences between the depression and anxiety scores of the healthy and ASD groups.We examined fibromyalgia severity in 40 age-and gender-matched mothers of children with ASD and 40 mothers of healthy children without psychiatric illness. Conclusion: Mothers of children with ASD had higher rates of fibromyalgia than mothers of healthy children.
... Stress is presumed to play an important role to the extent that FM is considered a stress-related disease, but this may vary depending on intensity, type, and exposure time of stress. In a community-based study, significant tenderness in FM was strongly associated with psychological distress and somatization [71]. In the British Birth Cohort Study, which was conducted from 1958 onward, chronic widespread pain in adulthood was more common among participants whose childhood experiences included hospitalization due to a traffic accident, residence in institutional care, maternal death, and familial financial hardship [72]. ...
Fibromyalgia is characterized by chronic widespread pain, and it is often accompanied by various symptoms such as fatigue, sleep disturbance, mood changes, cognitive dysfunction, and several somatic symptoms. The etiopathogenesis of fibromyalgia remains poorly understood, but it is thought to be caused by complex interactions among genetic predisposition, environmental factors, and biological factors. Emerging evidence suggests that central sensitization, which is characterized by impairment in the processes of pain perception, transmission, and modulation, plays an important role in fibromyalgia. Although various treatments have been used for fibromyalgia, patients still suffer from uncontrolled symptoms. Fibromyalgia still has many challenges to be solved. In this review, we discuss existing evidence on the etiopathogenesis of fibromyalgia.
... Therefore, caution must be used in interpreting these results, which are nonetheless consistent with other reports describing a history of trauma and abuse among fibromyalgia patients. [20][21][22][23][24][25] Our findings regarding psychiatric disorders are also generally consistent with other published research findings. [1][2][3]21 In particular, depression among fibromyalgia patients might be expected, because considerable overlap exists between fibromyalgia symptoms and symptoms of depression (eg, fatigue and sleep disturbance). ...
Objective
The objective of this study was to describe the prevalence of current psychiatric disorders and functional disability among a sample of patients attending a fibromyalgia group clinic in the Rheumatology Department at Kaiser Permanente Colorado.
Methods
A sample of 184 patients, 92% of whom were women, were given questionnaires at the beginning of the group clinic. Questionnaires included items on demographics, work disability, and history of trauma and abuse. Also included were the following instruments: the Illness Intrusiveness Scale, the Fibromyalgia Impact Questionnaire, and the Quick Psychodiagnostics Panel.
Results
Most patients reported a history of trauma (74.7%) or abuse (53.5%). Major depression (34.2%), anxiety (29.9%), and panic disorders (17.4%) were prevalent in this sample. Symptoms of bipolar disorder were present in 59.2% of patients. In addition, a high level of psychiatric comorbidity was evident: 64.1% of the patients met DSM-IV criteria for two or more diagnoses. These patients also reported clinically significant functional impairment (especially in the life domains of active recreation, health, and work) and were most negatively affected by fatigue, lack of restfulness at waking, and stiffness.
Conclusions
Baseline assessment of this patient sample confirmed clinicians’ suspicion of clinically significant psychiatric and functional disability and led to the addition of a clinical psychologist to the group clinic to target and intervene with patients who had psychiatric disorders. We conclude that treatment effectiveness for fibromyalgia can be enhanced by collaboration between rheumatologists and behavioral medicine specialists.
... Baseline questionnaire results obtained from our sample of FMS patients showed a high prevalence of major depression and anxiety, significant functional disability, and a history of past physical or emotional trauma and physical, emotional, or sexual abuse. 1 These findings are consistent with what has been reported in the literature. [5][6][7][8][9][10] The results of our follow-up assessment indicate that the FMS group clinic was associated with statistically significant improvement in symptoms of anxiety, depression, and panic as well as in pain, restful sleep, stiffness, nervousness, and tenseness. Days of work missed showed a statistically significant decrease, and patients' ability to do their jobs also showed statistically significant improvement. ...
Objective
To assess psychiatric symptoms and functional impairment in patients with fibromyalgia after they participated in a half-day group clinic administered by the rheumatology department at Kaiser Permanente in Colorado.
Methods
Questionnaires were given to 184 patients at the beginning of the group clinic and by telephone interview 11 to 23 months after completion of the group clinic. Questionnaires assessed demographics, psychiatric symptoms, functional impairment, work disability, and history of physical or emotional trauma and physical, emotional, or sexual abuse.
Results
Questionnaire responses indicated that patients had statistically significantly less anxiety (p = 0.002), depression (p < 0.001), panic (p = 0.029), pain (p = 0.003), restless sleep (p < 0.001), stiffness (p < 0.001), nervousness/tenseness (p < 0.001) after attending the group clinic. Number of missed work days significantly decreased (p = 0.003), and patients’ ability to do their jobs was also significantly improved (p < 0.001). However, neither interference in five major life domains nor instrumental activities of daily living improved. Number of visits to primary and specialty care also decreased significantly (p < 0.005).
Conclusions
In fibromyalgia patients referred to a rheumatology department, a multidisciplinary group clinic intervention may effectively improve outcomes in both mental health and functional status. This group clinic model may also reduce medical utilization and associated costs.
... Para alguns autores, um número elevado de tender points era um sinal de dor generalizada em doentes com o "diagnóstico objetivo" de fibromialgia, e não um indicador de mal -estar ou de perturbação psicológica (Nicassio, Weisman, et al., 2000). Para outros autores, a fibromialgia não justificava o estatuto de uma entidade descontínua e os tender points não eram mais do que um análogo da "velocidade de sedimentação" para o mal -estar do doente, associados às características habituais do processo de somatização e respetivos antecedentes biográficos, como por exemplo experiências de abuso ou perdas significativas (Wolfe, 1997b;McBeth, Macfarlane, et al., 1999). Ou seja, numa perspetiva crítica, tinha sido operado um salto conceptual prematuro dos tender points para a fibromialgia, na ausência de qualquer explicação fisiopatológica. ...
... The ACE inhibitor trandolapril was shown to improve peripheral neuropathy even in normotensive patients with diabetes. In general, the ACE inhibitor class of medications appears to have some protective effect against microvascular complications and organ damage from diabetes (30). ...
... This type of personality is more prone to react to stress adversely. Other relevant psychological inputs include poor coping abilities and tendencies to calamity under stressful situations [82]. These types of processes often overlap. ...
The promulgation of the American College of Rheumatology (ACR) 1990 criteria for fibromyalgia (FM) classification has significantly contributed to an era of increased research into mechanisms that underlie the disorder. The previous emphasis on putative peripheral nociceptive mechanisms has advanced to identifying of changes in central neural networks that modulate pain and other sensory processes. The influences of psychosocial factors on the dynamic and complex neurobiological mechanisms involved in the fibromyalgia clinical phenotype are now better defined. This review highlights key milestones that have directed knowledge concerning the fundamental mechanisms contributing to fibromyalgia.
... In a community-based pain study, McBeth et al. (1999) reported that the relationship between characteristics of somatization and illness behavior (associated with the presence of multiple tender points) has childhood antecedents. Robert Anda (2004) and numerous other investigators at the Kaiser Foundation Health Plan have identified childhood exposure to emotional, physical, and sexual abuse; battered syndrome; household substance abuse; mental illness in the household; parental separation or divorce; and incarcerated household members as contributors to adult job problems, financial problems, and absenteeism. ...
Vocational disability and lost time can be a consequence of psychosocial and biological dynamics that pre-existed a specific accident, injury, or illness. More specifically, Adverse Childhood Experience (ACE) can predispose employees to being disability prone and lead to long-term absence from work following claimed injury or illness. For the vulnerable employee, the reported injury or illness can serve as an “explanatory event,” which can be transformed into an “acceptable disability.” A case study depicts how ACEs can be risk factors for occupational disability and lost time. Vocational evaluators, rehabilitation professionals, and medical personnel must be willing to take thorough histories as part of comprehensive rehabilitation evaluations so that these dynamics can be explored and their impact on medical and vocational recoveries can be better understood.
... found that individuals who reported higher tender point counts were significantly more likely to report ACEs. 27 Mothers with childhood-onset chronic pain reported experiencing more ACEs compared to mothers with adult-onset chronic pain suggesting that ACEs may contribute to the development of pediatric chronic pain, which then persists into adulthood; ACEs have indeed been associated with pediatric chronic pain. 24,32 A recent study showed that youth who reported ...
Adverse childhood experiences (ACEs; eg, parental divorce, physical or sexual abuse) are more prevalent in individuals with chronic pain compared with the general population. Both increased maternal ACEs and chronic pain have been associated with poor physical and emotional functioning in offspring. However, the mechanisms driving these associations are poorly understood. Thus, this cross-sectional study evaluated the relation between maternal ACEs, mothers’ current functioning, and children's physical and emotional functioning in a sample of mothers with chronic pain and their 8- to 12-year-old children. Results indicated a higher prevalence of ≥1 ACE in this sample of mothers with chronic pain (84%) compared with normative data from a community sample of women. Higher maternal ACE scores corresponded with lower physical and social functioning, greater anxiety and depressive symptoms, greater fatigue and sleep disturbances, and greater pain intensity and pain interference in mothers. Higher maternal ACE scores significantly correlated with higher child self-reported depressive symptoms, but not somatic symptoms or functional impairment. A path model indicated that maternal depressive symptoms accounted for the relation between higher maternal ACE scores and children's depressive symptoms. Intervening on maternal depression among mothers with chronic pain may reduce the impact of intergenerational ACE transmission. Perspective: This article presents evidence regarding the intergenerational impact of ACEs in a large sample of mothers with chronic pain and their school-aged children. Maternal depressive symptoms accounted for the relation between maternal ACEs and children's depressive symptoms providing evidence regarding targets for preventive interventions.
... Interestingly, a dose-dependent effect has been found between ALEs and negative sequelae. For example, the number of adverse childhood experiences is associated with worse physical health/quality of life, 8,18,26 somatic symptoms, 38,45,49 mood/anxiety/stress symptoms, [1][2][3][4]17,21,23,24,26,49,53,76 sleep disturbance, 3,16 anger control, 3 and corticotropin-releasing factor (stress hormone). 94 It is, therefore, possible that a dose-dependent relationship exists between ALEs and pain. ...
Adverse life experiences (ALEs) are associated with hyperalgesia and chronic pain, but the underlying mechanisms are poorly understood. One potential mechanism is hyperexcitability of spinal neurons (ie, central sensitization). Given that Native Americans (NAs) are more likely to have ALEs and to have a higher prevalence of chronic pain, the relationship between ALEs and spinal hyperexcitability might contribute to their pain risk. The present study assessed temporal summation of the nociceptive flexion reflex (TS-NFR; a correlate of spinal hyperexcitability) and pain (TS-Pain) in 246 healthy, pain-free non-Hispanic whites and NAs. The Life Events Checklist was used to assess the number of ALEs. Multilevel growth models were used to predict TS-NFR and TS-Pain, after controlling for age, perceived stress, psychological problems, negative and positive affect, and painful stimulus intensity. ALEs and negative affect were significantly associated with greater pain, but not enhanced TS-Pain. By contrast, ALEs were associated with enhanced TS-NFR. Race did not moderate these relationships. This finding implies that ALEs promote hyperalgesia as a result of increased spinal neuron excitability. Although relationships between ALEs and the nociceptive flexion reflex/pain were not stronger in NAs, given prior evidence that NAs experience more ALEs, this factor might contribute to the higher prevalence of chronic pain in NAs.
Perspective
This study found a dose-dependent relationship between ALEs and spinal neuron excitability. Although the relationship was not stronger in NAs than non-Hispanic whites, given prior evidence that NAs experience more ALEs, this could contribute to the higher prevalence of chronic pain in NAs.
... It is estimated that 10-64% of FMS patients have history of CSA (Walker et al., 1997;Goldberg et al., 1999;Imbierowicz and Egle, 2003;Häuser et al., 2013). In fact, there is also a correlation between past trauma history and symptoms severity (Walker et al., 1997;McBeth et al., 1999) where patients who suffered CSA, report higher psychological stress, greater functional disability and poorer psychological adjustment (Taylor et al., 1995). ...
Background: Fibromyalgia syndrome (FMS), a condition considered to represent a prototype of central sensitization syndrome, can be induced by different triggers including childhood sexual abuse (CSA). Recent studies have demonstrated hyperbaric oxygen therapy (HBOT) can induce neuroplasticity and improve clinical outcome of FMS. The aim of the current study was to evaluate the effect of HBOT on patients suffering from FMS with a history of CSA.
Materials and methods: A prospective randomized clinical trial conducted between July 2015 and November 2017 included women with a history of CSA who fulfilled fibromyalgia diagnosis criteria for at least 5 years prior to inclusion. Included participants (N = 30) were randomly assigned to treatment group, treated with 60 HBOT sessions and a control/crossover group received psychotherapy. After the control period, the control/crossover group was crossed to HBOT. Clinical outcomes were assessed using FMS questioners, post-traumatic stress disorder (PTSD) questioners and quality of life questioners. Objective outcome were assessed using brain function and structure imaging.
Findings: Following HBOT, there was a significant improvement in all FMS questionnaires (widespread pain index, Fibromyalgia symptoms severity scale, Fibromyalgia functional impairment), most domains of quality of life, PTSD symptoms and psychological distress. The same significant improvements were demonstrated in the control following crossover to HBOT. Following HBOT, brain SPECT imaging demonstrated significant increase in brain activity in the prefrontal cortex, orbital frontal cortex, and subgenual area (p < 0.05). Brain microstructure improvement was seen by MRI-DTI in the anterior thalamic radiation (p = 0.0001), left Insula (p = 0.001), and the right Thalamus (p = 0.001).
Conclusion: HBOT induced significant clinical improvement that correlates with improved brain functionality and brain microstructure in CSA related FMS patients.
Trial Registration: www.Clinicaltrials.gov, identifier: NCT03376269. url: https://clinicaltrials.gov/show/NCT03376269
... 18 Tender points can be regarded as the "sedimentation rate" of somatic and psychological distress. 19,20 The new diagnostic criteria for FM give unrefreshed sleep and fatigue a nearly equal weight for diagnosis and even include depression as a minor symptom. [21][22][23] The composite of symptoms that occur in patients with FM raises the question of whether these various other symptoms are merely the consequence of chronic pain or whether they occur uniquely as a critical component of this disorder. ...
Fibromyalgia (FM) is characterized by chronic widespread pain, unrefreshing sleep, physical exhaustion, and cognitive difficulties. It occurs in all populations throughout the world, with prevalence between 2% and 4% in general populations. Definition, pathogenesis, diagnosis, and treatment of FM remain points of contention, with some even contesting its existence. The various classification systems according to pain medicine, psychiatry, and neurology (pain disease; persistent somatoform pain disorder; masked depression; somatic symptom disorder; small fiber neuropathy; brain disease) mostly capture only some components of this complex and heterogeneous disorder. The diagnosis can be established in most cases by a general practitioner when the symptoms meet recognized criteria and a somatic disease sufficiently explaining the symptoms is excluded. Evidence-based interdisciplinary guidelines give a strong recommendation for aerobic exercise and cognitive behavioral therapies. Drug therapy is not mandatory. Only a minority of patients experience substantial symptom relief with duloxetine, milnacipran, and pregabalin.
... Additional ACE studies have expressed concerns about bias from nonresponse, with mixed results from further investigation. In a study of the association between tender points in arthritis, psychological distress, and ACEs, researchers found that, compared to those who completed both the interview and the ACE questionnaire, those who did not complete the interview were not significantly different in terms of self-reported health or ACEs, but were more likely to report a lower level of self-care (Mcbeth, Macfarlane, Benjamin, Morris, & Silman, 1999 underestimate of observed associations. A study of the association between ACEs and social services use by university students reported a response rate of 18.6% (72.7% female, 27.2% male), from which they inferred "obvious non-response bias" despite finding ACE scores comparable to American college-educated populations and similar response rates as other online surveys with similar populations (Mcgavock & Spratt, 2014). ...
Background: A wealth of research has examined the prevalence and impact of adverse childhood experiences (ACEs) via various research methodologies. Some of these studies have also examined the presence of nonresponse bias, showing minimal nonresponse bias effects. More recently, many states and the District of Columbia have used the Behavioral Risk Factor Surveillance System (BRFSS) to examine ACEs, however, limited research exists on the impact of nonresponse bias in ACE studies using the BRFSS. Methods: This study used data from the 2014–2015 South Carolina BRFSS to examine nonresponse bias to the ACE module. Results: Significant differences between responders and non-responders were found for sex, age, race/ethnicity, education, income, and rurality. Findings indicate that marginalized populations were more likely to be under-represented in ACE survey data because of nonresponse, potentially limiting targeted prevention and intervention efforts. Conclusion: Future research should examine differences in health and social outcomes between responders and non-responders to the ACE module in the BRFSS and ways to increase responses from marginalized groups.
... Acute trauma or illness has been linked to the onset of the disease process. 10,12 Psychological stressors such as low social support 12,15 or early childhood trauma 10,16 have been shown to be strong predictors of widespread pain development. Psychological factors play a large role in the triggering and persistence of FMS. 17 In combination with a genetic predisposition, both environmental and psychosocial factors can trigger an abnormal amount of physiological stress, 10 resulting in a dysregulation of a hypersensitive system. ...
Fibromyalgia syndrome is a chronic pain condition that affects 440,000 Canadians above the age of 12. People with fibromyalgia report lifelong biological, emotional, cognitive and social complications. Recent clinical practice guidelines indicate management of symptoms is limited outside of analgesics. Cognitive-behavioral therapy (CBT) is one emerging treatment that displays promise for these individuals. CBT helps individuals to realize their maladaptive thought processes and how these can affect their own emotional response as well as the significance they attribute to potentially noxious stimuli. In conjunction with a physical exercise program, CBT shows promise in both the management of pain, and an improvement of quality of life.
... Studies have reported that a history of childhood trauma or abuse may be commonly found in FMS patients relative to the general population [99][100][101][102] and even a risk factor of FMS [101]. Moreover, evidence suggests that childhood trauma is related with pain severity in FMS [101,103]. Interestingly, high rates of child abuse and stressful life events have been reported in a variety of forms of chronic pain, including generalized pain [104][105][106], pelvic pain and vulvodynia [107][108], chronic musculoskeletal pain [109], headache [110], and irritable bowel syndrome and gastro-intestinal conditions [111][112][113]. Whether or not preceded by stressful life events or other pathogenic route, our present results support the existence of a link between pain and negatively biased cognitions of one's own body in FMS, including low body esteem. ...
Fibromyalgia syndrome (FMS) is a highly prevalent, chronic musculoskeletal condition characterized by widespread pain and evoked pain at tender points. This study evaluated various aspects of body awareness in a sample of 14 women with FMS and 13 healthy controls, such as plasticity of the body schema, body esteem, and interoceptive awareness. To this end, the Rubber Hand Illusion (RHI), the Body Esteem Scale (BES), and the Body Perception Questionnaire (BPQ) were used, respectively. Consistent with increased plasticity of the body schema, FMS patients scored higher, with large or very large effect sizes, across all three domains evaluated in the RHI paradigm, namely proprioceptive drift and perceived ownership and motor control over the rubber hand. Scores on all items addressed by the BES were consistently lower among FMS subjects (2.52, SEM .19 vs 3.89, SEM .16, respectively, p < .01, Cohen’s d = .38-.66). In the FMS sample, BES scores assigned to most painful regions also were lower than those assigned to the remaining body sites (1.58, SEM .19 vs 2.87, SEM .18, respectively, p < .01). Significantly higher scores (p < .01, Cohen’s d = .51-.87) were found in the FMS sample across awareness (3.57 SEM .15 vs 1.87 SEM .11), stress response (3.76 SEM .11 vs 1.78 SEM .11), autonomic nervous system reactivity (2.59 SEM .17 vs 1.35 SEM .07), and stress style 2 (2.73 SEM .27 vs 1.13 SEM .04) subscales of the BPQ. Intensity of ongoing clinical pain was found to be strongly correlated with interoceptive awareness (r = .75, p = .002). The results suggest a disturbed embodiment in FMS, characterized by instability of the body schema, negatively biased cognitions regarding one’s own body, and increased vigilance to internal bodily cues. These manifestations may be interpreted as related with the inability of incoming sensory inputs to adequately update negatively biased off-line somatorepresentations stored as long-term memory.
... Acute trauma or illness has been linked to the onset of the disease process. 10,12 Psychological stressors such as low social support 12,15 or early childhood trauma 10,16 have been shown to be strong predictors of widespread pain development. Psychological factors play a large role in the triggering and persistence of FMS. 17 In combination with a genetic predisposition, both environmental and psychosocial factors can trigger an abnormal amount of physiological stress, 10 resulting in a dysregulation of a hypersensitive system. ...
Fibromyalgia syndrome is a chronic pain condition that
affects 440,000 Canadians above the age of 12. People with
fibromyalgia report lifelong biological, emotional, cognitive
and social complications. Recent clinical practice guidelines
indicate management of symptoms is limited outside of
analgesics. Cognitive-behavioral therapy (CBT) is one emerging
treatment that displays promise for these individuals. CBT
helps individuals to realize their maladaptive thought processes
and how these can affect their own emotional response as well
as the significance they attribute to potentially noxious stimuli.
In conjunction with a physical exercise program, CBT shows
promise in both the management of pain, and an improvement
of quality of life.
... Although evidence is still sparse, previous studies of ACEs exposure in adults with discrete pain conditions (eg, fibromyalgia) show findings of between 60% and 65% of participants reporting exposure to at least 1 ACE. 1,31 Because of the use of discrete chronic pain conditions in previous research, the current study's findings of higher rates of ACEs exposure may be more representative of the greater variation and potential rate of responding to ACEs exposure in broader pain clinic samples. The lower rates of ACEs found in previous research could be accounted for by the above noted lack of comprehensive ACE assessment and indicates that a significant number of people with ACEs may have been missed. ...
Objectives:
Adverse childhood experiences (ACEs) in youth have been found to be frequently associated with several chronic illnesses, including chronic pain. However, this relationship remains poorly understood. Previous research has examined the association between ACEs and chronic pain, but these have primarily been examined in the context of adults with limited assessment of ACEs and individual pain conditions. The primary objectives of this study were to examine the incidence and psychological/pain-related correlates of ACEs in a sample of youth with chronic pain. Exploratory analyses were also examined using primary pain diagnosis and number of pain locations.
Methods:
Data were gathered using retrospective data from a clinical databank. Participants were 141 youth ages 9-19 with chronic pain who presented for evaluation at a multidisciplinary pain clinic. Information on ACEs exposure, pain diagnostic information, pain-related impairment, and psychosocial functioning were gathered via self-report and retrospective review of the medical record.
Results:
Results revealed that over 80% of youth with chronic pain reported at least one ACE in their lifetime. Further, multiple and univariate analyses of variance revealed that ACEs exposure is significantly associated with greater symptoms of anxiety, depression, and fear of pain, with 3 or more ACEs associated with greatest impairment in functioning. No relationships were found between ACEs and increased pain-related disability or pain intensity.
Discussion:
ACEs exposure in youth with chronic pain occurs frequently and can be associated with increased psychosocial but not functional impairment. Future research is needed to further examine the relationship between ACEs and chronic pain in youth in a prospective fashion.
... Feeling pain in the absence of noxious stimuli or not reporting it following peripheral trauma reflects activity in salience networks (Borsook et al. 2013) including ACC/aMCC (Seeley et al. 2007). Further, centralized pain syndromes like fibromyalgia absent robust peripheral pathology and intervention responses (Clauw 2014) are limbic mediated and child abuse/rape are vulnerability factors for it (Imbierowicz and Egle 2003;McBeth et al. 1999). While cingulate cortex is often implicated in pain, its role in top-down, avoidance control is poorly understood and cingulate reorganization in the nociceptive stress model may explain these phenomena. ...
Adolescent physical abuse impairs emotional development and evokes cingulate pathologies, but its neuronal and circuit substrates are unknown. Conditioning adolescent rabbits with noxious colorectal distension for only 2 h over 3 weeks simulated the human child abuse in amplitude, frequency, and duration. Thermal withdrawal thresholds were unchanged suggesting that sensitized spinal mechanisms may not be operable. Unchanged weight, stools, colorectal histology, and no evidence of abdominal pain argue against tissue injury or irritable bowel syndrome. Contextual fear was amplified as they avoided the site of their abuse. Conditioning impacted anterior cingulate and anterior midcingulate (ACC, aMCC) neuron excitability: (1) more neurons responded to cutaneous and visceral (VNox) noxious stimuli than controls engaging latent nociception (present but not manifest in controls). (2) Rear paw stimulation increased responses over forepaws with shorter onsets and longer durations, while forepaw responses were of higher amplitude. (3) There were more VNox responses with two excitatory phases and longer durations. (4) Some had unique three-phase excitatory responses. (5) Long-duration VNox stimuli did not inhibit neurons as in controls, suggesting the release of an inhibitory circuit. (6) aMCC changes in cutaneous but not visceral nociception confirmed its role in cutaneous nociception. For the first time, we report neuroplasticities that may be evoked by adolescent physical abuse and reflect psychogenic pain: i.e., no ongoing peripheral pain and altered ACC nociception. These limbic responses may be a cognitive trace of abuse and may shed light on impaired human emotional development and sexual function.
... Current research tries to identify risk factors and pathophysiological mechanisms that contribute to the development of chronic pain. A number of genetic and behavioral risk factors have already been identified, including certain genetic predispositions [10,11], but also distress in daily life and traumatic events are thought to be associated with the development of chronic pain [12,13]. Apart from genetic and psychological considerations, functional magnetic resonance imaging (fMRI) has substantially advanced the field. ...
Fibromyalgia is characterized by chronic widespread pain and several additional symptoms such as fatigue, cognitive dysfunction, depressive episodes, and anxiety. The underlying pathophysiology of fibromyalgia is still poorly understood, and treatment is often unsatisfactory. Current research provides evidence for altered pain processing in chronic pain patients, and specifically in fibromyalgia patients, possibly based on altered functional connectivity and brain chemistry in brain regions within the pain processing system. Besides discussing evidence from studies applying brain imaging (specifically resting state fMRI (Functional magnetic resonance imaging)), the current review aims at providing an overview of pharmacological and non-pharmacological treatment options. We will also summarize the most important results from recently performed brain imaging studies providing new insights into the potential mechanisms of various therapeutic approaches.
... Während bei Gesunden das Ausmaß der Dopaminausschüttung mit der Schmerzstärke korrelierte, war dies bei FMS-Patienten nicht der Fall (Wood et al. 2007 (Goldberg et al. 1999;Walker et al. 1997;Boisset-Pioro et al. 1995). Im Vergleich zu einer nicht viktimisierten Subgruppe korrelierte dies mit einer größeren Anzahl an Tender Points und psychovegetativen Begleitsymptomen, einer stärkeren Inanspruchnahme des Gesundheitswesens sowie einem höheren Analgetikakonsum (Alexander et al. 1998;McBeth et al. 1999). Auswertungen der prospektiven britischen Kohortenstudie, in die 1958 insgesamt 17.638 Neugeborene aufgenommen worden waren, von denen 45 Jahre später noch 7.571 zu chronischen Schmerzen befragt werden konnten, belegten Jones et al. 2009) (Green et al 2011). ...
... In addition, somatisation, which is also associated with reports of adverse childhood events, has also been associated with fibromyalgia [5]. It has also been demonstrated that reports of adverse events in childhood, such as the separation or death of parents or abuse, and perceived paternal overprotection, or lack of care are strongly associated with a high tender point count (McBeth et al.,) [26]. ...
Objective: To examine the hypothesis that psychological factors
of psychological distress and perception of unhappiness in
childhood are associated with self reported orofacial pain and to
examine whether such patients have a poorer perception of their
oral health related quality of life and if so then to what extent.
Materials and Methods: A cross-sectional hospital based study
was conducted in Hitkarini Dental College and Hospital, Jabalpur
amongst 400 cases and 400 controls. Patients were included
based on Locker and Slade’s criteria. Patients were asked to
complete 27 items Questionnaire which included the General
Health Questionnaire to assess for psychological distress and
Oral Health Impact Profile-14 for evaluating impact on quality of
life. Bivariate and logistic regression analyses were performed
to determine the degree of association between psychological
factors, unhappy childhood and quality of life. P-value of less than
0.05 was considered statistically significant.
Results: An increased propensity to report orofacial pain was
seen for those individuals with higher levels of Psychological
Distress and with perception of Unhappiness in Childhood. These
individuals also reported with poorer perception of their oral health
related Quality of Life.
Conclusion: The present study has shown relationship between
Orofacial Pain, Quality of Life and Psychological Factors.
... State alexithymia has been related to the experience of childhood trauma (Frewen et al., 2008;Lumley, Smith, & Longo, 2002); patients with FMS frequently report a history of psychological trauma before the onset of the illness (Cohen et al., 2002;Greenfield, Fitzcharles, & Esdaile, 1992), including high rates of childhood trauma (Imbierowicz & Egle, 2003; Goldberg, Pachas, & Keith, 1999; Walker et al., 1997). Posttraumatic stress may give rise to maladaptive cognitive and affective information-processing (Heaton, Davis, & Happe, 2008) and sustained psychological distress (Alexander et al., 1998;McBeth, Macfarlane, Benjamin, Morris, & Silman, 1999). It has been recently suggested that the TAS-20 primarily assesses alexithymia in terms of a state-dependent syndrome, which varies according to stress levels, negative affect and clinical depression and anxiety (Marchesi et al., 2014). ...
The study compared alexithymia in fibromyalgia syndrome (FMS) patients and healthy individuals, and analyzed its association with clinical, emotional, and functional variables. Forty-five FMS patients and 31 healthy individuals completed the Toronto Alexithymia Scale, which includes the dimensions: Difficulty Identifying Feelings (DIF), Difficulty Describing Feelings (DDF), and Externally-Oriented Thinking (EOT). Participants also completed instruments assessing Eysenck's personality dimensions, pain, fatigue, sleep, anxiety, depression, health-related quality of life (HRQL) and coping with pain. FMS patients exhibited higher scores in DIF and DDF than healthy individuals; group differences were markedly lower when depression and anxiety were statistically controlled. Patients furthermore displayed greater depression-anxiety, fatigue, sleep problems and neuroticism, lower HRQL and dysfunctional coping. Alexithymia was overall more closely related to clinical variables in healthy individuals than in patients; in patients, many associations disappeared when anxiety and depression were controlled. The data corroborate the high prevalence of alexithymia in FMS; however, they also suggest that alexithymia may play a less important role in symptom experience in patients vs. healthy individuals. This result may be discussed by considering the distinction between state and trait alexithymia; the weaker associations in patients may be ascribed to specific enhancement of state alexithymia due to illness-related affective distress.
... In a study that examines sensitive points and relationships with the psychological conditions of a patience with fibromyalgia, relationship between sensitive points and psychological distress, especially somatization, was detected [17]. ...
Fibromyalgia is a chronic pain syndrome that generally appears with prevalent muscular pain, sleep disorder and fatigue. Its diagnosis is very difficult. It is diagnosed in a long time after evaluating variety of psychological test scores along with physiological and laboratory tests. Psychological tests are thought not to be as reliable as laboratory test results since they depend on oral reports of the patients, and can differ from patient to patient. Beck depression inventory is one of the psychological test scores. In this study, a new biological signal that could be used instead of Beck depression inventory is introduced. For this purpose, sympathetic skin responses were used along with physiological and laboratory test results that were collected both from diagnosed fibromyalgia patients and healthy patients. A relationship based on classification was aimed to be established between the data and Beck depression inventory by using artificial neural networks. Three different artificial neural network training algorithm were used in the study. According to the results, physiological and laboratory test results and back depression inventory were estimated with the accuracy rate of 77.70\%. When all the data were used with Levenberg-Marquardt back propagation training algorithm, this rate went up to 90.91\%. According to these results, sympathetic skin responses can be safely used instead of Beck depression inventory when they were used along with other parameters that were used in fibromyalgia diagnosis.
... This recommendation differs from previous recommendations where management is delayed to account for potential spontaneous recovery and advised only for patients that are resistant to recovery [12][13][14]. Despite neck pain being the second most common musculoskeletal disorder after low back pain [15,16] and physical therapists being the most frequently visited healthcare provider for neck pain [17], the effect of early physical therapist management on outcomes has not been investigated in patients with neck pain. ...
Background
Neck pain is one of the most common reasons for entry into the healthcare system. Recent increases in healthcare utilization and medical costs have not correlated with improvements in health. Therefore there is a need to identify management strategies for neck pain that are effective for the patient, cost efficient for the payer and provided at the optimal time during an episode of neck pain.
Methods
One thousand five hundred thirty-one patients who underwent physical therapist management with a primary complaint of non-specific neck pain from January 1, 2008 to December 31, 2012 were identified from the Rehabilitation Outcomes Management System (ROMS) database at Intermountain Healthcare. Patients reporting duration of symptoms less than 4 weeks were designated as undergoing “early” management and patients with duration of symptoms greater than 4 weeks were designated as receiving “delayed” management. These groups were compared using binary logistic regression to examine odds of achieving Minimal Clinically Important Difference (MCID) on the Neck Disability Index (NDI) and Numerical Pain Rating Scale (NPRS). Separate generalized linear modeling examined the effect of timing of physical therapist management on the metrics of value and efficiency.
Results
Patients who received early physical therapist management had increased odds of achieving MCID on the NDI (aOR = 2.01, 95 % CI 1.57, 2.56) and MCID on the NPRS (aOR = 1.82, 95 % CI 1.42, 2.38), when compared to patients receiving delayed management. Patients who received early management demonstrated the greatest value in decreasing disability with a 2.27 percentage point change in NDI score per 100 dollars, best value in decreasing pain with a 0.38 point change on the NPRS per 100 dollars. Finally, patients receiving early management were managed more efficiently with a 3.44 percentage point change in NDI score per visit and 0.57 point change in NPRS score per visit.
Conclusions
These findings suggest that healthcare systems that provide pathways for patients to receive early physical therapist management of neck pain may realize improved patient outcomes, greater value and higher efficiency in decreasing disability and pain compared to delayed management. Further research is needed to confirm this assertion.
... Indirekte Hinweise für eine Störung des Dopaminsystems stammen von Bildgebungsstudien, die eine eingeschränkte zerebrale Durchblutung im Bereich des Nucleus caudatus bei FMS-Patienten zeigen(vgl. Alexander et al. 1998;McBeth et al. 1999). Auswertungen der prospektiven britischen Kohortenstudie, in die 1958 insgesamt 17.638 Neugeborene aufgenommen worden waren, von denen 45 Jahre später noch 7.571 zu chronischen Schmerzen befragt werden konnten, belegtenJones et al. 2009) eine erhöhte Vulnerabilität für die spätere Entwicklung eines multilokulären Schmerzsyndroms aufgrund früher Stresserfahrungen (schlechte finanzielle Verhältnisse, längere Trennung von der Mutter, Heimaufenthalte, Krankenhausaufenthalte infolge von Straßenverkehrsunfällen). ...
... In a related study we have also established that tender points, the presence of which are typically elicited by an individual displaying evidence of distress in response to a 'normal' pressure applied to a pre-designated anatomical site (Cott et al., 1992), are associated with the same psychological factors. Indeed the relationship between tender points and psychosocial factors is observed even in the absence of pain (McBeth et al., 1999). ...
... Higher stress levels may also be a consequence of stigmatisation in society. Numerous studies have shown an association between psychological distress and subpopulations of FM patients [39][40][41][42], but the causal relationship may be bi-directional. This may also be the case with perturbations of the stress system (hypothalamic-pituitary-adrenal axis and autonomic nervous system) [43]. ...
Background:
Fibromyalgia (FM) is a pain syndrome, the mechanisms and predictors of which are still unclear. We have earlier validated a set of FM-symptom questions for detecting possible FM in an epidemiological survey and thereby identified a cluster with "possible FM". This study explores prospectively predictors for membership of that FM-symptom cluster.
Methods:
A population-based sample of 8343 subjects of the older Finnish Twin Cohort replied to health questionnaires in 1975, 1981, and 1990. Their answers to the set of FM-symptom questions in 1990 classified them in three latent classes (LC): LC1 with no or few symptoms, LC2 with some symptoms, and LC3 with many FM symptoms. We analysed putative predictors for these symptom classes using baseline (1975 and 1981) data on regional pain, headache, migraine, sleeping, body mass index (BMI), physical activity, smoking, and zygosity, adjusted for age, gender, and education. Those with a high likelihood of having fibromyalgia at baseline were excluded from the analysis. In the final multivariate regression model, regional pain, sleeping problems, and overweight were all predictors for membership in the class with many FM symptoms.
Results:
The strongest non-genetic predictor was frequent headache (OR 8.6, CI 95 % 3.8-19.2), followed by persistent back pain (OR 4.7, CI 95 % 3.3-6.7) and persistent neck pain (OR 3.3, CI 95 % 1.8-6.0).
Conclusions:
Regional pain, frequent headache, and persistent back or neck pain, sleeping problems, and overweight are predictors for having a cluster of symptoms consistent with fibromyalgia.
Polisemptomatik bir ağrı bozukluğu olan fibromiyalji sendromunun günümüzde etiyolojisi hâlâ bilinmemekte olup tanı almış kişilerin işlevselliğini ve yaşam kalitesini azaltan bir sendromdur. Yapılan çalışmalar travmatik bir yaşantı olan ebeveyn kaybının kişilerde psikolojik sorunlara yol açabileceğini gösterirken, fibromiyalji sendromunun psikolojik temelli açıklamaları bu sorunun daha çok travma yaşamış kişilerde ortaya çıkabileceği belirtmektedir. Gerek sözel gerekse yazılı duygusal tepki vermenin duygu düzenlemede önemli bir yere sahip olduğu, fibromiyalji sendromuna sahip bireylerin duygularını ifade ettikçe daha rahat hissettikleri ve daha az semptom gösterdikleri bilinmektedir.
There are intriguing theories regarding the biology of fibromyalgia. Whilst several researchers assume it is a psychogenic, others believe that fibromyalgia is a disease of neurological sensitization (an overactive alarm system). Fibromyalgia is a clinical entity that present with a mix of the symptoms including chronic widespread pain and other non-pain linked symptoms, such as poor sleep, fatigue and cognitive disturbances. Furthermore, fibromyalgia exhibits substantial variation not only between various patients, but also in the same patient during the disease course. Identifying a common language and classification to diagnose and treat fibromyalgia represent another challenge, as patients may seek care from different disciplines (such as rheumatology, general practice, neurology, psychology, or psychiatry and in some cases orthopedic surgery) with unique perspectives and terminologies. Furthermore, in concordance with other medically unexplained pain syndromes, fibromyalgia may be classified in several ways (such as functional somatic syndrome, chronic widespread pain syndrome, persistent somatoform pain disorder, somatic symptom disorder, affective spectrum condition, and central sensitivity syndrome). This chapter will discuss the debate of fibromyalgia as a bitterly controversial condition, the science of pain and where fibromyalgia fits in. It will then discuss fibromyalgia as a pain processing problem, different sources of pain in fibromyalgia patients and the wind-up theory. The chapter will expand to discuss Fibromyalgia associated comorbidities, fibromyalgia pain in the clinical setting, fibromyalgianess, neuroimaging, as well as pain pathways and the pharmacotherapy of Fibromyalgia.
Neuropathic pain is a complex and challenging secondary pain condition. It is a sequela of central nervous or peripheral nervous system lesions and pathologies. It can be debilitating and affects approximately 7% of the general population. Many factors contribute to the development of this chronic neuropathic pain. It can originate from the central part of the nervous system as a result of brain or spinal cord injury, stroke, or multiple sclerosis. Peripheral neuropathic pain manifests in the peripheral nervous system, and includes large fiber and small fiber polyneuropathy, radiculopathy, and mononeuropathy. Pharmacological options include tricyclic antidepressants (TCA), serotonin and norepinephrine reuptake inhibitors (SNRI), and gabapentinoids. For more severe cases, interventional pain management techniques such as peripheral nerve blocks, spinal cord, or peripheral nerve stimulation may be reasonable options.
Background
Resilience among adolescents can best be understood by examining the risk and protective factors in the lives of at-risk adolescents. A standardized tool to identify adolescent psychosocial risk and protective factors may help better understand the strengths, vulnerabilities, and the potential for resilience among adolescents. Hence, the present study aims to identify and measure the risk and protective factors in the lives of adolescents.
Methods
A sequential exploratory mixed-methods design was used to develop a tool that measures risk and protective factors among adolescents. The qualitative study explored psychosocial risk and protective factors among high-risk adolescents using 4 major domains: individual, family, school, and community. To develop the tool, prisoners (N = 12), caregivers of the prisoners’ children (N = 12), teachers of the prisoners’ children (N = 12), and prison authorities (N = 12) were interviewed about their experiences with prisoners’ children. The interview data were analyzed, and items reflecting the risk and protective factors in the lives of the adolescent children of incarcerated parents were generated. The item pool consisting of 239 items was administered to a sample of 312 rural adolescent students. To validate the risk factors scale and protective factors scale, self-report scales measuring behavior problems, adjustment, well-being, and positivity were used.
Results
The new tool developed to measure the risk and protective factors for adolescent psychosocial development was found to have adequate test-retest reliability, content validity, convergent validity, and divergent validity.
Conclusion
In this study, a scale to identify psychosocial risk and protective factors was developed and standardized. The tool will be helpful to psychologists and counselors working with adolescents to understand the risks and protective factors present in their lives and design interventions to nurture resilience in them.
The aims of this longitudinal study were to 1) identify categories of adverse childhood experiences (ACEs) (i.e., neglect, abuse, household dysfunction in childhood) that increase risk for internalizing mental health problems, pain-related impairment, and poorer quality of life and 2) examine the moderating role of posttraumatic stress symptoms (PTSS) in these associations, in a clinical sample of youth with chronic pain. At two timepoints, youth (N=155; aged 10-18 years) completed measures of exposure to ACEs, PTSS, depressive and anxiety symptoms, pain intensity, pain interference, and quality of life. Multivariate analyses of variance, linear mixed modeling, and moderation analyses were conducted. Results from cross-sectional and longitudinal analyses were similar; youth with a history of 3+ ACEs reported significantly higher PTSS, depressive and anxiety symptoms, and poorer quality of life than youth with no ACE history. Results also revealed differences in functioning between youth exposed to different types of ACEs (i.e., maltreatment only, household dysfunction only, both, none). Finally, PTSS was found to moderate the association between ACEs and anxiety symptoms. Findings underscore the influence that ACEs can have on the long-term functioning of youth with chronic pain as well as the important role of current PTSS in this association.
Perspective: This study found that the risk of poorer outcomes imposed by ACEs at baseline remains longitudinally and that posttraumatic stress symptoms (PTSS) moderate the relationship between ACEs and anxiety in youth with chronic pain. These results underscore the importance of assessing for ACEs and PTSS alongside chronic pain in youth.
In line with international best practice, the Arabian Gulf countries have ratified the Convention on the Right of the Child (CRC), which has some clauses on child abuse and neglect. The present discourse, made from within an Arabian Gulf society, specifically Oman, reviews the socio-cultural differences of the region and explores the potential regional challenges for effectively implementing the CRC mandated child protection legislation. The international best practices evolved for individualistic, “guilt-based” societies, which may need to be modified to suit the “shame-based” collective societies in the Arabian Gulf where the individual autonomy is overridden by that of the family and society. This may mean that the entire spectrum of child abuse may need to be studied in-depth, starting from what constitutes child abuse and neglect, the methods adopted for identifying cases, setting preventive measures in place, applying penal and corrective action on the perpetrators, and helping the victims recover. It is posited that while modifying the laws may be straightforward, implementation of certain clauses may initially come into conflict with deeply engrained socio-cultural conventions on these societies which have different parenting styles and child-rearing practices. The country in focus is Oman. Pointing out the sparsity of research on the topic in the region, the study suggests additional research to understand how to reconcile these sociocultural constraints with the international best practices of protecting child rights.
CİNSEL İSTİSMAR MAĞDURU KIZ ÇOCUKLARIN
UMUTSUZLUK DÜZEYİ İLE SALDIRGAN TUTUMLARI
ARASINDAKİ İLİŞKİ
(Güneydoğu Anadolu Bölgesi Örneği)
CONCLUSIONS Child abuse is a serious global health problem. Although most studies on it have been conducted in developed countries, there is compelling evidence that the phenomenon is common throughout the world. Much more can and should be done about the problem. In many countries, there is little recognition of child abuse among the public or health professionals. Recognition and awareness, although essential elements for effective prevention, are only part of the solution. Prevention efforts and policies must directly address children, their caregivers and the environments in which they live in order to prevent potential abuse from occurring and to deal effectively with cases of abuse and neglect that have taken place. The concerted and coordinated efforts of a whole range of sectors are required here, and public health researchers and practitioners can play a key role by leading and facilitating the process. Though there are certain acts as 'National Policy on Children, 1974'; 'Juvenile Justice (Care and Protection of Children) Act, 2000 and recently government passed 'The Protection of Children from Sexual Offences Act, 2012', but due to lack of awareness and proper implementation in these acts, cases of child abuse are increasing day by day. So the gravity of the situation demands that the issue of child abuse be placed on the national agenda.### Key Word-Child Abuse
Cite this review as – Singh, B. and Moral, A. (2013). Traumatic Consequences of Child Abuse. International Journal of Education & Management Studies, 3 (4), 500-506.
The major purpose of the present chapter is to provide a review of the currently most therapeutically effective method for managing chronic pain—functional restoration (FR). Before doing so, a brief overview of the rehabilitation process will be provided. Indeed, throughout history, the treatment of chronic pain conditions has been difficult, time consuming, expensive, and, all too often, unsuccessful. Many modes of treatment, both invasive (injections, procedures, surgery, etc.) and noninvasive methods (medications, physical therapy, counseling, applications of heat, ice, transcutaneous electrical stimulation, and many others), have been used by the health-care profession in an attempt to eliminate pain and return these patients to a productive, fulfilling life.
Die Hauptsymptome, die die meisten Fibromyalgiepatienten veranlassen, einen Arzt aufzusuchen, sind ausgedehnte Spontanschmerzen und Druckschmerzhaftigkeit in Muskeln, Faszien und Sehnen. Daneben kommt noch eine Vielzahl anderer Symptome vor, die die Lebensqualität weiter beeinträchtigen (s.u.).
Somatic awareness (SA) refers to heightened sensitivity to a variety of physical sensations and symptoms. Few attempts have been made to dissociate the relationship of SA and affective symptoms with pain outcomes. We used a validated measure of mood and anxiety symptoms that includes questions related to SA to predict the number of tender points found on physical examination in a large cross-sectional community sample (the Midlife in the United States [MIDUS] Biomarker study). General distress, positive affect, and SA, which were all significantly associated with tender point number in bivariate analyses, were used as predictors of the number of tender points in a multivariate negative binomial regression model. In this model a greater number of tender points was associated with higher levels of SA (P = .02) but not general distress (P = .13) or positive affect (P = .50). Follow-up mediation analyses indicated that the relationship between general distress and tender points was partially mediated by levels of SA. Our primary finding was that SA is strongly related to the number of tender points in a community sample. Mechanisms linking SA to the spatial distribution of pain sensitivity should be investigated further.
Perspective
This article presents an analysis of 3 overlapping psychological constructs and their relationship to widespread pain sensitivity on palpation. The findings suggest that SA is most strongly related to the spatial distribution of pain sensitivity and that further assessing it may improve our understanding of the relationship between psychological factors and pain.
The major purpose of the present chapter is to provide a review of the currently most therapeutically effective method for managing chronic pain—functional restoration (FR). Before doing so, a brief overview of the rehabilitation process will be provided. Indeed, throughout history, the treatment of chronic pain conditions has been difficult, time consuming, expensive, and, all too often, unsuccessful. Many modes of treatment, both invasive (injections, procedures, surgery, etc.) and noninvasive methods (medications, physical therapy, counseling, applications of heat, ice, transcutaneous electrical stimulation, and many others), have been used by the health-care profession in an attempt to eliminate pain and return these patients to a productive, fulfilling life.
Aims: To examine the relationship between depression and somatization and pain during muscle and joint palpation as well as limitations related to mandibular functioning (LRMF) in patients with temporomandibular disorders. Methods: The Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) data for Axes I and II for 196 consecutive patients (56 men and 140 women) with a history of facial pain were obtained. The mean age of the predominantly Chinese patient population (83.2%) was 33.4 years (range 18 to SS years). A computerized diagnostic system was used to collect the RDC/TMD history data. The Symptom Check List (SCL-90) depression and somatization scales were generated on-line and archived. The mean muscle pain (MP), joint pain (JP), and LRMF scores were computed with depression and somatization as main effects. Data were subjected to analysis of variance (Scheffe test) and Pearson's correlation at a significance level of. OS. Results: Depression scores ranged from 4.03 to 8.16 (MP), from 0.67 to 1.03 (JP), and from 0.30 to 0.38 (LRMF); somatization scores ranged from 2.64 to 7.75 (MP), from 0.58 to 1.00 (JP), and from 0.30 to 0.41 (LRMF). Interaction effects between depression and somatization were not significant. Patients with severe depression bad significantly higher MP scores than normal patients or patients with moderate depression. Patients with moderate and severe somatization bad significantly higher MP scores than normal patients. LRMF scores of patients with severe somatization were significantly greater than those who were normal or suffered from moderate somatization. No significant difference in JP scores was observed for depression and somatization scales. Correlations between depression/somatization and MP, JP, and LRMF scores were significant and positive but weak; coefficients ranged from 0.15 to 0.41. Conclusion: The results suggest that depression and somatization are related to the self-report of MP. In addition, severe somatization may be associated with an increase in law disability.
The fibromyalgia syndrome with its associated chronic pain and multiple painful tender points occurs in more than 25% of patients with systemic lupus erythematosus (SLE). Variables that contribute to pain sensitivity and other symptomatology in fibromyalgia include female gender, poor sleep, deconditioning, a variety of psychological elements, negative beliefs and attributions, and loss of control. Adverse childhood experiences, especially sexual abuse, contribute to vulnerability to chronic, unrelieved stress, and psychological distress as adults. Psychological stress in turn leads to dysregulation of the hypothalamic-pituitary- adrenocortical (HPA) axis, the autonomic nervous system and central nociceptive processing. Proinflammatory cytokines are important mediators, both centrally and peripherally of fatigue, poor sleep, musculoskeletal pain, and "sickness" in fibromyalgia and SLE. Although, the psychological stress and distress that accompanies comorbid fibromyalgia in SLE negatively influences functional impairment and quality of life and contributes importantly to fatigue and cognitive impairment, the available evidence does not support a role in flares of SLE disease activity or in major organ-system injury over time.
This review discusses the basic pathophysiological mechanisms that are necessary to understand the principles of diagnosis and management of fibromyalgia, and outlines a practical diagnostic approach to patients presenting with chronic widespread pain.
Objective:
To investigate the relation between measures of pain threshold and symptoms of distress to determine if fibromyalgia is a discrete construct/ disorder in the clinic.
Methods:
627 patients seen at an outpatient rheumatology centre from 1993 to 1996 underwent tender point and dolorimetry examinations. All completed the assessment scales for fatigue, sleep disturbance, anxiety, depression, global severity, pain, functional disability, and a composite measure of distress constructed from scores of sleep disturbance, fatigue, anxiety, depression, and global severity-the rheumatology distress index (RDI).
Results:
In regression analyses, the RDI was linearly related to the count of tender points (r2 = 0.30). Lesser associations were found between the RDI and dolorimetry measurements (r2 = 0.08). The RDI was more strongly correlated with the two measures of pain threshold than any of the individual fibromyalgia symptom variables. In partial correlation analyses, all of the information relating to symptom variables was contained in the tender point count, and dolorimetry was not independently related to symptoms.
Conclusion:
Tender points are linearly related to fibromyalgia variables and distress, and there is no discrete enhancement or perturbation of fibromyalgia or distress variables associated with very high levels of tender points. Although fibromyalgia is a recognisable clinical entity, there seems to be no rationale for treating fibromyalgia as a discrete disorder, and it would seem appropriate to consider the entire range of tenderness and distress in clinic patients as well as in research studies. The tender point count functions as a 'sedimentation rate' for distress, and is a better measure than the dolorimetry score.
To develop criteria for the classification of fibromyalgia, we studied 558 consecutive patients: 293 patients with fibromyalgia and 265 control patients. Interviews and examinations were performed by trained, blinded assessors. Control patients for the group with primary fibromyalgia were matched for age and sex, and limited to patients with disorders that could be confused with primary fibromyalgia. Control patients for the group with secondary-concomitant fibromyalgia were matched for age, sex, and concomitant rheumatic disorders. Widespread pain (axial plus upper and lower segment plus left- and right-sided pain) was found in 97.6% of all patients with fibromyalgia and in 69.1% of all control patients. The combination of widespread pain and mild or greater tenderness in greater than or equal to 11 of 18 tender point sites yielded a sensitivity of 88.4% and a specificity of 81.1%. Primary fibromyalgia patients and secondary-concomitant fibromyalgia patients did not differ statistically in any major study variable, and the criteria performed equally well in patients with and those without concomitant rheumatic conditions. The newly proposed criteria for the classification of fibromyalgia are 1) widespread pain in combination with 2) tenderness at 11 or more of the 18 specific tender point sites. No exclusions are made for the presence of concomitant radiographic or laboratory abnormalities. At the diagnostic or classification level, the distinction between primary fibromyalgia and secondary-concomitant fibromyalgia (as defined in the text) is abandoned.
Chronic pain and depression often coexist, but there is still uncertainty about the nature of this relationship. Virtually all the available data are cross-sectional and therefore do not clarify the causal relationship between the two variables. In epidemiological studies, chronic pain has often been defined fairly liberally in terms of the actual duration. In this study, the definition of chronic pain was based upon self-reports of pain present for most of the days in at least 1 month of the 12 months preceding the interview. We tested the hypotheses that depression causes pain and that pain causes depression in a sample of 2324 subjects who were assessed for the presence of musculo-skeletal pain and the presence of depression, using for the latter a standardized published instrument called the Center for Epidemiologic Studies Depression scale (CES-D). The subjects were first examined using the National Health and Nutrition Survey (NHANES 1) of the United States National Center for Health Statistics from 1974 to 1975, and were followed-up from 1981 to 1984. Those with data on both occasions represent 76% of an initial population of 3059 persons. On logistic regression analysis depressive symptoms at year 1 significantly predicted the development of chronic musculo-skeletal pain at year 8 with an odds ratio of 2.14 for the depressed subjects compared with the non-depressed subjects. In patients in whom pain was present at baseline no socio-demographic variable alone predicted its persistence; however, male sex and white race together with 2 items of the CES-D did predict the persistence of existing pain.(ABSTRACT TRUNCATED AT 250 WORDS)
The relationship between childhood sexual abuse and mental health in adult life was investigated in a random community sample of women. There was a positive correlation between reporting abuse and greater levels of psychopathology on a range of measures. Substance abuse and suicidal behaviour were also more commonly reported by the abused group. Childhood sexual abuse was more frequent in women from disrupted homes as well as in those who had been exposed to inadequate parenting or physical abuse. While elements in the individual's childhood which increased the risks of sexual abuse were also directly associated to higher rates of adult psychopathology, abuse emerged from logistic regression as a direct contributor to adult psychopathology. Severity of abuse reported was related to the degree of adult psychopathology. The overlap between the possible effects of sexual abuse and the effects of the matrix of disadvantage from which it so often emerges were, however, so considerable as to raise doubts about how often, in practice, it operates as an independent causal element. Further, many of those reporting childhood sexual abuse did not show a measurable long-term impairment of their mental health. Abuse correlated with an increased risk for a range of mental health problems, but in most cases its effects could only be understood in relationship to the context from which it emerged.
To investigate the hypothesis that fibromyalgia represents one end of a spectrum in which there is a more general association between musculoskeletal pain and tender points.
The subjects studied were 177 individuals selected from a population based screening survey for musculoskeletal pain. All subjects completed a pain mannikin and were examined for the presence of tender points at the nine American College of Rheumatology bilateral sites.
There were moderately strong associations (odds ratios range 1.3-3.1) between the reported presence of pain in a body segment and the presence of a tender point within that segment. Further, there was evidence of a trend of increasing number of tender points with increasing number of painful segments. The reporting of non-specific pain, aching, or stiffness, was also associated with high tender point counts.
This study illustrates that the association between tender points and pain is not restricted to the clinically defined subgroup with chronic widespread pain. Given that widespread pain and tender points have previously been linked with distress, this might reflect lesser degrees, or earlier phases of the somatisation of distress.
clinical features of fibrositis syndrome / alpha NREM [nonrapid eye movement] sleep and fibrositis / psychological distress and fibrositis syndrome / noxious environmental stimuli and fibrositis / primary sleep pathologies and fibrositis / rheumatic disease and fibrositis / altered central nervous system metabolism and fibrositis syndrome (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Objectives: The importance of psychosomatic factors in Primary Fibromyalgia Syndrome [PFS] is discussed with regard to the controversy about the prevalence of psychiatric disorders and psychological dysfunction. Methods: In a multicenter controlled study we investigated the psychological and organic factors of 65 patients with PFS and 53 patients with rheumatoid arthritis. Results: Pain behavior, psychological distress and psychiatric disorders differed significantly between PFS and RA patients. PFS patients were generally more disturbed and had more developmental risk factors [for example loss of parents or family violence] in their childhood. Conclusions: Nevertheless, PFS does not seem to be a psychogenic disease. According to a bio-psychosocial model, psychosomatic factors play a different etiological role within the different subgroups. This prospective investigation was designed to better elucidate these interconnections.
Concepts of illness and related beliefs and behaviours are often inappropriate to health state. They develop in childhood and we review the processes that are often involved, which are influenced by ethnic, cultural, demographic, social, psychological and biological factors. Unusual patterns of care experienced by some children and the inappropriate illness behaviours of those with particular influence over them play a central part in the development of the most extreme disorders. Prospective studies are limited but indicate that patterns of illness behaviour in childhood are often persistent and continue or recur in adult life. Inappropriate patterns of invalidism are common in children and adults and the poor prognosis, considerable costs and personal distress indicate the need for primary prevention as well as more active intervention for those who are at particular risk.
Objective:
To determine the prevalence of sexual and physical abuse in female patients with fibromyalgia syndrome (FMS), as compared with rheumatic disease control patients.
Methods:
Eighty-three female FMS patients and 161 consecutive female rheumatology (non-FMS) control patients answered a standardized confidential questionnaire recording previous sexual and physical abuse, drug and alcohol abuse, and eating disorders. Demographic information was collected on age, education, economic status, and cultural group.
Results:
Overall abuse was greater in FMS patients than in control patients (53% versus 42%; P not significant). Significant differences were observed for lifetime sexual abuse (17% versus 6%), physical abuse (18% versus 4%), combined physical and sexual abuse (17% versus 5%), and drug abuse (16% versus 3%). There was a trend toward a higher incidence of childhood sexual abuse (37% versus 22%) and of eating disorders (10% versus 3%) in the FMS patient group.
Conclusion:
A high frequency of sexual abuse was identified both in control patients and in FMS patients. A statistical association was demonstrated between FMS and the frequency and severity of sexual abuse, and the frequency of physical abuse and drug abuse. These results raise the possibility that abuse may have an effect upon the expression and perpetuation of FMS in adult life.
Two new scales of parental care and overprotection, and their combination as a Parental Bonding Instrument, are described. On measurements of reliability and validity the scales appear to be acceptable, and are independent of the parent's sex. It would appear that mothers are perceived as significantly more caring and slightly more overprotective than fathers, but that those judgements are not influenced by the sex of the child. Overprotection appears to be associated with lack of care. The scales and scoring method are appended. Norms for a general Sydney population are presented, and the possible influence of age, sex and social class examined.
To develop criteria for the classification of fibromyalgia, we studied 558 consecutive patients: 293 patients with fibromyalgia and 265 control patients. Interviews and examinations were performed by trained, blinded assessors. Control patients for the group with primary fibromyalgia were matched for age and sex, and limited to patients with disorders that could be confused with primary fibromyalgia. Control patients for the group with secondary-concomitant fibromyalgia were matched for age, sex, and concomitant rheumatic disorders. Widespread pain (axial plus upper and lower segment plus left- and right-sided pain) was found in 97.6% of all patients with fibromyalgia and in 69.1% of all control patients. The combination of widespread pain and mild or greater tenderness in ⩾ 11 of 18 tender point sites yielded a sensitivity of 88.4% and a specificity of 81.1%. Primary fibromyalgia patients and secondary-concomitant fibromyalgia patients did not differ statistically in any major study variable, and the criteria performed equally well in patients with and those without concomitant rheumatic conditions. The newly proposed criteria for the classification of fibromyalgia are 1) widespread pain in combination with 2) tenderness at 11 or more of the 18 specific tender point sites. No exclusions are made for the presence of concomitant radiographic or laboratory abnormalities. At the diagnostic or classification level, the distinction between primary fibromyalgia and secondary-concomitant fibromyalgia (as defined in the text) is abandoned.
Objective. To determine the prevalence and characteristics of fibromyalgia in the general population.
Methods. A random sample of 3,006 persons in Wichita, KS, were characterized according to the presence of no pain, non-widespread pain, and widespread pain. A subsample of 391 persons, including 193 with widespread pain, were examined and interviewed in detail.
Results. The prevalence of fibromyalgia was 2.0% (95% confidence interval [95% CI] 1.4, 2.7) for both sexes, 3.4% (95% CI 2.3, 4.6) for women, and 0.5% (95% CI 0.0, 1.0) for men. The prevalence of the syndrome increased with age, with highest values attained between 60 and 79 years (>7.0% in women). Demographic, psychological, dolorimetry, and symptom factors were associated with fibromyalgia.
Conclusion. Fibromyalgia is common in the population, and occurs often in older persons. Characteristic features of fibromyalgia–pain threshold and symptoms–are similar in community and clinic populations, but overall severity, pain, and functional disability are more severe in the clinic population.
The view that those with obsessive compulsive disorder or obsessional personality have been exposed to overcontrolling and overcritical parenting is examined. Two measures of obsessionality (the Maudsley Obsessional-Compulsive Inventory and the Leyton Obsessionality Inventory) were completed by 344 nonclinical subjects. They also scored their parents on the Parental Bonding Instrument (PBI), a measure assessing perceived levels of parental care and overprotection, before and after controlling for levels of state depression, trait anxiety and neuroticism in the analyses. Those scoring as more obsessional returned higher PBI protection scale scores. Links with PBI care scale scores were less clear, essentially restricted to the Maudsley Inventory, and variably influenced by controlling other variables.
In recent years a variety of questionnaires has been used to identify subjects with psychological illness in both community and hospital settings. Most questionnaires, unfortunately, lack of clinical validity, and, to date, none has been validated for an Australian sample. The present study describes a validation of the General Health Questionnaire in a sample of general-practice patients in Sydney, and finds this instrument to be an efficient, reliable, and valid index of non-psychotic psychological impairment.
We developed a set of preliminary response criteria for use in future clinical trials in fibromyalgia syndrome. We determined outcome measures from a previously reported clinical trial which best distinguished patients treated with effective medication from those treated with placebo or ineffective medication, using stepwise logistic regression analysis. Several combinations of outcome measures were identified and plotted in the form of receiver operating characteristic (ROC) curves. The combination of variables possessing the greatest area under the ROC curve included (1) physician global assessment score less than or equal to 4 (0 = extremely well, 10 = extremely poorly), (2) patient sleep score less than or equal to 6 (0 = sleeping extremely well, 10 = sleeping extremely poorly), and (3) tender point score less than or equal to 14 (maximum possible tender point score equalled 20). These criteria accurately distinguished those treated with effective drug from those treated with placebo when tested in an unreported therapeutic trial of cyclobenzaprine. The criteria identified 11 of 14 patients in the amitriptyline trial and 4 of 6 patients in the cyclobenzaprine trial who attained improvement measured independently. The methodology used to define these preliminary criteria may be applied to refine the criteria as additional sensitive and clinically relevant outcomes are developed.
Chronic diffuse myalgia, localized areas of tenderness, fatigue, and unrefreshing sleep are related to a physiologic arousal disorder within sleep, that is, the alpha EEG NREM sleep anomaly. This sleep physiologic disorder, nonrestorative sleep, and symptoms of fibrositis syndrome are shown to occur with psychologic, environmental, and physiologic distress conditions. Pathogenic mechanisms that link nonrestorative sleep physiology to pain and fatigue may involve metabolic dysfunction of the brain with sleep-related alteration in immunologic and neurotransmitter functions (serotonin, substance P, endorphins). These sleep-related mechanisms have important implications for the understanding and treatment of fibrositis/fibromyalgia syndrome.
Primary fibromyalgia syndrome (PFS) is a common form of nonarticular rheumatism with chronic and generalized musculoskeletal aching and stiffness, accompanied by tender points at characteristic sites in the absence of an underlying condition. No satisfactory criteria for its diagnosis, based on appropriate controlled studies, have yet been proposed. We undertook such a study which included a consecutive series of clinically diagnosed PFS and compared them with 3 control groups--mild rheumatoid arthritis, localized fibromyalgia secondary to trauma and normal controls. Multivariate statistical analysis plus clinical judgement identified 6 historical features and 7 pairs of tender points that best discriminated PFS from the control groups. The criteria, derived from a combination of these historical features and tender points, provided greater than 90% sensitivity and specificity. In an independent and consecutive sample of 45 PFS patients, the criteria yielded a sensitivity of 89%. The present study indicates that a combination of historical features and TP's will likely provide effective PFS criteria.
Psychiatric diagnoses, self-reports of symptoms, and illness behavior of 20 fibromyalgia patients and 23 rheumatoid arthritis patients were compared. The fibromyalgia patients were not significantly more likely than the arthritis patients to report depressive symptoms or to receive a lifetime psychiatric diagnosis of major depression. These results do not support the contention that fibromyalgia is a form of somatized depression. Fibromyalgia patients, however, reported significantly more somatic symptoms of obscure origin and exhibited a pattern of reporting more somatic symptoms, multiple surgical procedures, and help seeking that may reflect a process of somatization rather than a discrete psychiatric disorder.
We tested the current criteria for fibromyalgia. Pain tolerance was measured at tender point and control point sites using a pressure algometer, and responses to 6 standard psychological self-reports were obtained from 125 patients with generalized nonarticular rheumatism, rheumatoid arthritis, or osteoarthritis. Among patients with generalized nonarticular rheumatism, published symptom criteria for fibromyalgia did not correlate significantly with the number of tender points. Only lower generalized pressure point pain tolerance distinguished fibromyalgia from other generalized nonarticular rheumatism. Generalized nonarticular rheumatism mean scores were much higher than controls on tests measuring the tendency to report physical symptoms, including headaches and functional bowel syndrome. It is probable that patients with fibromyalgia do not differ in any important physical or psychological respect from other patients with generalized nonarticular rheumatism except for the presence of tender points. However, the presence of tender points is merely a reflection of the patient's general pressure pain sensitivity and is not indicative of any special localized pathological phenomenon. The concept of fibromyalgia as an entity separate from the rest of generalized nonarticular rheumatism may be an artifact of a physician's approach to the patient. Most patients with generalized nonarticular rheumatism demonstrate an abnormally high frequency of reporting manifold disagreeable symptoms and probably come to the attention of many medical disciplines.
Evaluation of the SCAS in three groups of patients demonstrates high levels of test-retest reliability and satisfactory internal consistency. Multiple investigations of validity support the use of the SCAS as a measure of self care deficit which is related to social disability. The potential uses of the SCAS in clinical work and research are discussed.
The Self Care Assessment Schedule (SCAS) is a new questionnaire which measures the frequency of ten behaviours during a period of fourteen days. Data are presented for five patient samples and a group of non consulting controls and the distributions of scores between groups show expected differences. In some groups scores are significantly greater for male subjects and those with the most chronic disorders but scores are not related to age. It is tentatively suggested that the SCAS may be used to determine the severity of aspects of disability based on percentile scores.
In order to explore fears, beliefs, and attitudes of patients with DSM-III hypochondriasis, the authors administered the self-rated Illness Attitude Scales to 21 patients with hypochondriasis, matched family practice patients, nonpatient employees, and nonhypochondriacal psychiatric patients. Hypochondriacal patients reported more fears of and false beliefs about disease; they attended more to bodily sensations, had more fears about death, and distrusted physicians' judgments more, yet sought more medical care than other subjects. They did not take better precautions about their health. The self-report of overt attitudes suggests a characteristic syndrome, consistent with the DSM-III description of hypochondriasis. Two of the subscales of the Illness Attitude Scales yielded characteristic responses in hypochondriasis.
For the diagnosis of somatization disorder, DSM-III requires the assessment of 37 specific symptoms, a time-consuming and cumbersome task. The authors describe a procedure by which the clinician can assess the presence of somatization disorder by screening for only seven symptoms, three of which must be present for a preliminary diagnosis of somatization disorder. The test was developed on female psychiatric outpatients (N = 85) who had multiple unexplained physical complaints beginning before the age of 30 years; it was validated on an independent sample (N = 47). The accuracy of this screening procedure is 80%-90%.
Fifteen patients with the loin pain and haematuria syndrome (LPH) were compared with 10 patients with complicated renal stone disease referred to the same tertiary centre and matched for age, sex and duration of illness. LPH patients had a history of three times more medically unexplained somatic symptoms other than loin pain (p < 0.01) and a higher proportion took analgesics regularly (p < 0.01). The onset of pain was associated with an adverse psychologically important life-event in eight of the LPH patients but in none of the controls (p < 0.02). LPH patients more frequently recalled serious parental illness and disability in childhood (p < 0.001) than controls, and a higher proportion felt responsible for causing or alleviating parental illness or distress (p < 0.05). LPH subjects scored higher in the 'paternal care' dimension of the Parental Bonding Instrument (p < 0.05). No difference was found between LPH patients and controls in terms of current depression and anxiety but both groups exhibited high rates of lifetime depression. LPH patients expressed lower levels of anger and hostility (p < 0.002) than did controls. Our observations suggest that psychological factors are of major importance in the aetiology of LPH, which may represent a type of somatoform pain disorder.
To determine the prevalence and characteristics of fibromyalgia in the general population.
A random sample of 3,006 persons in Wichita, KS, were characterized according to the presence of no pain, non-widespread pain, and widespread pain. A subsample of 391 persons, including 193 with widespread pain, were examined and interviewed in detail.
The prevalence of fibromyalgia was 2.0% (95% confidence interval [95% CI] 1.4, 2.7) for both sexes, 3.4% (95% CI 2.3, 4.6) for women, and 0.5% (95% CI 0.0, 1.0) for men. The prevalence of the syndrome increased with age, with highest values attained between 60 and 79 years (> 7.0% in women). Demographic, psychological, dolorimetry, and symptom factors were associated with fibromyalgia.
Fibromyalgia is common in the population, and occurs often in older persons. Characteristic features of fibromyalgia--pain threshold and symptoms--are similar in community and clinic populations, but overall severity, pain, and functional disability are more severe in the clinic population.
To determine the relation between tender points, complaints of pain, and symptoms of depression, fatigue, and sleep quality in the general population.
Two stage cross sectional study with an initial questionnaire about pain to classify those eligible for an examination of tender points.
Two general practices in north west England.
Stratified random sample of adults from age-sex registers. Of the responders, 250 were selected for examination of tender points on the basis of their reported pain complaints; 177 subsequently participated.
Tender point count (0 to 18) grouped into four categories with the highest (> or = 11) corresponding to the criteria of the American College of Rheumatology for fibromyalgia. Assessment of pain (chronic widespread, regional, none). Measures of depression, fatigue, and difficulty with sleeping.
Women had a higher median tender point count (six) than did men (three). Counts were higher in those with pain than in those who had no pain and in those with widespread compared with regional pain. Most subjects with chronic widespread pain, however, had fewer than 11 tender points (27/45; 60%). Two people with counts of 11 or more were in the group reporting no pain. Mean symptom scores for depression, fatigue, and sleep problems increased as the tender point count rose (P value for trend < 0.001). These trends were independent of pain complaints.
Tender points are a measure of general distress. They are related to pain complaints but are separately associated with fatigue and depression. Sleep problems are associated with tender points, although prospective studies are needed to determine whether they cause tenderness to develop. Fibromyalgia does not seem to be a distinct disease entity.
A psychosomatic syndrome is defined as a syndrome in which psychological processes play a substantial role in the etiology of the illness in some of the patients. The main conclusions on the extent of the biological and psychosocial contributions to several psychosomatic syndromes are presented and the relationship of these syndromes to somatization and somatoform disorders is discussed. The syndromes summarized include fibromyalgia, chronic fatigue, motility disorders of the esophagus, nonulcer dyspepsia, irritable bowel syndrome, urethral syndrome, behaviors causing disturbances of physiology, and some defined pain syndromes. The findings suggest that the extent of the biological and psychosocial contributions vary among these syndromes as well as among individuals with the same syndrome. In some syndromes the extent and nature of the biological contribution has not been established with certainty. There is evidence to suggest that many of the phenomena of the somatoform disorders are caused by clustering of psychosomatic syndromes or their incomplete or atypical manifestations and a low sensation threshold. The results of the controlled studies of various methods of psychotherapy and drug treatments of the psychosomatic syndromes are listed; these studies have practical implications because the adoption of these methods is likely to enhance the efficacy of the treatment of somatoform disorders.
In a two-year longitudinal study, a two-stage screening procedure was used to identify subjects in primary care with emotional disorder presenting with a recent onset of physical symptoms and a comparison sample of patients presenting with physical symptoms only. Somatisers (n = 44) were defined as subjects who had an emotional disorder but who presented with physical symptoms that could not be attributed to organic disease. The course and outcome of these conditions were compared with those of pure emotional disorder (n = 11), pure physical disorder (n = 90) and 'mixed' conditions (n = 39). The physical symptoms of somatisers were less likely to improve and lagged behind those of the other groups, and 16 of these acute somatisers went on to develop chronic somatoform disorders. Among somatisers, changes in physical symptom levels throughout the follow-up closely mirrored changes in emotional arousal. Emotionally disordered subjects reported more instances of parental lack of care, but somatisers were also more likely than other groups to report parental physical illness and to have had more physical illness themselves in childhood. A logistic regression suggests that adult somatisation is best modelled by parental lack of care followed by childhood illness.
A self-rating scale was developed to measure the severity of fatigue. Two-hundred and seventy-four new registrations on a general practice list completed a 14-item fatigue scale. In addition, 100 consecutive attenders to a general practice completed the fatigue scale and the fatigue item of the revised Clinical Interview Schedule (CIS-R). These were compared by the application of Relative Operating Characteristic (ROC) analysis. Tests of internal consistency and principal components analyses were performed on both sets of data. The scale was found to be both reliable and valid. There was a high degree of internal consistency, and the principal components analysis supported the notion of a two-factor solution (physical and mental fatigue). The validation coefficients for the fatigue scale, using an arbitrary cut off score of 3/4 and the item on the CIS-R were: sensitivity 75.5 and specificity 74.5.
To establish the prevalence of chronic widespread pain and associated symptoms in a general population sample.
Cross sectional postal survey of 2,034 adults in the north of England.
The point prevalence of chronic widespread pain was 11.2%. The symptom was strongly associated with other somatic complaints and with measures of depression and anxiety.
In the general population, this cardinal symptom of fibromyalgia is common and identifies a group who are more likely also to report symptoms of fatigue and depression.
The aim of this study was to assess the reliability and validity of the Whitely Index (WI), the Illness Attitude Scales (IAS), and the Somatosensory Amplification Scale (SAS). The study population consisted of 130 general medical outpatients, 113 general practice patients, and 204 subjects from the general population. The factorial structure of the IAS appeared to consist of two subscales, namely Health Anxiety and Illness Behaviour. The internal consistency and stability of the three questionnaires were satisfactory, and their scores were highly intercorrelated. Scores on the WI and Health Anxiety subscale of the IAS declined significantly from general medical outpatients, through general practice patients to subjects from the general population. This might imply that medical care utilisation is related to hypochondriasis. A prospective study is needed to determine whether health anxiety contributes to the decision to seek medical care or the consultation of a general practitioner or consultant gives rise to worry about possible illness.
The classification of widespread pain, proposed by the American College of Rheumatology (ACR) for use in the clinic as a screen for fibromyalgia, as described, does not require truly widespread pain. Studies considering the epidemiology of widespread pain per se may therefore require a definition with greater face validity, which might also show enhanced associations with other physical and psychological measures. We aimed to develop a more coherent definition of widespread pain for use in epidemiological studies and to compare performance in identifying individuals with significant morbidity.
A group of 172 subjects who had participated in a community based study on the occurrence of pain were identified and categorized by their pain experience as indicated on line drawings of the body according to ACR definition and to a new, more stringent definition that required the presence of more diffuse limb pain. A number of other clinical and psychological measures were recorded for these individuals and the association between their pain status measures and these other variables was assessed and compared.
Persons satisfying the newly proposed definition for chronic widespread pain, in comparison with those who satisfied only the present ACR definition, had a significantly higher score on the General Health Questionnaire [median difference (MD) 7.95% CI 1.13], a higher score on the Health and Fatigue Questionnaire (MD 10.95% CI 0.15), and greater problems with sleep (sleep problem score MD 4.95% CI 0.9). Those satisfying the new definition also had a greater number of tender points on examination (MD 3.95% CI -1.7). The morbidity of those satisfying only the present ACR definition was closer to persons who had regional pain.
A redefinition of widespread pain has produced a group of subjects whose pain is (a) likely to be more "widespread" and (b) is associated more strongly with factors such as psychological disturbance, fatigue, sleep problems, and tender points, and may be more appropriate in epidemiological studies.
Fibromyalgia is a form of nonarticular rheumatism characterized by musculoskeletal aching and tenderness on palpation. The role of psychological factors in fibromyalgia has been controversial. The aim of this study was to evaluate the relationship of fibromyalgia to the intensity of anxiety and depression and to determine the correlation between psychological disturbances with disease duration and pain severity. Thirty-nine patients with fibromyalgia and 36 healthy controls were included in this study. Beck depression inventory, State and trait anxiety inventory and Beck hopelessness scale were used to evaluate psychological disturbances. Visual analog scale was used to determine pain intensity. We found a significant difference in the psychological status between patients with fibromyalgia and control subjects as measured by Beck depression inventory and trait anxiety inventory; 35.9% of the patients scored higher than the cut-off score on the Beck depression rating scale. Pain severity was found to be correlated with trait anxiety inventory scores. These results suggest that somatic expression of depression is an important difference between fibromyalgia and control groups. The difference between state and trait anxiety inventory reflects that current anxiety is not secondary to pain but trait anxiety is possibly causally related to pain.
Survey data are presented on the associations between retrospectively reported childhood adversities and subsequent onset and persistence of DSM-III-R disorders.
Data come from the US National Comorbidity Survey, a large survey of the US household population.
Twenty-six adversities were considered, including loss events (e.g. parental divorce), parental psychopathologies (e.g. maternal depression), interpersonal traumas (e.g. rape) and other adversities (e.g. natural disaster). These adversities were consistently associated with onset, but not persistence, of DSM-III-R mood disorders, anxiety disorders, addictive disorders and acting out disorders. Most bivariate associations with onset attenuated in models that controlled for clustering of adversities and for lifetime co-morbidities among psychiatric disorders. Multivariate effects of adversities in logistic models were additive, which means that they have multiplicative effects on probability of disorder onset. Adversities showed little specificity. An analysis of time decay showed that the effects of childhood adversities on disorder onset persist beyond childhood.
The existence of strong clustering among childhood adversities and lifetime co-morbidity among adult disorders means that caution is needed in interpreting the results of previous single-adversity single-disorder studies as documenting unique effects of specific childhood adversities on specific adult disorders. Future studies need to assess a broader range of adversities and disorders and to explore the existence and effects of commonly occurring adversity clusters. Replication is needed to verify that the effects of childhood adversities are mostly on first onset rather than on the creation of vulnerabilities that lead to increased risk of persistence.
The growth in the USA of 'recovered memory therapy' for past sexual abuse has caused great public and professional concern. It became apparent that the polarisation of views and fierce controversy within the American psychiatric community was in danger of bringing psychotherapy into disrepute and it seemed important to examine objectively the scientific evidence before such polarisation developed in the UK.
A small working group reviewed their own experience, visited meetings and centres with expertise in this field, interviewed 'retractors' and accused parents, and then began a comprehensive review of the literature.
There is a vast literature but little acceptable research. Opinions are expressed with great conviction but often unsupported by evidence.
The issue of false or recovered memories should not be allowed to confuse the recognition and treatment of sexually abused children. We concluded that when memories are 'recovered' after long periods of amnesia, particularly when extraordinary means were used to secure the recovery of memory, there is a high probability that the memories are false, i.e. of incidents that had not occurred. Some guidelines which should enable practitioners to avoid the pitfalls of memory recovery are offered.
Reported recovered memories of child sexual abuse: recommendations for good practice and implications for training, continuing professional development and research
Royal College of Psychiatry. Reported recovered memories of
child sexual abuse: recommendations for good practice and implications for training, continuing professional development and
research. Psychol Bull 1997;21:663-5.
Somatization and depres-sion in fibromyalgia syndrome
- Robbins Lj Jm Kirmayer
- Kapusta
- Ma
Kirmayer LJ, Robbins JM, Kapusta MA. Somatization and depres-sion in fibromyalgia syndrome. Am J Psychiatry 1988;145:950–4.
The relationship between pain and depression: a longitudinal study of early synovitis
- Sm Skevington
- Gf Gebhart
- Dl Hammond
- Jensen
Skevington SM. The relationship between pain and depression: a longitudinal study of early synovitis. In: Gebhart GF, Hammond DL, Jensen TS, editors. Proceedings of the 7th World Congress in Pain Research and Management. Vol. 2. Seattle: IASP Press; 1994. p. 201–10.
Somatization and depression in fibromyalgia syndrome
- L J Kirmayer
- J M Robbins
- M A Kapusta
Kirmayer LJ, Robbins JM, Kapusta MA. Somatization and depression in fibromyalgia syndrome. Am J Psychiatry 1988;145:950-4.
The relationship between pain and depression: a longitudinal study of early synovitis
- S M Skevington
- G F Gebhart
- D L Hammond
- T S Jensen
Skevington SM. The relationship between pain and depression: a
longitudinal study of early synovitis. In: Gebhart GF, Hammond
DL, Jensen TS, editors. Proceedings of the 7th World Congress in
Pain Research and Management. Vol. 2. Seattle: IASP Press;
1994. p. 201-10.