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(210) Prevalence of migraine headaches in patients with Fibromyalgia
S28
The Journal of Pain
B04 Fibromyalgia (208) Catastrophizing cognitions promote proinflammatory cytokine responses to acute pain in fibromyalgia O Franceschelli, C Cahalan, M Martel, and R Edwards; Brigham and Women’s Hospital, Boston, MA For patients that suffer from musculoskeletal pain conditions such as fibromyalgia and osteoarthritis, catastrophizing plays an important role in shaping the pain experience. The mechanisms that underlie catastrophizing’s effects are multifactorial, and some research has reported that high levels of catastrophizing are associated with enhanced physiological reactivity to painful stimulation. In the present study we investigated the association between catastrophizing and inflammatory pain responses (i.e., increases in IL-6 during experimental pain testing) in several groups. Data was collected from 51 participants in the following demographically-matched groups: fibromyalgia patients (n=24), healthy controls (n=12), and osteoarthritis patients (n=15). These participants underwent a series of psychophysical testing procedures assessing responses to mechanical and thermal stimuli during two separate visits (in randomized order). One visit consisted of standard QST procedures, while the other visit involved non-painful analogues to these testing procedures (i.e., immersing a hand in room-temperature water instead of an ice-water bath). Catastrophizing cognitions were measured using the PCS, and situation-specific catastrophizing was assessed at several points during the testing procedures. Blood samples were taken at baseline, and then for up to 2 hours after QST. Interleukin-6 levels increased substantially (P< .001) in all groups for both sessions, confirming the presence of an inflammatory stress response. We found that associations between catastrophizing and IL-6 responses were group- and context-specific. Within the fibromyalgia group, the magnitude of situation-specific catastrophizing during the painful testing session was significantly associated (r= .47, p= .02) with IL-6 increases over the course of that session. No such relationships were evident in the other groups (or in the non-painful testing session). These findings highlight the utility of assessing situation-specific catastrophizing, and suggest that facilitation of inflammatory responses to pain may be one pathway by which catastrophizing influences pain and hyperalgesia in patients with fibromyalgia.
Abstracts
(210) Prevalence of migraine headaches in patients with Fibromyalgia B Vij, M Whipple, S Tepper, A Mohabbat, M Stillman, and A Vincent; Mayo and Cleveland Clinic, Rochester and Cleveland, MN and OH Several studies have reported a high prevalence of fibromyalgia in patients with migraines,1 but there is little research on the prevalence of migraines in patients with fibromyalgia, despite clinical observation suggesting that migraines are a common complaint. Given the high degree of comorbidity between fibromyalgia and migraines, assessment of headache in patients with fibromyalgia is important. A total of 3,717 patients in the Mayo Clinic Fibromyalgia Registry who had previously agreed to be contacted regarding fibromyalgia research were sent an electronic survey consisting of medical history and demographic questions, the ID-Migraine screener, and the Fibromyalgia Research Survey criteria. Of the 3,717 contacted, 1,730 (46.5%) completed the survey. The majority of participants where white (97.2%) and non-Hispanic (98.1%). Ninety two percent were female, and the mean age was 56.2 (613.1). 966 (or 55.8%) of respondents met criteria for migraine headaches (at least two of the three ID-Migraine symptoms – sensitivity to light, nausea, effect of headache on activity). A number of self-reported medical and psychiatric comorbidities were significantly more common in patients who met criteria for migraines than those who did not, including hypertension (p=.004), asthma (p=.011), irritable bowel syndrome (p=.017), chronic fatigue syndrome (p=<.0001), depression (p=.0002), anxiety (p=.0011), and post-traumatic stress disorder (p=.006). This cross-sectional study demonstrates that migraine headaches, when defined using the ID-migraine questionnaire, are extremely common among patients with fibromyalgia and that patients with migraines report a greater number of additional medical and psychiatric comorbidities. This finding suggests that treatment of one pain syndrome might improve symptoms of the other,2 and points to possible common central pathophysiological mechanisms. Further research is needed to evaluate the influence of migraines on other fibromyalgia symptoms and the cumulative burden for the patient who has both disorders. (1. Marcus, Clin Rheumatol, 2013; 2. Kararizou J Clin Psychopharmacol, 2013.)
(209) Sleep and pain in fibromyalgia: an assessment of the daily relationship and individual difference moderators
(211) Modulation of experimental and clinical pain by distraction in fibromyalgia patients and controls
M Hyde-Nolan, M Lumley, R Slatcher, N Lockhart, H Doherty, A Lyden, D Clauw, and D Williams; Wayne State University, Detroit, MI
K Schreiber, M Loggia, C Cahalan, V Napadow, and R Edwards; Brigham and Women’s Hospital, Massachusetts General Hospital, Boston, MA
Fibromyalgia (FM) is characterized not only by widespread pain and tenderness, but also nonrestorative sleep. Poor sleep quality is reported by over 90% of individuals with FM, and research has established a reliable association between poor sleep and pain, although the direction of this relationship remains unclear. This study examined nightly sleep quality and daily pain in patients with FM, as well as potential patient moderators of this relationship. Ninety adults with FM completed baseline measures of depression, sleep disturbance, and pain catastrophizing. For 2 weeks, participants wore an actiwatch, which provided movement-based indices of multiple nightly sleep variables, and completed daily diaries about their sleep quality and pain. Hierarchical linear modeling examined intraindividual variability in daily sleep and pain as well as baseline factors that predicted individual differences in these relationships. Results indicated a bidirectional relationship; participants who reported less than their average refresh score upon awakening experienced more pain the next day, and those who reported more than their average pain one day experienced a greater latency to sleep the following night. Individuals who had more wake after sleep onset (WASO) on average experienced increased daily pain, and those who reported greater daily pain on average experienced increased nightly WASO. Age, depression, and pain catastrophizing all exhibited bidirectional moderation of the sleep and pain relationship; individuals who were older or who reported higher levels of baseline depression or pain catastrophizing demonstrated a relatively stronger relationship between poor sleep and increased pain. These findings suggest that both pathways are active in patients with FM. Pain interferes with sleep, poor sleep enhances pain, and these patterns are especially pronounced among those with more difficulties with emotional regulation. Interventions should address both sleep and pain in individuals with FM. Funded by NIH grant R01 AR057808
Fibromyalgia involves chronic multisite pain, and both its manifestation and response to therapy are variable between individual patients. It is unknown whether FM patients exhibit deficits in the degree to which distraction-based therapies can lessen their experience of pain, compared to controls without FM, and to what degree this varies between individual patients. In this study, 53 patients with FM and 17 control subjects without FM underwent quantitative sensory testing (QST), including an exposure to a sustained, moderatelypainful mechanical stimulus under conditions of distraction (subjects trained to use visual imagery) and pain-focused attention. While FM patients had lower thresholds and higher pain ratings to experimental painful stimuli, both controls and FM patients showed significant distraction analgesia, with no difference in efficacy of distraction analgesia between groups. Distraction analgesia was measured twice, on separate days, in separate settings, revealing that individual differences in the magnitude of the distraction effect were stable across assessment periods. Distraction was also able to reduce scores on the situational pain catastrophizing scale (SPCS), which correlated to the degree of distraction analgesia, suggesting that negative cognitive-emotional processes may play a mechanistic role in contributing to the pain-reducing effects of distraction. Additionally, FM patients showed greater temporal summation of pain than controls, and temporal summation of pain was also reduced by distraction. Importantly, FM patients’ rating of clinical pain was also significantly reduced following the distraction block. Furthermore, there was a positive correlation between distraction’s effect on experimental and clinical pain ratings, suggesting that this assay may be useful in identifying patients who would benefit from such an approach. There was variability in success of distraction analgesia among FM patients, with those reporting greater ability to attend to the distracting image in an MRI scanning session exhibiting greater distraction analgesia.
The Journal of Pain
B04 Fibromyalgia (208) Catastrophizing cognitions promote proinflammatory cytokine responses to acute pain in fibromyalgia O Franceschelli, C Cahalan, M Martel, and R Edwards; Brigham and Women’s Hospital, Boston, MA For patients that suffer from musculoskeletal pain conditions such as fibromyalgia and osteoarthritis, catastrophizing plays an important role in shaping the pain experience. The mechanisms that underlie catastrophizing’s effects are multifactorial, and some research has reported that high levels of catastrophizing are associated with enhanced physiological reactivity to painful stimulation. In the present study we investigated the association between catastrophizing and inflammatory pain responses (i.e., increases in IL-6 during experimental pain testing) in several groups. Data was collected from 51 participants in the following demographically-matched groups: fibromyalgia patients (n=24), healthy controls (n=12), and osteoarthritis patients (n=15). These participants underwent a series of psychophysical testing procedures assessing responses to mechanical and thermal stimuli during two separate visits (in randomized order). One visit consisted of standard QST procedures, while the other visit involved non-painful analogues to these testing procedures (i.e., immersing a hand in room-temperature water instead of an ice-water bath). Catastrophizing cognitions were measured using the PCS, and situation-specific catastrophizing was assessed at several points during the testing procedures. Blood samples were taken at baseline, and then for up to 2 hours after QST. Interleukin-6 levels increased substantially (P< .001) in all groups for both sessions, confirming the presence of an inflammatory stress response. We found that associations between catastrophizing and IL-6 responses were group- and context-specific. Within the fibromyalgia group, the magnitude of situation-specific catastrophizing during the painful testing session was significantly associated (r= .47, p= .02) with IL-6 increases over the course of that session. No such relationships were evident in the other groups (or in the non-painful testing session). These findings highlight the utility of assessing situation-specific catastrophizing, and suggest that facilitation of inflammatory responses to pain may be one pathway by which catastrophizing influences pain and hyperalgesia in patients with fibromyalgia.
Abstracts
(210) Prevalence of migraine headaches in patients with Fibromyalgia B Vij, M Whipple, S Tepper, A Mohabbat, M Stillman, and A Vincent; Mayo and Cleveland Clinic, Rochester and Cleveland, MN and OH Several studies have reported a high prevalence of fibromyalgia in patients with migraines,1 but there is little research on the prevalence of migraines in patients with fibromyalgia, despite clinical observation suggesting that migraines are a common complaint. Given the high degree of comorbidity between fibromyalgia and migraines, assessment of headache in patients with fibromyalgia is important. A total of 3,717 patients in the Mayo Clinic Fibromyalgia Registry who had previously agreed to be contacted regarding fibromyalgia research were sent an electronic survey consisting of medical history and demographic questions, the ID-Migraine screener, and the Fibromyalgia Research Survey criteria. Of the 3,717 contacted, 1,730 (46.5%) completed the survey. The majority of participants where white (97.2%) and non-Hispanic (98.1%). Ninety two percent were female, and the mean age was 56.2 (613.1). 966 (or 55.8%) of respondents met criteria for migraine headaches (at least two of the three ID-Migraine symptoms – sensitivity to light, nausea, effect of headache on activity). A number of self-reported medical and psychiatric comorbidities were significantly more common in patients who met criteria for migraines than those who did not, including hypertension (p=.004), asthma (p=.011), irritable bowel syndrome (p=.017), chronic fatigue syndrome (p=<.0001), depression (p=.0002), anxiety (p=.0011), and post-traumatic stress disorder (p=.006). This cross-sectional study demonstrates that migraine headaches, when defined using the ID-migraine questionnaire, are extremely common among patients with fibromyalgia and that patients with migraines report a greater number of additional medical and psychiatric comorbidities. This finding suggests that treatment of one pain syndrome might improve symptoms of the other,2 and points to possible common central pathophysiological mechanisms. Further research is needed to evaluate the influence of migraines on other fibromyalgia symptoms and the cumulative burden for the patient who has both disorders. (1. Marcus, Clin Rheumatol, 2013; 2. Kararizou J Clin Psychopharmacol, 2013.)
(209) Sleep and pain in fibromyalgia: an assessment of the daily relationship and individual difference moderators
(211) Modulation of experimental and clinical pain by distraction in fibromyalgia patients and controls
M Hyde-Nolan, M Lumley, R Slatcher, N Lockhart, H Doherty, A Lyden, D Clauw, and D Williams; Wayne State University, Detroit, MI
K Schreiber, M Loggia, C Cahalan, V Napadow, and R Edwards; Brigham and Women’s Hospital, Massachusetts General Hospital, Boston, MA
Fibromyalgia (FM) is characterized not only by widespread pain and tenderness, but also nonrestorative sleep. Poor sleep quality is reported by over 90% of individuals with FM, and research has established a reliable association between poor sleep and pain, although the direction of this relationship remains unclear. This study examined nightly sleep quality and daily pain in patients with FM, as well as potential patient moderators of this relationship. Ninety adults with FM completed baseline measures of depression, sleep disturbance, and pain catastrophizing. For 2 weeks, participants wore an actiwatch, which provided movement-based indices of multiple nightly sleep variables, and completed daily diaries about their sleep quality and pain. Hierarchical linear modeling examined intraindividual variability in daily sleep and pain as well as baseline factors that predicted individual differences in these relationships. Results indicated a bidirectional relationship; participants who reported less than their average refresh score upon awakening experienced more pain the next day, and those who reported more than their average pain one day experienced a greater latency to sleep the following night. Individuals who had more wake after sleep onset (WASO) on average experienced increased daily pain, and those who reported greater daily pain on average experienced increased nightly WASO. Age, depression, and pain catastrophizing all exhibited bidirectional moderation of the sleep and pain relationship; individuals who were older or who reported higher levels of baseline depression or pain catastrophizing demonstrated a relatively stronger relationship between poor sleep and increased pain. These findings suggest that both pathways are active in patients with FM. Pain interferes with sleep, poor sleep enhances pain, and these patterns are especially pronounced among those with more difficulties with emotional regulation. Interventions should address both sleep and pain in individuals with FM. Funded by NIH grant R01 AR057808
Fibromyalgia involves chronic multisite pain, and both its manifestation and response to therapy are variable between individual patients. It is unknown whether FM patients exhibit deficits in the degree to which distraction-based therapies can lessen their experience of pain, compared to controls without FM, and to what degree this varies between individual patients. In this study, 53 patients with FM and 17 control subjects without FM underwent quantitative sensory testing (QST), including an exposure to a sustained, moderatelypainful mechanical stimulus under conditions of distraction (subjects trained to use visual imagery) and pain-focused attention. While FM patients had lower thresholds and higher pain ratings to experimental painful stimuli, both controls and FM patients showed significant distraction analgesia, with no difference in efficacy of distraction analgesia between groups. Distraction analgesia was measured twice, on separate days, in separate settings, revealing that individual differences in the magnitude of the distraction effect were stable across assessment periods. Distraction was also able to reduce scores on the situational pain catastrophizing scale (SPCS), which correlated to the degree of distraction analgesia, suggesting that negative cognitive-emotional processes may play a mechanistic role in contributing to the pain-reducing effects of distraction. Additionally, FM patients showed greater temporal summation of pain than controls, and temporal summation of pain was also reduced by distraction. Importantly, FM patients’ rating of clinical pain was also significantly reduced following the distraction block. Furthermore, there was a positive correlation between distraction’s effect on experimental and clinical pain ratings, suggesting that this assay may be useful in identifying patients who would benefit from such an approach. There was variability in success of distraction analgesia among FM patients, with those reporting greater ability to attend to the distracting image in an MRI scanning session exhibiting greater distraction analgesia.