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(313) Utilizing psychophysical measurements of central sensitization to evaluate the interdisciplinary treatment of fibromyalgia
Abstracts
(310) The association between catastrophizing, fatigue, and sleep quality among patients with fibromyalgia K Dorado, A Lazaridou, O Franceschelli, K Protsenko, V Napadow, and R Edwards; Harvard Medical School, Brigham and Women’s Hosp, Departments of Anesthesiology, Perioperative and Pain Medicine and Psychiatry, Boston, MA
Catastrophizing is the most studied psychosocial factor affecting pain. However, little research has been conducted on the relationship between catastrophizing, sleep quality and fatigue. It is possible that catastrophizing leads to heightened levels of painrelated thoughts affecting fatigue in Fibromyalgia. The primary objective of this study was to examine the association between catastrophizing, fatigue and sleep quality among a sample of fibromyalgia patients. Patients with fibromyalgia were asked to report their levels of catastrophizing thoughts, sleep quality and fatigue once a day for a period of 7 days using REDcap (a web-based software for electronic data collection). Multilevel modeling (MLM) analyses of baseline data indicated that heightened levels of catastrophizing were associated with higher levels of fatigue (p < .01). In addition, lower levels of sleep quality were associated with higher levels of day-to day fatigue (p<.01). Catastrophizing and poor sleep quality appear to influence day-to-day fatigue. These findings are congruent with other studies showing that high catastrophizers are more likely to report more fatigue and pain throughout the day. Fatigue being one of the main symptoms of fibromyalgia, it seems that catastrophizing and poor quality of sleep affects its levels. Collectively, catastrophizing appears related not only to fatigue but also to a wide range of patient symptoms. Study supported by National Institutes of Health grant R01AR064367-03S1. Grant awarded to RRE and VN.
(311) Pain drawings for fibromyalgia show that catastrophizing is associated with pain quality and distribution to specific bodily locations D Ellingsen, F Beissner, T Alsadi, A Lazaridou, O Franceschelli, E Protsenko, L Jeungchan, R Edwards, and N Vitaly; Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA
Pain catastrophizing is prominent in chronic pain conditions such as fibromyalgia. Nevertheless, the relationship between pain catastrophizing and overall pain intensity has been variable across studies. Here, we applied digital pain drawings to investigate whether catastrophizing is associated with the quality and spread of pain to distinct body sites. Sixteen patients with fibromyalgia, enrolled in a non-pharmacological longitudinal trial, reported their current clinical pain in terms of body location and extent (free-hand drawing, 1000x1084 pixels on a body illustration), quality of pain (aching, shooting, burning, or tenderness), and pain intensity, using recently developed software for a digital tablet. Subjects also completed a Pain Catastrophizing Scale (PCS) questionnaire. Each individual’s 2-dimensional pain map for each pain quality was converted to NIFTI image format, and analyzed using conventional image analysis tools for functional MRI analysis (FSL). Data were spatially smoothed using a 3-pixel Gaussian kernel and used in General Linear Model analyses (separate for each quality of pain) for group pain frequency map and linear regression using individual PCS scores as regressor of interest. Resultant group and regression maps of Z-scores were thresholded at Z=2.0 for statistical significance. Although patients reported pain in widespread body sites, with greatest frequency over the back and upper legs, higher PCS scores were instead correlated with pain in shoulders, forearms, thighs, and head, and to a lesser degree, neck and lower back. Furthermore, spatial distribution of aching pain and tenderness showed the strongest correlation with PCS, while shooting pain showed the weakest correlation. Our relatively novel approach demonstrates that pain catastrophizing in fibromyalgia is linked with spread of pain to non-torso regions, further supporting the importance of widespread pain in this functional pain syndrome.
(312) The association between day-to-day physical activity, catastrophizing and pain among patients with fibromyalgia: The moderating role of catastrophizing O Franceschelli, A Lazaridou, E Protsenko, L Galenkamp, V Napadow, and R Edwards; Brigham and Women’s Hospital, Boston, MA
The Journal of Pain
S53
Catastrophizing (consisting of negative pain-related cognitive and emotional processes) is among the most-studied psychosocial factors affecting the experience of pain. Catastrophizing forms a key part of many models of pain such as the fear-avoidance model, which highlights the role of psychosocial factors in shaping chronic pain patients’ activity patterns. To date, however, little research has been conducted on the direct relationship between levels of physical activity and catastrophizing in shaping pain experiences. The primary objective of this study was to examine the association between dayto-day physical activity, catastrophizing, and pain intensity among a sample of patients with fibromyalgia. Patients with fibromyalgia were asked to report their real-time levels of pain, catastrophizing, and physical activity daily for a period of 7 days using REDcap (A web-based software application for electronic data collection). Patients were also asked to report their employment status, which impacts daily activity levels. In the full sample, higher catastrophizing was associated with lower levels of daily activity. In unemployed patients, multilevel modeling analyses indicated that high daily catastrophizing was associated with heightened levels of pain (p< .01); moreover, the association between physical activity and pain was moderated by catastrophizing (p < .01), with patients higher in catastrophizing showing a relatively stronger link between physical activity and pain. In employed patients, multilevel modeling analyses indicated that catastrophizing and physical activity had independent associations with heightened levels of pain. Catastrophizing and physical activity appear to influence pain levels in fibromyalgia patients, with catastrophizing magnifying the impact of physical activity among the most vulnerable and sedentary patients. The theoretical and clinical implications of our findings will be discussed. This research was supported by NIH grant R01AR064367 grant.
(313) Utilizing psychophysical measurements of central sensitization to evaluate the interdisciplinary treatment of fibromyalgia K Huffman, R Gopalakrishnan, R Martincin, A Aboussouan, E Perry, N Thompson, G Sweis, and X Jimenez; Cleveland Clinic, Cleveland, OH Chronic pain disorders, such as fibromyalgia, are characterized by a hyperexcitability of the central nervous system, termed central sensitization. Interdisciplinary biopsychosocial treatments are thought to be the gold standard for treating central sensitization syndromes. Studies that evaluate treatment outcomes rely on patient selfreport. Developing protocols that measure physiological hallmarks of central sensitization may be used to objectively evaluate treatment outcomes. Pain windup, an important precursor to the development of central sensitization is easily induced in labs, may hold utility in evaluating the treatment efficacy. Here we present preliminary data from an ongoing study (target n=35) from five female patients with fibromyalgia treated in a three-week interdisciplinary chronic pain rehabilitation program (iCPRP). Participants were 44.60 68.02 years old, and ranged in age from 34 to 54. Pain severity and pain windup was measured at admission and discharge. Pain severity was assessed using the NRS-11. Pain windup was measured using thermal stimulation with a contact heat evoked potential simulator of the Medoc pathway system. First, heat pain threshold was titrated individually. Pain windup was assessed through ten identical repetitive noxious thermal stimulations, delivered at .33Hz. Participants were asked to rate pain sensation on a scale of 0-100 after the first and final thermal pulse of each series and a pain windup was generated by subtracting the initial pain rating from the final pain rating. This method has been used previously to characterize abnormal sensitization in patients with fibromyalgia. Matched pairs t-tests were used to evaluate improvements. Results showed that pain severity decreased from 6.00 61.41 to 3.40 61.52 (t = 2.80, p < .05) and pain windup decreased from 23.00 613.51 to 4.00 67.42 (t = 2.97, p < .05). This data shows that psychophysical measurements of central sensitization may hold utility in objectively evaluating iCPRP treatment outcomes.
(314) Sleep and pain sensitivity and its relationship to cellular aging in women with fibromyalgia E Iacob, A Hassett, A Neikrug, and A Okifuji; University of Utah, Salt Lake City, UT
Fibromyalgia syndrome (FMS) is a common musculoskeletal pain disorder that presents a serious public health concern and imposes significant costs on society. Sleep disturbance is ubiquitous in FMS and
(310) The association between catastrophizing, fatigue, and sleep quality among patients with fibromyalgia K Dorado, A Lazaridou, O Franceschelli, K Protsenko, V Napadow, and R Edwards; Harvard Medical School, Brigham and Women’s Hosp, Departments of Anesthesiology, Perioperative and Pain Medicine and Psychiatry, Boston, MA
Catastrophizing is the most studied psychosocial factor affecting pain. However, little research has been conducted on the relationship between catastrophizing, sleep quality and fatigue. It is possible that catastrophizing leads to heightened levels of painrelated thoughts affecting fatigue in Fibromyalgia. The primary objective of this study was to examine the association between catastrophizing, fatigue and sleep quality among a sample of fibromyalgia patients. Patients with fibromyalgia were asked to report their levels of catastrophizing thoughts, sleep quality and fatigue once a day for a period of 7 days using REDcap (a web-based software for electronic data collection). Multilevel modeling (MLM) analyses of baseline data indicated that heightened levels of catastrophizing were associated with higher levels of fatigue (p < .01). In addition, lower levels of sleep quality were associated with higher levels of day-to day fatigue (p<.01). Catastrophizing and poor sleep quality appear to influence day-to-day fatigue. These findings are congruent with other studies showing that high catastrophizers are more likely to report more fatigue and pain throughout the day. Fatigue being one of the main symptoms of fibromyalgia, it seems that catastrophizing and poor quality of sleep affects its levels. Collectively, catastrophizing appears related not only to fatigue but also to a wide range of patient symptoms. Study supported by National Institutes of Health grant R01AR064367-03S1. Grant awarded to RRE and VN.
(311) Pain drawings for fibromyalgia show that catastrophizing is associated with pain quality and distribution to specific bodily locations D Ellingsen, F Beissner, T Alsadi, A Lazaridou, O Franceschelli, E Protsenko, L Jeungchan, R Edwards, and N Vitaly; Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA
Pain catastrophizing is prominent in chronic pain conditions such as fibromyalgia. Nevertheless, the relationship between pain catastrophizing and overall pain intensity has been variable across studies. Here, we applied digital pain drawings to investigate whether catastrophizing is associated with the quality and spread of pain to distinct body sites. Sixteen patients with fibromyalgia, enrolled in a non-pharmacological longitudinal trial, reported their current clinical pain in terms of body location and extent (free-hand drawing, 1000x1084 pixels on a body illustration), quality of pain (aching, shooting, burning, or tenderness), and pain intensity, using recently developed software for a digital tablet. Subjects also completed a Pain Catastrophizing Scale (PCS) questionnaire. Each individual’s 2-dimensional pain map for each pain quality was converted to NIFTI image format, and analyzed using conventional image analysis tools for functional MRI analysis (FSL). Data were spatially smoothed using a 3-pixel Gaussian kernel and used in General Linear Model analyses (separate for each quality of pain) for group pain frequency map and linear regression using individual PCS scores as regressor of interest. Resultant group and regression maps of Z-scores were thresholded at Z=2.0 for statistical significance. Although patients reported pain in widespread body sites, with greatest frequency over the back and upper legs, higher PCS scores were instead correlated with pain in shoulders, forearms, thighs, and head, and to a lesser degree, neck and lower back. Furthermore, spatial distribution of aching pain and tenderness showed the strongest correlation with PCS, while shooting pain showed the weakest correlation. Our relatively novel approach demonstrates that pain catastrophizing in fibromyalgia is linked with spread of pain to non-torso regions, further supporting the importance of widespread pain in this functional pain syndrome.
(312) The association between day-to-day physical activity, catastrophizing and pain among patients with fibromyalgia: The moderating role of catastrophizing O Franceschelli, A Lazaridou, E Protsenko, L Galenkamp, V Napadow, and R Edwards; Brigham and Women’s Hospital, Boston, MA
The Journal of Pain
S53
Catastrophizing (consisting of negative pain-related cognitive and emotional processes) is among the most-studied psychosocial factors affecting the experience of pain. Catastrophizing forms a key part of many models of pain such as the fear-avoidance model, which highlights the role of psychosocial factors in shaping chronic pain patients’ activity patterns. To date, however, little research has been conducted on the direct relationship between levels of physical activity and catastrophizing in shaping pain experiences. The primary objective of this study was to examine the association between dayto-day physical activity, catastrophizing, and pain intensity among a sample of patients with fibromyalgia. Patients with fibromyalgia were asked to report their real-time levels of pain, catastrophizing, and physical activity daily for a period of 7 days using REDcap (A web-based software application for electronic data collection). Patients were also asked to report their employment status, which impacts daily activity levels. In the full sample, higher catastrophizing was associated with lower levels of daily activity. In unemployed patients, multilevel modeling analyses indicated that high daily catastrophizing was associated with heightened levels of pain (p< .01); moreover, the association between physical activity and pain was moderated by catastrophizing (p < .01), with patients higher in catastrophizing showing a relatively stronger link between physical activity and pain. In employed patients, multilevel modeling analyses indicated that catastrophizing and physical activity had independent associations with heightened levels of pain. Catastrophizing and physical activity appear to influence pain levels in fibromyalgia patients, with catastrophizing magnifying the impact of physical activity among the most vulnerable and sedentary patients. The theoretical and clinical implications of our findings will be discussed. This research was supported by NIH grant R01AR064367 grant.
(313) Utilizing psychophysical measurements of central sensitization to evaluate the interdisciplinary treatment of fibromyalgia K Huffman, R Gopalakrishnan, R Martincin, A Aboussouan, E Perry, N Thompson, G Sweis, and X Jimenez; Cleveland Clinic, Cleveland, OH Chronic pain disorders, such as fibromyalgia, are characterized by a hyperexcitability of the central nervous system, termed central sensitization. Interdisciplinary biopsychosocial treatments are thought to be the gold standard for treating central sensitization syndromes. Studies that evaluate treatment outcomes rely on patient selfreport. Developing protocols that measure physiological hallmarks of central sensitization may be used to objectively evaluate treatment outcomes. Pain windup, an important precursor to the development of central sensitization is easily induced in labs, may hold utility in evaluating the treatment efficacy. Here we present preliminary data from an ongoing study (target n=35) from five female patients with fibromyalgia treated in a three-week interdisciplinary chronic pain rehabilitation program (iCPRP). Participants were 44.60 68.02 years old, and ranged in age from 34 to 54. Pain severity and pain windup was measured at admission and discharge. Pain severity was assessed using the NRS-11. Pain windup was measured using thermal stimulation with a contact heat evoked potential simulator of the Medoc pathway system. First, heat pain threshold was titrated individually. Pain windup was assessed through ten identical repetitive noxious thermal stimulations, delivered at .33Hz. Participants were asked to rate pain sensation on a scale of 0-100 after the first and final thermal pulse of each series and a pain windup was generated by subtracting the initial pain rating from the final pain rating. This method has been used previously to characterize abnormal sensitization in patients with fibromyalgia. Matched pairs t-tests were used to evaluate improvements. Results showed that pain severity decreased from 6.00 61.41 to 3.40 61.52 (t = 2.80, p < .05) and pain windup decreased from 23.00 613.51 to 4.00 67.42 (t = 2.97, p < .05). This data shows that psychophysical measurements of central sensitization may hold utility in objectively evaluating iCPRP treatment outcomes.
(314) Sleep and pain sensitivity and its relationship to cellular aging in women with fibromyalgia E Iacob, A Hassett, A Neikrug, and A Okifuji; University of Utah, Salt Lake City, UT
Fibromyalgia syndrome (FMS) is a common musculoskeletal pain disorder that presents a serious public health concern and imposes significant costs on society. Sleep disturbance is ubiquitous in FMS and