Sociocultural, Physiologic, and Psychologic Variables That Influence Pain in the Fibromyalgia Patient

Abstract

It is estimated that fibromyalgia, a chronic condition in which pain occurs in 98% of the patients, can be found in 3- to 6-million American adults with females as the majority of those suffering. The purpose of this study was to determine variables that influence pain in women with fibromyalgia. The study's conceptual framework, based on Melzack and Casey (1968) and fibromyalgia literature, depicts the influence of three domains of variables on pain: sociocultural (i.e. age, education, ethnicity), physical (i.e. activity; comorbidity such as pelvic pain; flare-up; physical trauma; sleep-wake disturbance; fatigue; physical fitness) and psychologic (i.e. depression). One-hundred-seven fibromyalgia participants were identified by rheumatology clinics and volunteered from the community. These participants ranged in age from 27 to 77 years (M = 51, SD = 9.8) and were diagnosed by a physician as having fibromyalgia based on a history of pain in 11 of 18 tender points. Data were collected using a demographic questionnaire, McGill Pain questionnaire, visual analog scale, Human Activity Profile, Multidimensional Assessment of Fatigue scale and the Center for Epidemiologic Studies Depression scale. The participants also completed a modified sit and reach test, a grip test, and a walk test. A subset of the participants, consisting of 85 patients, performed actigraphy testing to describe the relationships between sleep-wake disturbance, activity, and the morning and evening intensity of pain. Results indicated significant associations between the evening intensity of pain and the night awakenings. Multiple regression equations were generated that explained the variance of 23% of sensory pain (i.e. fatigue, pelvic pain, and physical trauma), 23% of affective pain (i.e. activity, depression, and pelvic pain), and 25% of the intensity of pain (i.e. flare-up and depression). These findings suggest that different predictors influence different components of pain and that interventions should be directed toward decreasing depression, fatigue, and increasing activity to influence the pain. Pain has multidimensional components which we, as health care professionals, need to consider when assisting fibromyalgia patients with their pain management.