Current Pain and Headache Reports

, Volume 11, Issue 5, pp 333–338 | Cite as

Comorbidity of fibromyalgia and psychiatric disorders

  • Dan Buskila
  • Hagit Cohen


There are mounting data supporting comorbidity of fibromyalgia syndrome (FMS) and psychiatric conditions. These include depression, panic disorders, anxiety, and post-traumatic stress disorder (PTSD). The nature of the relationship between depression and FMS is not fully understood, and it was hypothesized that chronic pain causes depression, or vice versa, and that chronic pain syndromes are variants of depression. A link between PTSD symptoms and FMS has been reported, and both conditions share similar symptomatology and pathogenetic mechanisms. Assessment of comorbid psychiatric disorders in FMS patients has clinical implications because treatment in these patients should focus both on physical and emotional dimensions of dysfunction.


Heart Rate Variability Major Depressive Disorder Irritable Bowel Syndrome Chronic Fatigue Syndrome Ptsd Symptom 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References and Recommended Reading

  1. 1.
    Dadabhoy D, Clauw DJ: Fibromyalgia progress in diagnosis and treatment. Curr Pain Headache Rep 2005, 9:399–404.PubMedCrossRefGoogle Scholar
  2. 2.
    Neumann L, Buskila D: Epidemiology of fibromyalgia. Curr Pain Headeche Rep 2003, 7:362–368.CrossRefGoogle Scholar
  3. 3.
    Harris RE, Clauw DJ: How do we know that the pain in fibromyalgia is “real”? Curr pain Headache Rep 2006, 10:403–407.PubMedCrossRefGoogle Scholar
  4. 4.
    Buskila D, Sarzi-Puttini P, Ablin JN: The genetics of fibromyalgia syndrome. Pharmacogenomics 2007, 8:67–74.PubMedCrossRefGoogle Scholar
  5. 5.
    Giesecke T, Williams DA, Harris RT, et al.: Subgrouping of fibromyalgia patients on the basis of pressure pain thresholds and psychological factors. Arthritis Rheum 2003, 48:2916–2922.PubMedCrossRefGoogle Scholar
  6. 6.
    Arnold LM, Hudson JI, Hess EV, et al.: Family study of fibromyalgia. Arthritis Rheum 2004, 50:944–952.PubMedCrossRefGoogle Scholar
  7. 7.
    Fishbain DA, Cutler R, Rosomoff HL, Rosomoff RS: Chronic pain-associated depression: antecedent or consequence of chronic pain? A review. Clin J Pain 1997, 13:116–137.PubMedCrossRefGoogle Scholar
  8. 8.
    Epstein SA, Kay G, Clauw D, et al.: Psychiatric disorders in patients with fibromyalgia. Psychosomatics 1999, 40:57–63.PubMedGoogle Scholar
  9. 9.
    Henningsem P, Zimmermann T, Sattel H: Medically unexplained physical symptoms, anxiety, and depression: a meta-analytic review. Psychosom Med 2003, 65:528–533.CrossRefGoogle Scholar
  10. 10.
    Hudson JI, Hrnold LM, Keck PE Jr, et al.: Family study of fibromyalgia and affective spectrum disorder. Biol Psychiatry 2004, 56:884–891.PubMedCrossRefGoogle Scholar
  11. 11.
    Arnold LM, Hudson JI, Keck PE, et al.: Comorbidity of fibromyalgia and psychiatric disorders. J Clin Psychiatry 2006, 67:1219–1225.PubMedCrossRefGoogle Scholar
  12. 12.
    Raphael KG, Janal MN, Nayak S, et al.: Psychiatric comorbidities in a community sample of women with fibromyalgia. Pain 2006, 124:117–125.PubMedCrossRefGoogle Scholar
  13. 13.
    Carta MG, Cardia C, Mannu F, et al.: The high frequency of manic symptoms in fibromyalgia does influence the choice of treatment? Clin Pract Epidemol Ment Health 2006, 2:36–41.PubMedCrossRefGoogle Scholar
  14. 14.
    Kato K, Sullivan PF, Evengard B, Pedersen NL: Chronic widespread pain and its comorbidities: a population-based study. Arch Intern Med 2006, 166:1649–1654.PubMedCrossRefGoogle Scholar
  15. 15.
    Dohrenwend BP, Raphael KG, Marback JJ, Gallagher RM: Why is depression comorbid with chronic myofascial face pain? A family study test of alternative hypotheses. Pain 1999, 83:183–192.PubMedCrossRefGoogle Scholar
  16. 16.
    Raphael KG, Janal MN, Nayak S, et al.: Familial aggregation of depression in fibromyalgia: a community-based test of alternate hypotheses. Pain 2004, 110:449–460.PubMedCrossRefGoogle Scholar
  17. 17.
    Giesecke T, Gracely RH, Williams DA, et al.: The relationship between depression, clinical pain, and experimental pain in a chronic pain cohort. Arthritis Rheum 2005, 52:1577–1584.PubMedCrossRefGoogle Scholar
  18. 18.
    Zautra AJ, Fasman R, Reich JW, et al.: Fibromyalgia: evidence for deficits in positive affect regulation. Psychosom Med 2005, 67:147–155.PubMedCrossRefGoogle Scholar
  19. 19.
    Kassman A, Patten SB: Major depression, fibromyalgia and labour force participation: a population-based cross-sectional study. BMC Musculoskelet Disord 2006, 7:4.CrossRefGoogle Scholar
  20. 20.
    Karst M, Rahe-Meyer N, Gueduex A, et al.: Abnormality in the self monitoring mechanism in patients with fibromyalgia and somatoform pain disorder. Psychosom Med 2005, 67:111–115.PubMedCrossRefGoogle Scholar
  21. 21.
    Palomino RA, Nicassio PM, Greenberg MA, Medina EP Jr: Helplessness and loss as mediators between pain and depressive symptoms in fibromyalgia. Pain 2007, 129:185–194.PubMedCrossRefGoogle Scholar
  22. 22.
    Anderberg UM, Marteins Dottir I, Theorell T, Von Knorring L: The impact of life events in female patients with fibromyalgia and in female healthy controls. Eur Psychiatry 2000, 15:295–301.PubMedCrossRefGoogle Scholar
  23. 23.
    Amir M, Kaplan Z, Neumann L, et al.: Posttraumatic stress disorder, tenderness and fibromyalgia. J Psychosom Res 1997, 42:607–613.PubMedCrossRefGoogle Scholar
  24. 24.
    Cohen H, Neumann L, Haiman Y, et al.: Prevalence of post-traumatic stress disorder in fibromyalgia patients: overlapping syndromes or posttraumatic fibromyalgia syndrome? Semin Arthritis Rheum 2002, 32:38–50.PubMedCrossRefGoogle Scholar
  25. 25.
    Sherman JJ, Turk DC, Okifuji A: Prevalence and impact of posttraumatic stress disorder-like symptoms on patients with fibromyalgia syndrome. Clin J Pain 2000, 16:127–134.PubMedCrossRefGoogle Scholar
  26. 26.
    Roy-Byrne P, Smith WR, Goldberg J, et al.: Post-traumatic stress disorder among patients with chronic pain and chronic fatigue. Psychol Med 2004, 34:363–368.PubMedCrossRefGoogle Scholar
  27. 27.
    Johnson KM, Bradley KA, Bush K, et al.: Frequency of mastalgia among women veterans. Association with psychiatric conditions and unexplained pain syndromes. J Gen Intern Med 2006, 21(Suppl 3):S70–S75.PubMedCrossRefGoogle Scholar
  28. 28.
    Seng JS, Clark MK, McCarthy AM, Ronis DL: PTSD and physical comorbidity among women receiving Medicaid: results from service-use data. J Trauma Stress 2006, 19:45–56.PubMedCrossRefGoogle Scholar
  29. 29.
    Arguelles LM, Afari N, Buchwald DS, et al.: A twin study of posttraumatic stress disorder symptoms and chronic widespread pain. Pain 2006, 124:150–157.PubMedCrossRefGoogle Scholar
  30. 30.
    Amital D, Fostick L, Polliack ML, et al.: Posttraumatic stress disorder, tenderness, and fibromyalgia syndrome: are they different entities? J Psychosom Res 2006, 61:663–669.PubMedCrossRefGoogle Scholar
  31. 31.
    Kessler RC, Sonnega A, Bromet E, et al.: Posttraumatic stress disorder in the National Comorbidity Survey. Arch Gen Psychiatry 1995, 52:1048–1060.PubMedGoogle Scholar
  32. 32.
    Ravindren AV, Griffiths J, Waddell C, Anisman H: Stressful life events and coping styles in relation to dysthymia and major depressive disorder: variations associated with alleviation of symptoms following pharmacotherapy. Prog Neuropsychopharmacol Biol Psychiatry 1995, 19:637–653.CrossRefGoogle Scholar
  33. 33.
    Wilke WS: Fibromyalgia. Recognizing and addressing the multiple inter related factors. Postgrad Med 1996, 100:153–156.PubMedCrossRefGoogle Scholar
  34. 34.
    Yehuda R: Current status of cortisol findings in post-traumatic stress disorder. Psychiatr Clin North Am 2002, 25:341–368.PubMedCrossRefGoogle Scholar
  35. 35.
    McCain GA, Tilbe KS: Diurnal hormone variation in fibromyalgia syndrome: a comparison with rheumatoid arthritis. J Rheumatol 1989, 19(Suppl):154–157.Google Scholar
  36. 36.
    Grofford LJ, Young EA, Engleberg NC, et al.: Basal circadian and pulsatile ACTH, and cortisol secretion in patients with fibromyalgia and/or chronic fatigue syndrome. Brain Behav Immun 2004, 18:314–325.CrossRefGoogle Scholar
  37. 37.
    Cohen H, Neumann L, Kotler M, Buskila D: Autonomic nervous system derangement in fibromyalgia syndrome and related disorders. Isr Med Assoc J 2001, 3:755–760.PubMedGoogle Scholar
  38. 38.
    Cohen H, Neumann L, Shore M, et al.: Autonomic dysfunction in patients with fibromyalgia: application of power spectral analysis of heart rate variability. Semin Arthritis Rheum 2000, 29:217–227.PubMedCrossRefGoogle Scholar
  39. 39.
    Cohen H, Neumann L, Alhosshle A, et al.: Abnormal sympathovagal balance in men with fibromyalgia. J Rheumatol 2001, 28:581–589.PubMedGoogle Scholar
  40. 40.
    Cohen H, Kotler M, Matar M, Kaplan Z: Normalization of heart rate variability in post-traumatic stress disorder patients following treatment: preliminary results. Isr Med Assoc J 2000, 2:296–301.PubMedGoogle Scholar
  41. 41.
    Cohen H, Benjamin J, Geva AB, et al.: Autonomic dysregulation in panic disorder: application of heart rate variability at rest and in response to recollection of trauma or panic attacks. Psychiatry Res 2000, 96:1–13.PubMedCrossRefGoogle Scholar
  42. 42.
    Bennett RM: Adult growth hormone deficiency in patients with fibromyalgia. Curr Rheumatol Rep 2002, 4:306–312.PubMedCrossRefGoogle Scholar
  43. 43.
    Morris P, Hopwood M, Maguire K, et al.: Blunted growth hormone response to clonidine in post-traumatic stress disorder. Psychoneuroendocrinology 2004, 29:269–278.PubMedCrossRefGoogle Scholar
  44. 44.
    Moldofsky H: Management of sleep disorders in fibromyalgia. Rheum Dis Clin North Am 2002, 28:353–365.PubMedCrossRefGoogle Scholar
  45. 45.
    Lavie P: Sleep disturbances in the wake of traumatic events. N Engl J Med 2001, 345:1825–1832.PubMedCrossRefGoogle Scholar
  46. 46.
    Ablin JN, Cohen H, Buskila D: Mechanisms of disease: genetics of fibromyalgia. Nat Clin Pract Rheumatol 2006, 2:671–678.PubMedCrossRefGoogle Scholar
  47. 47.
    Buskila D, Sarzi-Puttini P: Biology and therapy of fibromyalgia. Genetic aspects of fibromyalgia syndrome. Arthritis Res Ther 2006, 8:218–222.PubMedCrossRefGoogle Scholar
  48. 48.
    Koenen KC, Lyons MJ, Goldenberg J, et al.: A high risk twin study of combat-related PTSD comorbidity. Twin Res 2003, 6:218–226.PubMedCrossRefGoogle Scholar
  49. 49.
    Lee HJ, Lee MS, Kang RH, et al.: Influence of the serotonin transporter promoter gene polymorphism on susceptibility to posttraumatic stress disorder. Depress Anxiety 2005, 21:135–139.PubMedCrossRefGoogle Scholar
  50. 50.
    Lawford BR, McD Young R, Noble EP, et al.: D2 dopamine receptor gene polymorphism: paroxetine and social functioning in posttraumatic stress disorder. Eur Neuropsychopharmacol 2003, 13:313–320.PubMedCrossRefGoogle Scholar
  51. 51.
    Beckham JC, Moore SD, Feldman ME, et al.: Health status, somatization and severity of posttraumatic stress disorder in Vietnam combat veterans with posttraumatic stress disorder. Am J Psychiatry 1998, 155:1565–1569.PubMedGoogle Scholar
  52. 52.
    Andreski P, Chilcoat H, Breslau N: Post traumatic stress disorder and somatization symptoms: a prospective study. Psychiatry Res 1998, 79:131–138.PubMedCrossRefGoogle Scholar
  53. 53.
    McBeth J, Macfarlane GI, Benjamin S, Silman AJ: Features of somatization predict the onset of chronic widespread pain: results of a large population-based study. Arthritis Rheum 2001, 44:940–946.PubMedCrossRefGoogle Scholar
  54. 54.
    Thieme K, Turk DC, Flor H: Comorbid depression and anxiety in fibromyalgia syndrome: relationship to somatic and psychosocial variables. Psychosom Med 2004, 66:837–844.PubMedCrossRefGoogle Scholar
  55. 55.
    Blasco CL, Mallo CM, Mencia PA, et al.: Clinical profiles in fibromyalgia patients of the community mental health center: a predictive index of psychopathological severity. Actas Esp Psiquiatr 2006, 34:112–122.Google Scholar

Copyright information

© Current Medicine Group LLC 2007

Authors and Affiliations

  1. 1.Department of Medicine HSoroka Medical CenterBeer ShevaIsrael

Personalised recommendations