Abstract
This review examines the current literature regarding psychiatric comorbidities associated with fibromyalgia. The aim of this review is to enhance understanding of psychiatric disorders that, alone or in combination with other physiologic (eg, neuroendocrine dysfunction) and psychosocial factors (eg, poor coping skills), may contribute to abnormal pain sensitivity and other illness behaviors of individuals with fibromyalgia. The review first identifies the psychiatric comorbidities that are associated most often with fibromyalgia and tend to aggregate within families of individuals with this disorder. It then examines the literature regarding the extent to which psychiatric illness, environmental stressors, or other psychosocial factors may contribute to the development of fibromyalgia. The review also presents recent findings concerning the extent to which psychosocial factors may contribute to treatment-related outcomes in pain and other health status variables among patients with fibromyalgia.
Similar content being viewed by others
References and Recommended Reading
Wolfe F, Smythe HA, Yunus MB, et al.: The American College of Rheumatology 1990 criteria for the classification of fibromyalgia: report of the multicenter criteria committee. Arthritis Rheum 1990, 33:160–172.
Gibson JJ, Littlejohn GO: Altered heat pain thresholds and cerebral event-related potentials following painful CO2 laser stimulation in subjects with fibromyalgia syndrome. Pain 1994, 58:185–193.
Wolfe F, Cathey MA, Kleinheksel SM, et al.: Psychological status in primary fibrositis and fibrositis associated with rheumatoid arthritis. J Rheumatol 1984, 11:500–506.
Ahles TA, Yunus MB, Riley SD, et al.: Psychological factors associated with primary fibromyalgia syndrome. Arthritis Rheum 1984, 27:1101–1106.
Payne TC, Leavitt F, Garron DC, et al.: Fibrositis and psychological disturbance. Arthritis Rheum 1982, 25:213–217.
Kersh BC, Bradley LA, Alarcón GS, et al.: Psychosocial and health status variables independently predict health care seeking in fibromyalgia. Arthritis Rheum 2001, 45:362–371.
Wolfe F, Anderson J, Harkness P, et al.: A prospective, longitudinal, multicenter study of service utilization and costs in fibromyalgia. Arthritis Rheum 1997, 40:1560–1570.
Ter Borg EJ, Gerards-Rociu E, Hannen HC, Westers P: High frequency of hysterectomies and appendectomies in fibromyalgia compared with rheumatoid arthritis: a pilot study. Clin Rheumatol 1999, 18:1–3.
Dobkin PL, De Civita M, Bernatsky S, et al.: Does psychological vulnerability determine health care utilization in fibromyalgia? Rheumatology 2003, 42:1324–1331.
Barsky AJ, Borus JF: Functional somatic syndromes. Ann Intern Med 1999, 130:910–921.
Melzack R: Gate control theory: on the evolution of pain concepts. Pain Forum 1996, 5:125–128.
Hudson JI, Goldenberg DL, Pope HG, et al.: Comorbidity of fibromyalgia with medical and psychiatric disorders. Am J Med 1992, 92:363–367.
Hudson JI, Pope HG: Fibromyalgia and psychopathology: Is fibromyalgia a form of “affective spectrum disorder”? J Rheumatol 1989, 16:15–22.
Davidson J, Krishnan R, France R, Pelton S: Neurovegetative symptoms in chronic pain and depression. J Affect Disord 1985, 9:213–218.
Arnold LM, Hudson JI, Hess EV, et al.: Family study of fibromyalgia. Arthritis Rheum 2004, 50:944–952. This study provides evidence that fibromyalgia coaggregates with major mood disorder and enhanced pain sensitivity in families.
Hudson JI, Arnold LM, Keck PE Jr, et al.: Family study of fibromyalgia and affective spectrum disorder. Biol Psychiatry 2004, 56:884–891.
Maxwell ME: Family Interview for Genetic Studies (FIGS). Washington DC: National Institute of Mental Health; 1992.
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. This study provides evidence that fibromyalgia coaggregates with depression in families of individuals sampled from a communitybased test.
Aaron LA, Bradley LA, Alarcon GS, et al.: Psychiatric diagnoses in patients with fibromyalgia are related to health care-seeking behavior rather than to illness. Arthritis Rheum 1996, 39:436–445.
Drossman DA, McKee DC, Sandler RS, et al.: Psychosocial factors in the irritable bowel syndrome: a multivariate study of patients and nonpatients with irritable bowel syndrome. Gastroenterology 1988, 95:701–708.
Mogil JS, Wilson SG, Chesler EJ, et al.: The melanocortin-1 receptor gene mediates female-specific mechanisms of analgesia in mice and humans. Proc Natl Acad Sci U S A 2003, 100:4867–4872.
Zubieta JK, Heitzig MM, Smith YR, et al.: COMT val158 met genotype affects µ-opioid neurotransmitter responses to a pain stressor. Science 2003, 299:1240–1243.
Domschke K, Freitag CM, Kuhlenbaumer G, et al.: Association of the functional V158M catechol-O-methyl-transferase polymorphism with panic disorder in women. Int J Neuropsychopharmacol 2004, 7:183–188.
Diatchenko L, Slade GD, Nackley AG, et al.: Genetic basis for individual variations in pain perception and the development of a chronic pain condition. Hum Mol Genet 2005, 14:135–143. This is the first study to demonstrate that haplotypes of the COMT gene that are associated with enhanced pain sensitivity help to predict the onset of TMD in healthy young women.
Aaron LA, Burke MM, Buchwald D: Overlapping conditions among patients with chronic fatigue syndrome, fibromyalgia, and temporomandibular disorder. Arch Intern Med 2000, 160:221–227.
Maixner W, Fillingim R, Sigurdsson A, et al.: Sensitivity of patients with painful temporomandibular disorders to experimentally evoked pain: evidence for altered temporal summation of pain. Pain 1998, 76:71–81.
Offenbaecher M, Bondy B, de Jonge S, et al.: Possible association of fibromyalgia with a polymorphism in the serotonin transporter gene regulatory region. Arthritis Rheum 1999, 42:2482–2488.
Cohen H, Buskila D, Neumann L, Ebstein RP: Confirmation of an association between fibromyalgia and serotonin transporter promoter region (5-HTTLPR) polymorphism, and relationship to anxiety-related personality traits. Arthritis Rheum 2002, 46:845–847.
Raphael KG, Natelson BH, Janal MN, Nayak S: A communitybased survey of fibromyalgia-like pain complaints following the World Trade Center terrorist attacks. Pain 2002, 100:131–139.
McBeth J, Macfarlane GJ, 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.
Harkness EF, Macfarlane GJ, Nahit E, et al.: Mechanical injury and psychosocial factors in the work place predict the onset of widespread body pain: a 2-year prospective study among cohorts of newly employed workers. Arthritis Rheum 2004, 50:1655–1664.
McBeth J, Harkness EF, Silman AJ, Macfarlane GJ: The role of workplace low-level mechanical trauma, posture, and environment in the onset of chronic widespread pain. Rheumatology 2003, 42:1–9.
Goldenberg DL: Do infections trigger fibromyalgia [Editorial]? Arthritis Rheum 1993, 36:1489–1492.
Bradley LA, McKendree-Smith NL, Deutsch G, et al.: Stressful imagery evokes enhanced thermal pain unpleasantness ratings and activation of cerebellum and motor, prefrontal, and posterior/temporal cortex in patients with fibromyalgia (FM). Arthritis Rheum 2004, 50(suppl):S493-S494.
Williams DA: Psychological and behavioural therapies in fibromyalgia and related syndromes. Best Pract Res Clin Rheumatol 2003, 17:649–665.
Bradley LA, Alberts KR: Psychological and behavioral approaches to pain management for patients with rheumatic disease. Rheum Dis Clin North Am 1999, 25:215–232.
Arnold LM, Lu Y, Crofford LJ, et al.: A double-blind, multicenter trial comparing duloxetine with placebo in the treatment of fibromyalgia patients with or without major depressive disorder. Arthritis Rheum 2004, 50:2974–2984.
McCracken LM, Zayfert C, Gross RT: The Pain Anxiety Symptoms Scale: development and validation of a scale to measure fear of pain. Pain 1992, 50:67–73.
Roelofs J, Goubert L, Peters ML, et al.: The Tampa Scale for Kinesiophobia: further examination of psychometric properties in patients with chronic low back pain and fibromyalgia. Eur J Pain 2004, 8:495–502.
Waddell G, Newton M, Henderson I, et al.: A Fear-Avoidance Beliefs Questionnaire (FABQ) and the role of fear-avoidance beliefs in chronic low back pain and disability. Pain 1993, 52:157–168.
Burns JW, Mullen JT, Higdon LJ, et al.: Validity of the pain anxiety symptoms scale (PASS): prediction of physical capacity variables. Pain 2000, 84:247–252.
Ciccone DS, Just N: Pain expectancy and work disability in patients with acute and chronic pain: a test of the fear avoidance hypothesis. J Pain 2001, 2:181–194.
Turk DC, Robinson JP, Burwinkle T: Prevalence of fear of pain and activity in patients with fibromyalgia syndrome. J Pain 2004, 5:483–490.
Bradley LA, Alarcón GS: Fibromyalgia. In Arthritis and Allied Conditions: A Textbook of Rheumatology, edn 15. Edited by Koopman WK, Moreland LW. Philadelphia: Lippincott Williams & Wilkins; 2004:1869–1910.
Vlaeyen JW, de Jong J, Geilen M, et al.: The treatment of fear of movement/(re)injury in chronic low back pain: further evidence on the effectiveness of exposure in vivo. Clin J Pain 2002, 18:251–261.
Rooks DS, Silverman CB, Kantrowitz FG: The effects of progressive strength training and aerobic exercise on muscle strength and cardiovascular fitness in women with fibromyalgia: a pilot study. Arthritis Rheum (Arthritis Care Res) 2002, 47:22–28.
Prochaska JO, Velicer WF: The transtheoretical model of health behavior change. Am J Health Promot 1997, 12:38–48.
Kerns RD, Habib S: A critical review of the pain readiness to change model. J Pain 2004, 5:357–367.
Kerns RD, Rosenberg R, Jamison RN, et al.: Readiness to adopt a self-management approach to chronic pain: the Pain Stages of Change Questionnaire (PSOCQ). Pain 1997, 72:227–234.
Jensen MP, Nielson WR, Turner JA, et al.: Readiness to selfmanage pain is associated with coping and with psychological and physical functioning among patients with chronic pain. Pain 2003, 104:529–537.
Jensen MP, Nielson WR, Turner JA, et al.: Changes in readiness to self-manage pain are associated with improvement in multidisciplinary pain treatment and pain coping. Pain 2004, 111:84–95.
Evers AW, Kraaimaat FW, van Lankveld W, et al.: Beyond unfavorable thinking: the illness cognition questionnaire for chronic diseases. J Consult Clin Psychol 2001, 69:1026–1036.
Viane I, Crombez G, Eccleston C, et al.: Acceptance of pain is an independent predictor of mental well-being in patients with chronic pain: empirical evidence and reappraisal. Pain 2003, 106:65–72.
Viane I, Crombez G, Eccleston C, et al.: Acceptance of the unpleasant reality of chronic pain: effects upon attention to pain and engagement with daily activities. Pain 2004, 112:282–288.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Bradley, L.A. Psychiatric comorbidity in fibromyalgia. Current Science Inc 9, 79–86 (2005). https://doi.org/10.1007/s11916-005-0042-3
Issue Date:
DOI: https://doi.org/10.1007/s11916-005-0042-3