Fibromyalgia symptoms can snowball and negatively affect the quality of life of people with the condition, a study reports.
The study, “Depression and trait-anxiety mediate the influence of clinical pain on health-related quality of life in fibromyalgia,” was published in the Journal of Affective Disorders.
People with fibromyalgia who experience depression, anxiety, insomnia, fatigue, and pain are at increased risk for lower health-related quality of life (HRQoL), which is defined as their own perception of their health and the level at which they are able to carry out their normal daily activities.
Previous studies have suggested severe chronic pain and difficulties in its management are the main reasons for the low HRQoL levels in patients with fibromyalgia. In addition, mental health issues such as depression and anxiety, which are also common in fibromyalgia, are thought to negatively impact the overall HRQoL of these patients.
Now, researchers at the University of Jaén in Spain in collaboration with colleagues at the University for Health Sciences in Austria set out to investigate the relationship between HRQoL and the levels of pain, insomnia, fatigue, depression, and anxiety in people with fibromyalgia.
Additionally, the investigators studied how standard medications for depression, anxiety, and pain affected HRQoL for these patients.
The study enrolled 145 women with fibromyalgia and 94 healthy women of approximately the same age, years of education, and body mass index.
Study participants were asked to complete the Short-Form Health Survey (SF-36), an eight-domain questionnaire commonly used to assess HRQoL, as well as other questionnaires to evaluate pain intensity, symptoms of depression, anxiety, fatigue, and insomnia.
The researchers found that women with fibromyalgia had lower scores in all eight domains of the SF-36 questionnaire, compared with healthy women. Both clinical symptoms (pain intensity, insomnia, and fatigue) and mental health symptoms (anxiety and depression) were linked to low HRQoL scores in these women.
Moreover, the use of antidepressants, anxiolytics, and non-opioid analgesics was also associated with lower HRQoL scores.
“The lower HRQoL scores in patients taking medication might reflect differences in their clinical state,” the researchers wrote. “It may be assumed that the most severely affected patients are those who take medications. However, these results may also indicate the low effectiveness of current pharmacological treatments for [fibromyalgia].”
Statistical analyses revealed that anxiety, depression, and fatigue were mediators of the effect of clinical pain on a person’s overall HRQoL score. In addition, total pain mediated the relationship between anxiety, depression, fatigue, and insomnia, and the overall HRQoL score.
Depression alone accounted for 36% of the overall HRQoL score, whereas anxiety also predicted 17% of the emotional role domain scores and 7% of the bodily pain domain scores of the SF-36 questionnaire.
Pain intensity was linked to lower scores in all SF-36 domains and accounted for 35% of the physical function scores, while total pain explained 7% of the general health perception scores in women with fibromyalgia.
“These results suggest that pain intensity is more closely associated with the physical facets of HRQoL, while depression and anxiety are more closely associated with the psychological facets,” the researchers wrote.
Overall, the findings suggest that pain increases depression and anxiety, which in turn worsen other typical symptoms of fibromyalgia, including fatigue and insomnia — altogether lowering HRQoL.
“In conclusion, [fibromyalgia] patients exhibited markedly lower HRQoL than healthy individuals, with the impairments manifesting at physical, psychological and social levels of functioning,” the researchers wrote.
“Taken together, these results underline the need to evaluate and treat aversive emotional states in [fibromyalgia]. Besides their effect on affective symptoms [depression and anxiety], such interventions would directly and indirectly (i.e., by limiting the negative influence of pain, fatigue and insomnia) improve HRQoL in [fibromyalgia],” they added.