Background/Purpose: Fibromyalgia (FM) is a composite of symptoms with the pivot symptom of pain, traditionally measured as intensity with little attention to other qualities. Emotional pain is an important component of the global pain experience, although seldom measured in the clinical setting.  The McGill Pain Questionnaire (MPQ) evaluates pain beyond intensity through subgroups of descriptor words. We have examined the associations of pain quality as measured by the subsections of the MPQ with quality of life, psychological status and function.

Methods: In a prospective cohort of FM patients attending a multidisciplinary pain clinic, emotional pain was measured by the affective component of the McGill Pain Questionnaire (MPQ). The MPQ has 4 subsections, measuring sensory, evaluative, affective and miscellaneous pain. Other measures included pain intensity by a visual analog scale (VAS), patient global assessment (PGA), the Fibromyalgia Impact Questionnaire (FIQ), the Health Assessment Questionnaire (HAQ), the Pain Disability Index (PDI), the Pain Catastrophizing Scale (PCS), and the Arthritis Impact Measurement Scale (AIMS) for anxiety and depression.

Results: 229 FM patients (91% females, mean age and symptom duration, years, 48 and 11) had pain VAS 6.5, PGA 6.5 and MPQ 41.  With the exception of unemployment, no demographic variable correlated with the MPQ. MPQ (total and subsections) was significantly correlated with pain VAS, PGA, FIQ, HAQ, PDI, PCS, and AIMS anxiety and depression. Stepwise hierarchical multiple regression analysis examining the association with the MPI total score retained FIQ, PCS, and HAQ. A MANOVA assessed if there were differences in measures (FIQ, HAQ, PGA, included on clinical judgement) based on a linear combination of MPI scores, while taking catastrophizing into account. The miscellaneous subsection correlated highly with the sensory subsection (p <.001) and was eliminated. A significant effect was found for the affective subscale (Wilks’ Lambda Λ= .941, F= (3, 222) = 4.64, p <.005, multivariate η²=.06), but not for evaluative or sensory subscales. The main effect of covariation for catastrophizing was significant (Wilks’ lambda Λ= .880, F (3, 222) = 10.1, p <.001, multivariate η²=.12). Follow-up ANOVAs indicate that affective scores contribute significantly to FIQ and PGA; evaluative scores contribute significantly to PGA, and the sensory scores contribute significantly only to HAQ. Catastrophizing contributes significantly to PGA and FIQ. Catastrophizing is the variable with the largest and significant Beta weights for each of the MPQ variables.

Conclusion: Higher scores on emotional pain and catastrophizing were predictors of poor quality of life, whereas sensory scores better predicted function. Emotional pain, especially when associated with high levels of catastrophization has important negative effects on well-being for FM patients.  Psychological interventions targeting these aspects may offer additional benefits to the standard pharmacological management of pain.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/emotional-pain-and-catastrophizing-influence-quality-of-life-in-fibromyalgia/