Background/Purpose: Patients with fibromyalgia syndrome (FMS) experience severe chronic pain and usually are tender to touch. They are hyperactive to weather changes and stress. Do FMS patients perceive physical pain the way they are hypersensitive to their environment? Are FMS patients more likely to be hypervigilant? Hypervigilance is a symptom associated with post-traumatic stress disorder, experience an exaggerated sense of threat in their surroundings that is disproportionate to reality. They are easily set off and startled by mild stimuli and feel anxious in public.

Methods: 128 office patients with fibromyalgia (FMS) or rheumatoid arthritis (RA) (111 women, 17 men; mean age 51 ± 13) completed a questionnaire about hypervigilance symptoms. 100 patients had FMS and 28 had RA. The chi-square test of association and Fisher’s exact test were used to compare the responses of FMS and RA patients, with a two-sided 0.05 significance level. As a part of an Internet survey administered by the volunteer community fibromyalgia organization AFFTER, 763 female self-identified FMS patients and 115 female controls without FMS responded to questions asking if they experience the symptoms common to hypervigilance. Only women’s responses were analyzed to eliminate confounding by gender. Percentages were compared using the chi-square test of association with a 0.05 significance level.

Results: FMS patients were more likely than RA patients to report hypervigilance symptoms: waking up more than once during the nights, FMS 75.0%, RA 46.4% (p = 0.004); feeling uncomfortable in crowded places, FMS 57.6%, RA 25.0% (p = 0.002); feeling uncomfortable if people are standing behind them, FMS 33.0%, RA 10.7% (p = 0.021); and easily startled, FMS 59.4%, RA 29.6% (p = 0.006)


In the Internet questionnaire The mean respondent age was 49.8 ± 11.4 years. 73.9% of FMS and 45.4% of controls were easily startled (p < 0.001). 57.4% of FMS and 30.2% of controls reported that they did not feel at ease around strangers (p < 0.001). 77.2% of FMS reported feeling uncomfortable in crowded places, versus to 42.7% of controls (p < 0.001). 44.9% of FMS and 16.5% of controls reported feeling uncomfortable if people are standing behind them (p < 0.001). For, easily “let their hair down”, only 39.1% of FMS said yes, versus 66.0% of controls (p < 0.001). 32.7% of FMS and 15.5% of controls do not find it easy to trust people  (p = 0.001). Easy for other people to pull the wool over their eyes, FMS responded yes (45.9%) more often than controls (32.0%) (p = 0.009). 32.5% of FMS and 11.3% of controls found themselves disliking people for no reason (p < 0.001). 75.0% of FMS and 21.6% of controls had trouble falling asleep(p < 0.001). 86.8% of FMS said they wake up more than once a night to 48.5% of controls (p < 0.001).


Conclusion: Results suggest that FMS patients are more aware of social and environmental stressors and more likely to be hypervigilant. They have trouble sleeping and are more easily startled. They are less likely to trust their surroundings. Hypervigilance might confer a survival advantage in threatening circumstances, but the hyper-reactivity associated with the condition could also be associated with the central sensitization of pain and dysesthesias, insomnia and other symptoms associated with FMS.

ACR Meeting Abstracts - https://acrabstracts.org/abstract/hypervigiliance-in-fibromyalgia/