Background/Purpose:

Fibromyalgia is a common, chronic pain disorder. Initial development of symptoms occurs under conditions unique to each patient.  Psychological and physical triggers are recognized, however their frequency and contribution to illness onset is less defined.  

The aim of this study was to examine fibromyalgia triggers and identify clinical features linked to specific triggering situations.

Methods:

Fibromyalgia patients seen in a public outpatient clinic were questioned using a standardized interview regarding the circumstances of their symptom onset.  Demographic and clinical data were collected, including the Widespread Pain Index (WPI), Symptom Severity Score (SSS) and the Fibromyalgia Impact Questionnaire (FIQ).    Patients were divided into groups based on whether or not they reported a trigger for their fibromyalgia, and if this involved increased levels of psychosocial stress, physical illness or injury.  These groups were then compared for differences regarding clinical and demographic features.

Results:

Information was collected on 260 consecutive patients.  232 (89.2%) patients reported a specific triggering situation corresponding to the onset of their symptoms.  77 (29.7%) described a triggering situation of purely increased psychosocial stress and a further 107 (41.3%) described a physical illness or injury combined with increased psychosocial stress.  46 (17.8%) described a purely physical trigger.  Patients with a trigger involving increased psychosocial stress had a higher number of coexisting fibromyalgia-associated conditions (e.g. irritable bowel syndrome, temporomandibular joint disorder, etc) (p<0.005), higher levels of anxiety (p<0.05) and depression (p<0.05) than those patients who did not.  If patients who had a psychosocial stress component of their trigger were currently regularly exercising, they had significantly lower FIQ scores (p<0.05), better physical function (p<0.05), less reported pain (p<0.05), less sleep disturbance (p<0.05), fewer positive tender points (p<0.05), and a lower WPI (p<0.05) and SSS (p<0.05) than those patients who were not regularly exercising.  Patients without a trigger involving increased psychosocial stress who were regularly exercising had lower FIQ scores (p<0.05) and less anxiety (p<0.05) only.  If patients with psychosocial stress triggers were currently using medications with proven benefit in fibromyalgia (amitriptyline, duloxetine or pregabalin), they had better reported physical function (p<0.05) than those patients not using these medications.  There was no significant clinical difference found between those using pain management psychology and those who were not, in the group of patients who had reported increased psychosocial stress as part of their trigger.

Conclusion:

Most patients report a specific trigger for their fibromyalgia. The majority of these involved increased levels of psychosocial stress, including those with injury or illness.  Patients with an increased psychosocial stress component to their trigger had less severe clinical features if they regularly exercised.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/increased-psychosocial-stress-is-a-major-component-of-fibromyalgia-triggers/