J Rheum Dis.  2011 Dec;18(4):242-252. 10.4078/jrd.2011.18.4.242.

Psychiatric Approach of Fibromyalgia

• Kim SH
• Jung SW

• KMID: 2223127
• DOI: http://doi.org/10.4078/jrd.2011.18.4.242

Abstract

Fibromyalgia is a disease that occurs frequently. However, people do not know much about this disease and many doctors find it difficult to diagnose such patients. Symptoms of fibromyalgia may not only include pain, but also sleep disorder, fatigue, melancholia, and other mood disorders. Pain is one of the major symptoms of many diseases and may greatly impede the quality and functionof an individual's life. Yet many clinicians have trouble treating chronic pain in part because they focus on the pain itself, which is merely one of the causes, and not on the evaluation and treatment of problems incidental to pain. It is noted that pain may be accompanied by not only physical suffering, but also emotional problems, such as melancholia and other secondary problems. The causes for fibromyalgia syndrome have not yet been clearly revealed but it is known that mental factors contribute to the occurrence and progress of the symptoms, and that the evaluation of or therapeutic interventions for the mental causes may be due to physical effects. Therefore, based on adequate psychiatric knowledge, clinicians should understand and treat the patients accordingly. It may be that more effective medical services are needed through intensive treatments in multidisciplinary teams for the patients. This article is aimed at investigating the psychological issues that fibromyalgia patients encounter. It also considers the psychiatric drugs and psychosocial treatment that are applied to the disease.

Keyword

Fibromyalgia; Psychiatric approach

MeSH Terms

Chronic Pain
Depressive Disorder
Fatigue
Fibromyalgia
Humans
Mood Disorders
Stress, Psychological

Figure

• 

  Figure 1. Biopsychosocial model of fibromyalgia.

Reference

References

1. Lawrence RC, Felson DT, Helmick CG, Arnold LM, Choi H, Deyo RA, et al. National Arthritis Data Workgroup. Estimates of the prevalence of arthritis and other rheumatic conditions in the United States. Part II. Arthritis Rheum. 2008; 58:26–35.

2. Kim SH, Bae GR, Lim HS. Prevalence and risk factors of eibromyalgia syndrome and chronic widespread pain in two communities in Korea-first report in Korean. J Korean Rheum Assoc. 2006; 13:18–25.

3. Arnold LM, Clauw DJ, McCarberg BH. Fibro Collaborative. Improving the recognition and diagnosis of fibromyalgia. Mayo Clin Proc. 2011; 86:457–64.

4. Mease PJ, Arnold LM, Crofford LJ, Williams DA, Russell IJ, Humphrey L, et al. Identifying the clinical do-mains of fibromyalgia: contributions from clinician and patient Delphi exercises. Arthritis Rheum. 2008; 59:952–60.

5. Kato K, Sullivan PF, Evengård B, Pedersen NL. Chronic widespread pain and its comorbidities: a population-based study. Arch Intern Med. 2006; 166:1649–54.

6. Vandvik PO, Lydersen S, Farup PG. Prevalence, comorbidity and impact of irritable bowel syndrome in Norway. Scand J Gastroenterol. 2006; 41:650–6.

7. Cole JA, Rothman KJ, Cabral HJ, Zhang Y, Farraye FA. Migraine, fibromyalgia, and depression among people with IBS: a prevalence study. BMC Gastroenterol. 2006; 6:26.

8. Goldenberg DL. Pain/Depression dyad: a key to a better understanding and treatment of functional somatic syndromes. Am J Med. 2010; 123:675–82.

9. Turk DC, Dworkin RH. What should be the core outcomes in chronic pain clinical trials? Arthritis Res Ther. 2004; 6:151–4.

10. Breivik H, Borchgrevink PC, Allen SM, Rosseland LA, Romundstad L, Hals EK, et al. Assessment of pain. Br J Anaesth. 2008; 101:17–24.

11. Bigatti SM, Hernandez AM, Cronan TA, Rand KL. Sleep disturbances in fibromyalgia syndrome: relationship to pain and depression. Arthritis Rheum. 2008; 59:961–7.

12. Glass JM. Fibromyalgia and cognition. J Clin Psychiatry. 2008; 69(Suppl 2):20–4.

13. Wilbarger JL, Cook DB. Multisensory hypersensitivity in women with fibromyalgia: implications for well being and intervention. Arch Phys Med Rehabil. 2011; 92:653–6.

14. Weir PT, Harlan GA, Nkoy FL, Jones SS, Hegmann KT, Gren LH, et al. The incidence of fibromyalgia and its associated comorbidities: a population-based retrospective cohort study based on International Classification of Diseases, 9th Revision codes. J Clin Rheumatol. 2006; 12:124–8.

15. Fleming MF, Balousek SL, Klessig CL, Mundt MP, Brown DD. Substance use disorders in a primary care sample receiving daily opioid therapy. J Pain. 2007; 8:573–82.

16. Nicholl BI, Halder SL, Macfarlane GJ, Thompson DG, O'Brien S, Musleh M, et al. Psychosocial risk markers for new onset irritable bowel syndrome–results of a large prospective population-based study. Pain. 2008; 137:147–55.

17. Knaster P, Karlsson H, Estlander AM, Kalso E. Psychiatric disorders as assessed with SCID in chronic pain patients: the anxiety disorders precede the onset of pain. Gen Hosp Psychiatry. 2011.

18. Diagnostic and Statistical Manual of Mental Disorders DSM-IV-TR. 4th ed.Washington DC: American Psychiatric Association Press;2000.

19. Geisser ME, Roth RS, Robinson ME. Assessing depression among persons with chronic pain using the Center for Epidemiological Studies-Depression Scale and the Beck Depression Inventory: a comparative analysis. Clin J Pain. 1997; 13:163–70.

20. Bair MJ, Robinson RL, Katon W, Kroenke K. Depression and pain comorbidity: a literature review. Arch Intern Med. 2003; 163:2433–45.

21. Arnold LM, Hudson JI, Keck PE, Auchenbach MB, Javaras KN, Hess EV. Comorbidity of fibromyalgia and psychiatric disorders. J Clin Psychiatry. 2006; 67:1219–25.

22. Haley WE, Turner JA, Romano JM. Depression in chronic pain patients: relation to pain, activity, and sex differences. Pain. 1985; 23:337–43.

23. Dworkin SF, Von Korff M, LeResche L. Multiple pains and psychiatric disturbance. An epidemiologic investigation. Arch Gen Psychiatry. 1990; 47:239–44.

24. Fishbain DA, Cutler R, Rosomoff HL, Rosomoff RS. Chronic pain-associated depression: antecedent or con-sequence of chronic pain? A review. Clin J Pain. 1997; 13:116–37.

25. Okifuji A, Turk DC, Sherman JJ. Evaluation of the relationship between depression and fibromyalgia syndrome: why aren't all patients depressed? J Rheumatol. 2000; 27:212–9.

26. Arnold LM. Management of fibromyalgia and comorbid psychiatric disorders. J Clin Psychiatry. 2008; 69(Suppl 2):14–9.

27. Benarroch EE. Descending monoaminergic pain modulation: bidirectional control and clinical relevance. Neuro-logy. 2008; 71:217–21.

28. Sullivan MJ, Stanish W, Waite H, Sullivan M, Tripp DA. Catastrophizing, pain, and disability in patients with soft-tissue injuries. Pain. 1998; 77:253–60.

29. Merikangas KR, Zhang H, Avenevoli S, Acharyya S, Neuenschwander M, Angst J. Zurich Cohort Study. Longitudinal trajectories of depression and anxiety in a prospective community study: the Zurich Cohort Study. Arch Gen Psychiatry. 2003; 60:993–1000.

30. Granot M, Ferber SG. The roles of pain catastrophizing and anxiety in the prediction of postoperative pain in-tensity: a prospective study. Clin J Pain. 2005; 21:439–45.

31. Beesdo K, Hartford J, Russell J, Spann M, Ball S, Wittchen HU. The short- and longterm effect of duloxetine on painful physical symptoms in patients with generalized anxiety disorder: results from three clinical trials. J Anxiety Disord. 2009; 23:1064–71.

32. Wittchen HU, Kessler RC, Beesdo K, Krause P, Höfler M, Hoyer J. Generalized anxiety and depression in primary care: prevalence, recognition, and management. J Clin Psychiatry. 2002; 63(Suppl 8):24–34.

33. Polatin PB, Kinney RK, Gatchel RJ, Lillo E, Mayer TG. Psychiatric illness and chronic low-back pain. The mind and the spine–which goes first? Spine (Phila Pa 1976). 1993; 18:66–71.

34. Parker G, Wilhelm K, Mitchell P, Austin MP, Roussos J, Gladstone G. The influence of anxiety as a risk to early onset major depression. J Affect Disord. 1999; 52:11–7.

35. Fava M, Rankin MA, Wright EC, Alpert JE, Nierenberg AA, Pava J, et al. Anxiety disorders in major depression. Compr Psychiatry. 2000; 41:97–102.

36. Linton SJ. A review of psychological risk factors in back and neck pain. Spine (Phila Pa 1976). 2000; 25:1148–56.

37. Wolfe F, Hawley DJ. Evidence of disordered symptom appraisal in fibromyalgia: increased rates of reported comorbidity and comorbidity severity. Clin Exp Rheumatol. 1999; 17:297–303.

38. Hallberg LR, Carlsson SG. Anxiety and coping in patients with chronic work-related muscular pain and patients with fibromyalgia. Eur J Pain. 1998; 2:309–19.

39. Hassett AL, Cone JD, Patella SJ, Sigal LH. The role of catastrophizing in the pain and depression of women with fibromyalgia syndrome. Arthritis Rheum. 2000; 43:2493–500.

40. Van Houdenhove B, Egle U, Luyten P. The role of life stress in fibromyalgia. Curr Rheumatol Rep. 2005; 7:365–70.

41. Goldenberg DL, Burckhardt C, Crofford L. Management of fibromyalgia syndrome. JAMA. 2004; 292:2388–95.

42. Carville SF, Arendt-Nielsen S, Bliddal H, Blotman F, Branco JC, Buskila D, et al. EULAR. EULAR evidence-based recommendations for the management of fibromyalgia syndrome. Ann Rheum Dis. 2008; 67:536–41.

43. White KP, Nielson WR, Harth M, Ostbye T, Speechley M. Does the label "fibromyalgia" alter health status, function, and health service utilization? A prospective, with-in-group comparison in a community cohort of adults with chronic widespread pain. Arthritis Rheum. 2002; 47:260–5.

44. Gracely RH, Geisser ME, Giesecke T, Grant MA, Petzke F, Williams DA, et al. Pain catastrophizing and neural responses to pain among persons with fibromyalgia. Brain. 2004; 127:835–43.

45. Edwards RR, Bingham CO 3rd, Bathon J, Haytho-rnthwaite JA. Catastrophizing and pain in arthritis, fibromyalgia, and other rheumatic diseases. Arthritis Rheum. 2006; 55:325–32.

46. Butler AC, Chapman JE, Forman EM, Beck AT. The em-pirical status of cognitive-behavioral therapy: a review of meta-analyses. Clin Psychol Rev. 2006; 26:17–31.

47. Hofmann SG, Smits JA. Cognitive-behavioral therapy for adult anxiety disorders: a meta-analysis of randomized placebo-controlled trials. J Clin Psychiatry. 2008; 69:621–32.

48. Dadabhoy D, Crofford LJ, Spaeth M, Russell IJ, Clauw DJ. Biology and therapy of fibromyalgia. Evidence-based biomarkers for fibromyalgia syndrome. Arthritis Res Ther. 2008; 10:211.

49. Keel PJ, Bodoky C, Gerhard U, Müller W. Comparison of integrated group therapy and group relaxation training for fibromyalgia. Clin J Pain. 1998; 14:232–8.

50. Martí nez-Lavín M. Is fibromyalgia a generalized reflex sympathetic dystrophy? Clin Exp Rheumatol. 2001; 19:1–3.

51. Martí nez-Lavín M, Amigo MC, Coindreau J, Canoso J. Fibromyalgia in Frida Kahlo's life and art. Arthritis Rheum. 2000; 43:708–9.

52. Martí nez-Lavín M, Hermosillo AG. Autonomic nervous system dysfunction may explain the multisystem features of fibromyalgia. Semin Arthritis Rheum. 2000; 29:197–9.

53. Lehrer P, Smetankin A, Potapova T. Respiratory sinus arrhythmia biofeedback therapy for asthma: a report of 20 unmedicated pediatric cases using the Smetankin method. Appl Psychophysiol Biofeedback. 2000; 25:193–200.

54. Giardino ND, Chan L, Borson S. Combined heart rate variability and pulse oximetry biofeedback for chronic obstructive pulmonary disease: preliminary findings. Appl Psychophysiol Biofeedback. 2004; 29:121–33.

55. Humphreys PA, Gevirtz RN. Treatment of recurrent ab-dominal pain: components analysis of four treatment protocols. J Pediatr Gastroenterol Nutr. 2000; 31:47–51.

56. Schein MH, Gavish B, Herz M, Rosner-Kahana D, Naveh P, Knishkowy B, et al. Treating hypertension with a de-vice that slows and regularises breathing: a randomised, double-blind controlled study. J Hum Hypertens. 2001; 15:271–8.

57. Hassett AL, Radvanski DC, Vaschillo EG, Vaschillo B, Sigal LH, Karavidas MK, et al. A pilot study of the efficacy of heart rate variability (HRV) biofeedback in patients with fibromyalgia. Appl Psychophysiol Biofeedback. 2007; 32:1–10.

58. Green JP, Barabasz AF, Barrett D, Montgomery GH. Forging ahead: the 2003 APA Division 30 definition of hypnosis. Int J Clin Exp Hypn. 2005; 53:259–64.

59. Grossman P, Niemann L, Schmidt S, Walach H. Mindfulness-based stress reduction and health benefits. A meta-analysis. J Psychosom Res. 2004; 57:35–43.

60. Girault JA, Greengard P. The neurobiology of dopamine signaling. Arch Neurol. 2004; 61:641–4.

61. Holman AJ, Myers RR. A randomized, double-blind, pla-cebo-controlled trial of pramipexole, a dopamine agonist, in patients with fibromyalgia receiving concomitant medications. Arthritis Rheum. 2005; 52:2495–505.

62. Watson CP, Evans RJ. The postmastectomy pain syndrome and topical capsaicin: a randomized trial. Pain. 1992; 51:375–9.

63. Arnold LM, Keck PE Jr, Welge JA. Antidepressant treatment of fibromyalgia. A meta-analysis and review. Psychosomatics. 2000; 41:104–13.

64. Nicolodi M, Sicuteri F. Fibromyalgia and migraine, two faces of the same mechanism. Serotonin as the common clue for pathogenesis and therapy. Adv Exp Med Biol. 1996; 398:373–9.

65. Hannonen P, Malminiemi K, Yli-Kerttula U, Isomeri R, Roponen P. A randomized, double-blind, placebo-con trolled study of moclobemide and amitriptyline in the treatment of fibromyalgia in females without psychiatric disorder. Br J Rheumatol. 1998; 37:1279–86.

66. Patkar AA, Masand PS, Krulewicz S, Mannelli P, Peindl K, Beebe KL, et al. A randomized, controlled, trial of controlled release paroxetine in fibromyalgia. Am J Med. 2007; 120:448–54.

67. Anderberg UM, Marteinsdottir I, von Knorring L. Citalopram in patients with fibromyalgia–a randomized, double-blind, placebo-controlled study. Eur J Pain. 2000; 4:27–35.

68. Otto M, Bach FW, Jensen TS, Br⊘sen K, Sindrup SH. Escitalopram in painful polyneuropathy: a randomized, placebo-controlled, crossover trial. Pain. 2008; 139:275–83.

69. Samborski W, Lezańska-Szpera M, Rybakowski JK. Effects of antidepressant mirtazapine on fibromyalgia symptoms. Rocz Akad Med Bialymst. 2004; 49:265–9.

70. Samborski W, Lezanska-Szpera M, Rybakowski JK. Open trial of mirtazapine in patients with fibromyalgia. Pharma-copsychiatry. 2004; 37:168–70.

71. Krell HV, Leuchter AF, Cook IA, Abrams M. Evaluation of reboxetine, a noradrenergic antidepressant, for the treatment of fibromyalgia and chronic low back pain. Psychosomatics. 2005; 46:379–84.

72. Moret C, Briley M. Antidepressants in the treatment of fibromyalgia. Neuropsychiatr Dis Treat. 2006; 2:537–48.

73. Zijlstra TR, Barendregt PJ, van De Laar MAF. Venlafax-ine in fibromyalgia: results of a randomized, placebo-controlled, doubleblind trial. Arthritis Rheum. 2002; 46:S105.

74. Russell IJ, Mease PJ, Smith TR, Kajdasz DK, Wohlreich MM, Detke MJ, et al. Efficacy and safety of duloxetine for treatment of fibromyalgia in patients with or without major depressive disorder: Results from a 6-month, randomized, double-blind, placebo-controlled, fixed-dose trial. Pain. 2008; 136:432–44.

75. Arnold LM, Lu Y, Crofford LJ, Wohlreich M, Detke MJ, Iyengar S, 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; 50:2974–84.

76. Arnold LM, Rosen A, Pritchett YL, D'Souza DN, Goldstein DJ, Iyengar S, et al. A randomized, double-blind, placebo-controlled trial of duloxetine in the treatment of women with fibromyalgia with or without major depressive disorder. Pain. 2005; 119:5–15.

77. Gendreau RM, Thorn MD, Gendreau JF, Kranzler JD, Ribeiro S, Gracely RH, et al. Efficacy of milnacipran in patients with fibromyalgia. J Rheumatol. 2005; 32:1975–85.

78. Crofford LJ, Rowbotham MC, Mease PJ, Russell IJ, Dworkin RH, Corbin AE, et al. Pregabalin 1008–105 Study Group. Pregabalin for the treatment of fibromyalgia syndrome: results of a randomized, double-blind, place-bo-controlled trial. Arthritis Rheum. 2005; 52:1264–73.

79. Arnold LM, Goldenberg DL, Stanford SB, Lalonde JK, Sandhu HS, Keck PE Jr, et al. Gabapentin in the treatment of fibromyalgia: a randomized, double-blind, place-bo-controlled, multicenter trial. Arthritis Rheum. 2007; 56:1336–44.

80. Russell IJ, Perkins AT, Michalek JE. Oxybate SXB-26 Fibromyalgia Syndrome Study Group. Sodium oxybate re-lieves pain and improves function in fibromyalgia syndrome: a randomized, double-blind, placebo-controlled, multicenter clinical trial. Arthritis Rheum. 2009; 60:299–309.

81. Russell IJ, Holman AJ, Swick TJ, Alvarez-Horine S, Wang YG, Guinta D. Sodium Oxybate 06–008 FM Study Group. Sodium oxybate reduces pain, fatigue, and sleep disturbance and improves functionality in fibromyalgia: results from a 14-week, randomized, double-blind, place-bo-controlled study. Pain. 2011; 152:1007–17.

82. Moldofsky H, Lue FA, Mously C, Roth-Schechter B, Reynolds WJ. The effect of zolpidem in patients with fibromyalgia: a dose ranging, double blind, placebo controlled, modified crossover study. J Rheumatol. 1996; 23:529–33.

83. Rico-Villademoros F, Hidalgo J, Dominguez I, García-Leiva JM, Calandre EP. Atypical antipsychotics in the treatment of fibromyalgia: a case series with olanzapine. Prog Neuropsychopharmacol Biol Psychiatry. 2005; 29:161–4.

84. Hidalgo J, Rico-Villademoros F, Calandre EP. An open-label study of quetiapine in the treatment of fibromyalgia. Prog Neuropsychopharmacol Biol Psychiatry. 2007; 31:71–7.

85. Calandre EP, Hidalgo J, Rico-Villademoros F. Use of zi-prasidone in patients with fibromyalgia: a case series. Rheumatol Int. 2007; 27:473–6.