Assessment of disability: Prevalence of fear in subgroups of Fibromyalgia Syndrome (FMS) patients

Abstract

The aim was to examine anxiety about pain and fear of activity of FMS patients as a group and differences among subgroups. Despite evidence that numerous interventions have demonstrated significant improvement in symptoms, a substantial proportion of FMS patients continue to report significant pain, emotional distress, and disability. FMS patients frequently drop-out or do not adhere to treatments. Patients may restrict activities due to fear of increasing pain and fatigue following physical exercise. The role of fear in FMS has received little attention. 252 consecutive FMS patients completed a history, were examined by a physician, physical therapist, and psychologist, and completed the Tampa Scale of Kinesiophobia (TSK), selected items (anxious/worried because of pain [AP] or movement [FM]) from the Impairment Impact Inventory (I3), and Multidimensional Pain Inventory (MPI). Sample mean scores on the I3 and TSK were: 4.70, 5.46, and 35.12. Patients were grouped according to the MPI — Dysfunctional (DYS, 33%), Interpersonally Distressed (ID, 39%), and Adaptive Copers (AC, 29%). On the I3 items, DYS patients reported more (p<.01) AP and FM (Mean=6.1 and 6.8 respectively) than ID (Mean=4.7 and 5.18) and AC patients (Mean=3.10 and 4.31). Similarly, on the TSK, DYS patients reported more (p<.01) fear of movement (Mean=37.5) than ID (Mean=34.89) and AC (Mean=35.12) patients. Additionally, ID patients had greater (p<.001) AP and higher scores on the TSK than AC patients. On both I3 items and the TSK, more DYS patients (26%, 28%, and 21% respectively) reported “high fear” than ID patients (21%, 24%, and 17%) and AC patients (7%, 14%, and 10%). Fear of pain and movement appear to be common in FMS and may contribute to adaptation, particularly for DYS and ID patients. Treatment should address both patient fears and symptoms.