Abstract
Fibromyalgia (FM) is a generalized chronic pain condition associated with a variety of symptoms, including altered cognitive and emotional processing. It has been proposed that FM patients show a preferential allocation of attention to information related to the symptoms of the disease, particularly to pain cues. However, the existing literature does not provide conclusive evidence on the presence of this attentional bias, and its effect on cognitive functions such as inhibitory control. To clarify this issue, we recorded the electroencephalographic activity of 31 women diagnosed with FM and 28 healthy women, while performing an emotional Go/NoGo task with micro-videos of pain, happy, and neutral facial expressions. We analyzed behavioral data, performed EEG time-frequency analyses, and obtained the event-related potentials (ERPs) N2 and P3 components in NoGo trials. A series of self-reports was also administered to evaluate catastrophic thinking and the main symptoms of fibromyalgia. Pain expressions were associated with longer reaction times and more errors, as well as with higher theta and delta power, and P3 amplitude to NoGo stimuli. Thus, behavioral and psychophysiological data suggest that increased attention to pain expressions impairs the performance of an inhibitory task, although this effect was similar in FM patients and healthy controls. N2 amplitude was modulated by type of facial expression (larger to pain faces), but only for the control group. This finding suggests that the presentation of pain faces might represent a smaller conflict for the patients, more used to encounter pain stimuli. No main group effects were found significant for N2 or P3 amplitudes, nor for time-frequency data. Using stimuli with greater ecological validity than in previous studies, we could not confirm a greater effect of attentional bias toward negative stimuli over inhibitory performance in patients with FM. Studying these effects allow us to better understand the mechanisms that maintain pain and develop intervention strategies to modify them.
Highlights
Fibromyalgia (FM) is a chronic pain condition of unknown etiology, characterized by the presence of generalized musculoskeletal pain, in addition to fatigue, poor sleep quality, anxiety, depression, and altered cognitive and emotional processing
There were no significant differences between the FM and healthy controls (HCs) groups in terms of age, education, menopausal status, or laterality (Table 1)
The comparisons between the FM and HCs were statistically significant for all the scales and subscales analyzed (Table 2)
Summary
Fibromyalgia (FM) is a chronic pain condition of unknown etiology, characterized by the presence of generalized musculoskeletal pain, in addition to fatigue, poor sleep quality, anxiety, depression, and altered cognitive and emotional processing. It has been proposed that FM patients show a preferential allocation of attention to information related to the symptoms of the disease, to pain cues. This idea has been discussed as hypervigilance and, more recently, as attentional bias (AB) (Crombez et al, 2013). Even observing empathically other people’s pain can enhance our own intensity reports to painful stimuli (de Wied and Verbaten, 2001; Godinho et al, 2008). The investigation of AB to pain-related information may help to understand the causal mechanisms of pain maintenance as well as the development of anxiety and depression associated to pain (Aldrich et al, 2000; Crombez et al, 2012)
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