Abstract
Working memory (WM) is a critical process for cognitive functioning in which fibromyalgia (FM) patients could show cognitive disturbances. Dyscognition in FM has been explained by interference from pain processing, which shares the neural substrates involved in cognition and may capture neural resources required to perform cognitive tasks. However, there is not yet data about how pain is related to WM performance, neither the role that other clinical variables could have. The objectives of this study were (1) to clarify the WM status of patients with FM and its relationship with nociception, and (2) to determine the clinical variables associated to FM that best predict WM performance. To this end, 132 women with FM undertook a neuropsychological assessment of WM functioning (Digit span, Spatial span, ACT tests and a 2-Back task) and a complete clinical assessment (FSQ, FIQ-R, BDI-1A, HADS, PSQI, MFE-30 questionnaires), including determination of pain thresholds and tolerance by pressure algometry. Patients with FM seem to preserve their WM span and ability to maintain and manipulate information online for both visuospatial and verbal domains. However, up to one-third of patients showed impairment in tasks requiring more short-term memory load, divided attention, and information processing ability (measured by the ACT task). Cognitive performance was spuriously related to the level of pain experienced, finding only that pain measures are related to the ACT task. The results of the linear regression analyses suggest that sleep problems and fatigue were the variables that best predicted WM performance in FM patients. Future research should take these variables into account when evaluating dyscognition in FM and should include dynamic measures of pain modulation.
Highlights
Fibromyalgia (FM) is a chronic pain syndrome without a fully known organic etiology, characterized by widespread musculoskeletal pain, stiffness, fatigue, non-restorative sleep, and cognitive dysfunction (Wolfe et al, 2010)
The updated version of the Multicomponent Model of working memory (Baddeley, 2000) considers that Working memory (WM) activity is divided into four subsystems: the Central Executive system, which involves attention control and organization of cognitive resources and their distribution; the Phonological Loop, which involves the storage of phonological information and the processes of articulatory control; the Visuospatial Sketchpad, which involves recording and storage of spatial information associated with visual information; and the Episodic Buffer, which manages the establishment of episodic long-term memory
The mean number of years from patients’ diagnosis of FM was 9.96 (SD = 7.99). Their average pain threshold was 1.98 kg/cm2 (SD = 1.01), which is below the 4 kg/cm2 limit set by the American College of Rheumatology (ACR) criteria, and their average tolerance was 2.66 kg/cm2
Summary
Fibromyalgia (FM) is a chronic pain syndrome without a fully known organic etiology, characterized by widespread musculoskeletal pain, stiffness, fatigue, non-restorative sleep, and cognitive dysfunction (Wolfe et al, 2010). Working memory is a cognitive function critical for the attentional and executive functioning in which objective alterations have been found (Park et al, 2001; Dick et al, 2008; Cánovas et al, 2009; Kim et al, 2011; Seo et al, 2012; Tesio et al, 2014; Coppieters et al, 2015; Gelonch et al, 2018; PidalMiranda et al, 2018) and has been proposed as central to dyscognition in FM (Ambrose et al, 2012); other results have failed to find WM disturbances (Walitt et al, 2016; Kratz et al, 2020). Studies are necessary to clarify the status of FM patients in WM by attending to its different components
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