Alexithymia, sense of coherence and dysregulation of biorhythms in fibromyalgia: implications for pain management and quality of life.

Background. Fibromyalgia (FM) is a chronic syndrome, characterized by lasting and diffuse chronic musculoskeletal pain. It is defined as a “central sensitization syndrome”, characterized by an increased sensitivity in the central nervous system to several stimuli. Some psychological factors worse or facilitate the adaptation and pain management in FM. In order to provide a rationale to implement further psychological and psycho-educational interventions to reduce FM impact, improving pain severity and quality of life (QOL), the aims of the present study was: 1) to verify the role of high alexithymia and low sense of coherence (SOC) as determinants (risk factors) for a severe FM impact, severe pain (current and in the last week), severe pain impact and poor QOL; 2) to evaluate the associations between the dysregulation of biological and social rhythms (eating, sleeping, daily life and social activities), FM impact, pain severity (current and in the last week), pain impact and QOL. Methods: Correlational, case-control study. 50 women with FM were assessed with FIQ (FM impact), FIQ “pain” item (pain severity in the last week), (VAS (current pain severity), TAS-20 (alexithymia), SOC (sense of coherence), SF-12 (QOL), SF-12 “pain” item (pain impact), BRIAN (biological rhythms). Results: FM impact, related pain and QOL were negatively correlated with SOC (p<0.01), positively with alexithymia (p<0.05) and dysregulation of biorhythms (p<0.01). Furthermore, subject with high alexithymia and low sense of coherence (risk factors) were more likely to have severe FM impact, severe pain in the last week and poor QOL (p<0.05) after controlling for potential confounders such as age, marital status, education level, occupation. Conclusions: psychological factors, such as alexithymia and sense of coherence, as well as behavioral factors, such as those implied in the regulation of biological and social rhythm,s play a significant role in FM impact, pain perception and QOL. Further studies are needed to point out the efficacy of psychological interventions on pain management and QOL of people with FM.