Background Primary fibromyalgia is accepted as “central pain syndrome” without inflammation. But rheumatoid arthritis (RA) is characterized by peripheral (nociceptive) pain with marked inflammation. It is well-known that acute and chronic pain can impair the cognitive function. Cognitive impairment is reported in both painful diseases, but there were limited number of controlled studies. The most prominent and common cognitive problem is attentional control impairment in fibromyalgia (FM).
Objectives We aimed to evaluate attention and to determine the predictor of attention deficit in premenopausal women with two chronic painful disease (FM and RA) and healthy controls
Methods Ninety-eight age-and education level-matched premenopausal female patients with fibromyalgia (n=40, mean age: 36.2±7.3), rheumatoid arthritis (n=28, mean age: 37.3±6) and healthy controls (n=30, mean age: 33.7±8) were included. Persons with both diseases, neurologic, major psychotic, endocrine diseases, and disabled persons were excluded. Stroop test was selected as attentional measure by certified psychologist (1). All symptoms of FM were evaluated as VAS-(0-10mm) and related measures such as sleep disorders, anxiety, depression an quality of life were applied to all groups. SPSS for Windows 11.5 statistical package program was used for statistics.
Results All sleep scores of Pittsburgh Sleep Quality Index were higher (showing bad sleep quality) in FM than RA and controls (p=0.001). All quality of life (fibromyalgia impact questionnaire-FIQ-) scores were also higher (bad quality of life) in FM than RA and controls (p=0.001). Hospital Anxiety and Depression Scale: depression scores were also higher according to the cut-off values in FM than RA and controls (p=0.001). All error and correction numbers of Stroop test were similar between groups. But the completion time of the Stroop test-parts 188.8.131.52 were similar in FM and RA, but different from controls (p=0.035). Cluster analysis were made according to the mild and severe symptom scores. Performance of time in Stroop test were not different in both clusters. But total sleep disorder (p=0.01) score, depression (p=0.002) and anxiety (p=0.02) scores of HADS and FIQ (p=0.005) scores were different between clusters of mild and severe FM.
After the adjustment for age, education level, and possible risk factors, the critical part of Stroop test (part5) was correlated with pain, anxiety, depression, dizziness, fatigue, forgetfulness, bladder and gastrointestinal complaints, tender point counts, sleep quality and quality of life. After stepwise regression fatigue was the predictor of attentional impairment.
Conclusions Attentional deficit was common in chronic widespread pain. And fatigue was the predictor of attentional deficit. Pharmacologic and non-pharmacologic strategies should be constructed to prevent or treat fatigue in FM because of the importance on attentional impairment.
MacLeod CM. The Stroop task: The “Gold standard” of attentional measures. Journal of Experimental Psycology: General 1992;121:12-14.
Disclosure of Interest None Declared