Anxiety and Fibromyalgia

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 Anxiety is one of the body’s natural reactions to stress, and when it occurs under normal circumstances, it can actually be beneficial. For example, normal levels of anxiety help people cope with the stress of taking a test and dealing with tense situations. However, when anxiety levels become excessive, it can become a truly debilitating disorder – individuals may have trouble carrying out the most simple activities of daily living. Generalized anxiety disorder is marked by chronically elevated levels of anxiety and excessive worrying and tension, often at times when no stimulus is present to cause such symptoms. People with this condition cannot relax, startle easily, and have difficulty concentrating. Sleep disturbances are also common. In addition, people with generalized anxiety disorder usually realize that their anxiety is disproportionate to their circumstances, yet they are unable to control it. In short, individuals with generalized anxiety disorder simply cannot stop worrying, even when there is no reason to do so. In addition to the mental aspect, physical symptoms are also common in generalized anxiety disorder and include fatigue, headache, muscle aches and tension, trouble swallowing, and irritability, among others.

 Anxiety is problematic in that it feeds on itself through negative feedback loops. Negative feedback loops are a cycle in which an event leads to another event, which leads to another and so on. The cycle continues until something terminates it. For example, an individual with anxiety disorder may begin to feel anxious prior to attending a big meeting at work. When the individual notices their anxiety building, they may feel an increase in heart rate and pace of breathing. These symptoms further increase the individual’s anxiety by causing him or her to feel like they may faint. This cycle of anxiety and fear of losing control perpetuates until something occurs to stop it, such as the cancellation of the meeting.

 The cause of generalized anxiety disorder is not known, although genes are believed to play a role. It usually develops gradually and can begin at any point, however onset is usually between childhood and middle age. Generalized anxiety disorder rarely occurs alone and is typically accompanied by other conditions, such as depression or substance abuse, for example. Nearly 7 million people in the United States are affected by generalized anxiety disorder, with women affected twice as often as men. Approximately 20% of patients with fibromyalgia also suffer from generalized anxiety disorder or depression. Treatment typically involves medication or cognitive-behavioral therapy (a type of psychotherapy that helps people understand how their thoughts and feelings influence their behavior), as well as treatment for any co-occurring conditions.

Research on Anxiety and Fibromyalgia

While some studies have shown evidence to support an association between anxiety and depression and the severity of fibromyalgia symptoms (Kurtze et al., 1998), others have not. Studies have, however, consistently found a high prevalence of anxiety, depression, and other mood disorders among individuals who suffer from fibromyalgia.

 A 2010 study by Jensen et al. studied the effect of depression and anxiety on the ability of the brain to process pain in 83 female patients with a confirmed diagnosis of fibromyalgia. The pain threshold for each individual was measured using an algometer, which is a handheld device with a hard rubber probe that is pressed against the body to induce pain. Overall pain thresholds for each individual were assessed on each side of the body at the following locations: back, elbow, thigh, and knees. To examine the brain’s response to pain, each subject underwent a magnetic resonance imaging (MRI) exam. An MRI uses magnetic fields and radio waves to create detailed images of the inner organs of the body. Individuals must lie motionless inside a tube-like machine for a period of time while the MRI machine takes pictures. For the purposes of this study, each subject was also asked to place their thumb into a small machine that applied pressure on the thumbnail bed in order to induce pain. The MRI took pictures of each patient’s brain while the pressure was applied. Questionnaires were used to gauge each subject’s level of depression, anxiety and ability to deal with chronic pain.

 Although the researchers did not find that depressive symptoms, anxiety, and ability to cope with pain were related to any of the measures of pain sensitivity, they did find that the subjects’ self-reported general health status was negatively related to depression and anxiety (i.e., the more depressed an individual was, the poorer their overall health status). In addition, the MRI images revealed that brain activity during the application of pressure to the nail bed (i.e., application of pain) was not related to depression or anxiety levels. The researchers concluded that mood disorders (including depression and anxiety) in individuals with fibromyalgia can result in a poor perception of one’s overall physical health, however they do not appear to be related to experimental measures of pain (Jensen et al., 2010).

  In 2004, Thieme and colleagues studied the prevalence of various psychiatric disorders in a group of 115 fibromyalgia patients, as well as the ability of each individual to adapt to their symptoms based on their psychological state. Various questionnaires were used to assess each subject’s history of the following: physical and sexual abuse; pain severity; perception of how pain interferes with activities of daily living; social support; perception of life control; distress; anxiety; post-traumatic stress disorder-like symptoms; and a general measure of daily activities. In addition, questionnaires also measured each individual’s perception of how other people responded to their outward displays of pain.

 In this study, the researchers found that 77.3% of the subjects had a psychiatric disorder, including 32.2% with anxiety disorders, 34.8% with mood disorders, 1.75% met criteria for substance abuse, and 1.75% met criteria for eating disorders. Of interest, 40.9% also reported a history of sexual abuse and 20.9% reported physical abuse during childhood. Furthermore, 11% of all subjects had more than two mental disorders (e.g., anxiety and a mood disorder). Subjects who had an anxiety disorder showed many more symptoms, including greater numbers of tender points and lower levels of activity, than those patients who were depressed. Furthermore, those with anxiety disorders were more likely to have experienced physical and sexual abuse than those who were depressed.

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References

1.        Jensen KB, Petzke F, Carville S, Fransson P, Marcus H, Williams SCR, Choy E, Mainguy Y, Gracely R, Ingvar M, Kosek E. Anxiety and depressive symptoms in fibromyalgia are related to poor perception of health but not to pain sensitivity or cerebral processing of pain. Arthritis Rheum. 2010;62(11):3488-3495.

2.        Thieme K, Turk DC, Flor H. Comorbid depression and anxiety in fibromyalgia syndrome: relationship to somatic and psychosocial variables. Psychosom Med. 2004;66:837-844.

Kurtze N, Gundersen DK, Svebak S. The role of anxiety and depression in fatigue and patterns of pain among subgroups of fibromyalgia patients. Br J Med Psychol. 1998;71(Pt.2):185-194.

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