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Psychological Factors Modulate Quantitative Sensory Testing Measures in Fibromyalgia Patients: A Systematic Review
Adriana Munhoz Carneiro1, Kevin Pacheco-Barrios, Maria Fernanda Andrade
1From the Mood Disorders Unity-ProGruda and Service of Interdisciplinary Neuromodulation; Department and Institute of Psychiatry, Faculty of Medicine (Carneiro), University of São Paulo, São Paulo, Brazil; Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital (Pacheco-Barrios, Andrade, Martinez-Magallanes, Pichardo, Fregni), Harvard Medical School, Boston, Massachusetts; Universidad San Ignacio de Loyola, Vicerrectorado de Investigación, Unidad de Investigación para la Generación y Síntesis de Evidencias en Salud (Pacheco-Barrios), Lima, Peru; Post-Graduate Program in Medical Sciences, School of Medicine (Caumo), Universidade Federal do Rio Grande do Sul; and Laboratory of Pain and Neuromodulation at Hospital de Clínicas de Porto Alegre (Caumo), Porto Alegre, Rio Grande do Sul, Brazil.
Objective:
Considering the growing evidence that psychological variables might contribute to fibromyalgia syndrome (FMS), our study aims to understand the impact of psychological factors in quantitative sensory testing (QST) in FMS patients by performing a systematic review with meta-analysis.
Methods:
A systematic search was carried out in PubMed/MEDLINE, EMBASE, Web of Science, and PsycINFO databases for records up until January 2024. We included 20 studies ( n = 1623, 16 randomized controlled trials, and 4 nonrandomized controlled trials) with low or moderate risk of bias included.
Results:
From nonrandomized evidence, our meta-analysis found a baseline relationship between anxiety, depression, and pain catastrophizing and QST measures in FMS patients. Higher pain catastrophizing levels were associated with less efficient conditioned pain modulation. Higher anxiety and depression were associated with lower pain threshold (PT). Randomized evidence showed a statistically significant increase in PT after fibromyalgia treatments (effect size = 0.29, 95% confidence interval = 0.03-0.56). The effect was not influenced by treatment type. Moreover, we found that only anxiety levels before treatment negatively influenced the PT improvements after treatment.
Conclusion:
FMS patients with higher anxiety levels at baseline showed a smaller increase in PT after the intervention. Depression factor was not significant in either changes in anxiety or depression. Baseline anxiety levels should be monitored as possible confounders of QST measurements. Understanding how psychological factors and QST are related in FMS patients is critical for improving the syndrome's management and treatment.Protocol Registration: CRD42023429397.
