Perceived threatening influences on severity of somatic symptoms in people with fibromyalgia: a concept mapping study

Abstract

Objective: It has been assumed that due to overactivation of the sensitive brain in individuals with fibromyalgia (FM), the threat detection system perceives threats in a more extreme way, leading to an increase in symptoms such as widespread musculoskeletal pain, fatigue and disturbed mood. In order to get a better idea of the perceived threatening influences on somatic symptoms in people with FM and to be able to adjust therapy accordingly, this study aims to obtain a hierarchical overview from the point of view of the individual suffering from FM. Methods: 701 individuals with somatic symptoms participated in an online survey providing 40 threatening influences. These influences were sorted by 73 other individuals with somatic symptoms using a card sorting task based on similarity of meaning. Severity of somatic symptoms was assessed with the Patient Health Questionnaire 15 (PHQ-15). Hierarchical cluster analysis (squared Euclidean distances, Ward's method) was used to obtain a hierarchical overview of threatening influences. Differences in perceived importance of threats per category were checked using a repeated measure analysis of variance. The association between the threats of each category and symptom severity were examined using three linear regression analyses, correlating the total PHQ-15 with the scores of each category. Results: The hierarchical cluster analysis outcomes showed three categories of threatening influences on somatic symptoms for people with FM: “symptoms and consequences of disease”, “(social) demands” and “negative thoughts and emotions”. The categories did not differ from each other in terms of relative importance. Nor were the categories related to somatic symptom severity. Conclusion: This study found a comprehensive hierarchical structure for threats that influence somatic symptoms according to people with FM. This structure can be used to guide research and it can lead to tailor-made treatments, for example by means of a screening instrument that can provide direction for treatment based on perceived threats within the categories. This could lead to higher effectiveness of treatment.