The role of interoception in the mechanism of pain and fatigue in fibromyalgia and myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS)
Introduction Pain, fatigue and anxiety are common features of fibromyalgia and ME/CFS and significantly impact quality of life. Aetiology is poorly defined but dysfunctional inflammatory, autonomic and interoceptive (sensing of internal bodily signals) processes are implicated. Objectives To inv...
| Main Authors: | , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Cambridge University Press
2021-04-01
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| Series: | European Psychiatry |
| Subjects: | |
| Online Access: | https://www.cambridge.org/core/product/identifier/S0924933821003825/type/journal_article |
| _version_ | 1797617271154147328 |
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| author | H. Sharp K. Themelis M. Amato A. Barritt K. Davies N. Harrison H. Critchley S. Garfinkel J. Eccles |
| author_facet | H. Sharp K. Themelis M. Amato A. Barritt K. Davies N. Harrison H. Critchley S. Garfinkel J. Eccles |
| author_sort | H. Sharp |
| collection | DOAJ |
| description |
Introduction
Pain, fatigue and anxiety are common features of fibromyalgia and ME/CFS and significantly impact quality of life. Aetiology is poorly defined but dysfunctional inflammatory, autonomic and interoceptive (sensing of internal bodily signals) processes are implicated.
Objectives
To investigate how altered interoception relates to baseline expression of pain, fatigue and anxiety symptoms in fibromyalgia and ME/CFS and in response to an inflammatory challenge.
Methods
Sixty-five patients with fibromyalgia and/or ME/CFS diagnosis and 26 matched controls underwent baseline assessment: pressure-pain thresholds and self-report questionnaires assessing pain, fatigue and anxiety severity. Participants received injections of typhoid (inflammatory challenge) or saline (placebo) in a randomised, double-blind, crossover design, before completing heartbeat tracking tasks. Three interoception dimensions were examined: subjective sensibility, objective accuracy and metacognitive awareness. Interoceptive trait prediction error was calculated as discrepancy between accuracy and sensibility.
Results
Patients with fibromyalgia and ME/CFS had significantly higher interoceptive sensibility and trait prediction error, despite no differences in interoceptive accuracy. Interoceptive sensibility and trait prediction error correlated with all self-report pain, fatigue and anxiety measures, and with lower pain thresholds. Anxiety mediated the positive-predictive relationships between pain (Visual Analogue Scale and Widespread Pain Index), fatigue impact and interoceptive sensibility. After inflammatory challenge, metacognitive awareness correlated with baseline self-reported symptom measures and lower pain thresholds.
Conclusions
This is the first study investigating interoceptive dimensions in patients with fibromyalgia and ME/CFS, which were found to be dysregulated and differentially influenced by inflammatory mechanisms. Interoceptive processes may represent a new potential target for diagnostic and therapeutic investigation in these poorly understood conditions.
Disclosure
No significant relationships.
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| first_indexed | 2024-03-11T07:53:27Z |
| format | Article |
| id | doaj.art-4b1aa0730e1a4686a8505e6acbfc5351 |
| institution | Directory Open Access Journal |
| issn | 0924-9338 1778-3585 |
| language | English |
| last_indexed | 2024-03-11T07:53:27Z |
| publishDate | 2021-04-01 |
| publisher | Cambridge University Press |
| record_format | Article |
| series | European Psychiatry |
| spelling | doaj.art-4b1aa0730e1a4686a8505e6acbfc53512023-11-17T05:06:11ZengCambridge University PressEuropean Psychiatry0924-93381778-35852021-04-0164S139S13910.1192/j.eurpsy.2021.382The role of interoception in the mechanism of pain and fatigue in fibromyalgia and myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS)H. Sharp0K. Themelis1M. Amato2A. Barritt3K. Davies4N. Harrison5H. Critchley6S. Garfinkel7J. Eccles8Department Of Neuroscience, Brighton and Sussex Medical School, PX, United Kingdom Psychiatry, Sussex Partnership NHS Foundation Trust, EP, United KingdomDepartment Of Neuroscience, Brighton and Sussex Medical School, PX, United Kingdom Department Of Psychology, University of Warwick, AL, United KingdomDepartment Of Neuroscience, Brighton and Sussex Medical School, PX, United KingdomDepartment Of Neuroscience, Brighton and Sussex Medical School, PX, United KingdomDepartment Of Clinical And Experimental Medicine, Brighton and Sussex Medical School, PX, United KingdomDepartment Of Neuroscience, Brighton and Sussex Medical School, PX, United Kingdom Cardiff University Brain Research Imaging Centre, University of Cardiff, HQ, United KingdomDepartment Of Neuroscience, Brighton and Sussex Medical School, PX, United Kingdom Psychiatry, Sussex Partnership NHS Foundation Trust, EP, United KingdomDepartment Of Neuroscience, Brighton and Sussex Medical School, PX, United Kingdom Institute Of Cognitive Neuroscience, University College London, AZ, United KingdomDepartment Of Neuroscience, Brighton and Sussex Medical School, PX, United Kingdom Psychiatry, Sussex Partnership NHS Foundation Trust, EP, United Kingdom Introduction Pain, fatigue and anxiety are common features of fibromyalgia and ME/CFS and significantly impact quality of life. Aetiology is poorly defined but dysfunctional inflammatory, autonomic and interoceptive (sensing of internal bodily signals) processes are implicated. Objectives To investigate how altered interoception relates to baseline expression of pain, fatigue and anxiety symptoms in fibromyalgia and ME/CFS and in response to an inflammatory challenge. Methods Sixty-five patients with fibromyalgia and/or ME/CFS diagnosis and 26 matched controls underwent baseline assessment: pressure-pain thresholds and self-report questionnaires assessing pain, fatigue and anxiety severity. Participants received injections of typhoid (inflammatory challenge) or saline (placebo) in a randomised, double-blind, crossover design, before completing heartbeat tracking tasks. Three interoception dimensions were examined: subjective sensibility, objective accuracy and metacognitive awareness. Interoceptive trait prediction error was calculated as discrepancy between accuracy and sensibility. Results Patients with fibromyalgia and ME/CFS had significantly higher interoceptive sensibility and trait prediction error, despite no differences in interoceptive accuracy. Interoceptive sensibility and trait prediction error correlated with all self-report pain, fatigue and anxiety measures, and with lower pain thresholds. Anxiety mediated the positive-predictive relationships between pain (Visual Analogue Scale and Widespread Pain Index), fatigue impact and interoceptive sensibility. After inflammatory challenge, metacognitive awareness correlated with baseline self-reported symptom measures and lower pain thresholds. Conclusions This is the first study investigating interoceptive dimensions in patients with fibromyalgia and ME/CFS, which were found to be dysregulated and differentially influenced by inflammatory mechanisms. Interoceptive processes may represent a new potential target for diagnostic and therapeutic investigation in these poorly understood conditions. Disclosure No significant relationships. https://www.cambridge.org/core/product/identifier/S0924933821003825/type/journal_articleInteroceptionPainfatigueAnxiety |
| spellingShingle | H. Sharp K. Themelis M. Amato A. Barritt K. Davies N. Harrison H. Critchley S. Garfinkel J. Eccles The role of interoception in the mechanism of pain and fatigue in fibromyalgia and myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) European Psychiatry Interoception Pain fatigue Anxiety |
| title | The role of interoception in the mechanism of pain and fatigue in fibromyalgia and myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) |
| title_full | The role of interoception in the mechanism of pain and fatigue in fibromyalgia and myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) |
| title_fullStr | The role of interoception in the mechanism of pain and fatigue in fibromyalgia and myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) |
| title_full_unstemmed | The role of interoception in the mechanism of pain and fatigue in fibromyalgia and myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) |
| title_short | The role of interoception in the mechanism of pain and fatigue in fibromyalgia and myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) |
| title_sort | role of interoception in the mechanism of pain and fatigue in fibromyalgia and myalgic encephalomyelitis chronic fatigue syndrome me cfs |
| topic | Interoception Pain fatigue Anxiety |
| url | https://www.cambridge.org/core/product/identifier/S0924933821003825/type/journal_article |
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