Psychologic risk factors

Mental disorders

Compared with controls, FMS patients show a significantly higher prevalence of depressive and anxiety disorders, reported in 20-80% and 13-63.8% of cases, respectively. This high variability may depend on the psychosocial characteristics of patients, since most of the studies were performed in tertiary care settings. Even referring to the lower percentages, the occurrence of mental disorders is significantly higher in FMS subjects compared to the general population [30]. Co-morbid post-traumatic stress disorders have been reported in 30-60% of FMS patients [9]. Moreover, elevated frequencies of mental disorders have been described in relatives of FMS patients [30, 31]. The FMS/mental disorder aggregation suggests a common pathophysiology, and alterations of neurotransmitter systems may constitute the shared underlying factors [30].

Depressed mood

A prospective Norwegian population-based study found that depressed mood predicted the manifestation of FMS in patients with only local pain on the initial assessment [32].

Functional somatic syndromes

The prevalence of other functional somatic syndromes such as chronic fatigue syndrome or irritable bowel symptoms has been reported as 30-80%, depending on the setting and the diagnostic methods used [33]. The frequent aggregation of functional somatic syn-droms suggests a common pathophysiology [17].

Somatization

Two British population-based studies found that somatization predicted the manifestation of CWP [34, 35].

Somatization was a stronger predictor of the manifestation of CWP than work-related mechanical factors [34]. A population-based British study demonstrated that subjects were at substantially increased odds of developing CWP if they displayed features of somatization, healthcare-seeking behavior and poor sleep [36].

Childhood adversities

Numerous retrospective case-control studies have shown that traumatic experiences (maltreatment, sexual abuse, emotional neglect) during childhood are more frequently reported by FMS patients in clinical populations than by medically ill or healthy controls [31]. However, these studies are biased due to recall setting and response bias [37]. A British population-based case-control study found an association between CWP and hospital treatment in childhood, but not with sexual abuse or chronically ill parents [38]. A systematic review of prospective studies on sexal abuse in childhood and chronic pain syndromes in adulthood found no clear evidence for a causal relationship to FMS [37].

Negative life events in adulthood Although retrospective studies in clinical samples suggest that the onset of FMS is frequently associated with various types of negative life events [31], prospective population-based studies failed to demonstrate an increased risk of FMS-like pain complaints following the World Trade Center terrorist attack [39].

Daily hassles

Workplace bullying, high workload and low decision latitude were associated with an increased incidence of diagnosed FMS within a Finnish prospective population-based study [40].

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