(221) Associations between post traumatic stress disorder symptoms and mental health in fibromyalgia.
s The Journal of Pain S31 expression study reported significantly higher expression of the gene coding for heat shock protein (HSP90AA1, highly involved in ubiquitination pathways) among FMSwomen compared to those without FMS. This current study examined the associations between plasma HPS90AA1 and various symptoms (i.e. pain, fatigue, sleep, cognitive dysfunction) among adults with FMS. This is an IRBapproved descriptive study part of a collaborative project between two institutions. Patients diagnosed with FMS based on 1990 or 2010 diagnostic criteria were included. Questionnaires and blood samples were collected. HSP90AA1 plasma levels weremeasured using Enzyme linked Immunosorbent Assay. Data analyses included 135 subjects using SPSSv22. There were 16% (n=21) who met only 1990 diagnostic criteria, 26% (n=35) met 2010 diagnostic criteria, while 59% (n=79) met both criteria. Ages ranged from 21 82 years with a mean of 45.99 (SD=11.19) Majority were female (n=119, 88% Nearly 60% were Caucasians, 34% African Americans, and 6%were of other ethnic groups. Duration of FMS diagnosis ranged from 1 29 years with a mean of 7.4 years (SD=7.0) Results showed that higher plasma HSP90AA1 levels were significantly associated with higher number of pain sites (high WPI, rs= 0.17, p=0.051) more general fatigue (rs=0.384, p=0.000) greater physical fatigue (rs=0.278, p=0.003) higher mental fatigue (rs=0.260, p=0.007) and reduced motivation (rs= 0.263, p=0.006) Higher plasma HSP90AA1 levels were trending toward significant associations to high pain severity at present (BPI pain now; rs=0.179, p=0.066) and sleep interference (rs=0.187, p=0.057) No significant associations were found between HSP90AA1 levels and cognitive dysfunction. Results suggest a significant role of ubiquitination pathways in symptom burden. Longitudinal studies should be conducted to better understand the role of HSP protein in symptoms biology. Supported by University of Nevada, Las Vegas, School of Nursing grant. (221) Associations between post traumatic stress disorder symptoms and mental health in fibromyalgia M Whipple, L Toussaint, K Fleming, S Nanda, A Mohabbat, and A Vincent; Mayo Clinic, Rochester, MN Research suggests that many patients who suffer from post traumatic stress disorder (PTSD) frequently also have fibromyalgia and vice versa. Patients with PTSD with concurrent fibromyalgia reported more pain, greater tenderness, lower quality of life, greater functional impairment, and more psychological distress as compared to patients with PTSD without concurrent fibromyalgia. However, it is unknown how PTSD may contribute to the mental health impairment in fibromyalgia. The purpose of this study was to evaluate symptoms of PTSD in patients with fibromyalgia and determine if PTSD symptoms could mediate differences in mental health between patients with fibromyalgia and healthy controls. Thirty patients and 30 healthy controls completed questionnaires assessing anxiety, depression, affect, and symptoms of PTSD. Multiple regression was used to assess the association between group (fibromyalgia versus healthy control) and mental health symptoms while controlling confounding influences of age and BMI and considering the mediating effect of trauma symptoms. On average, patients with fibromyalgia were 47.0 years of age (SD 10.4) white (96.7% and non Hispanic (100% As expected, patients with fibromyalgia had poorer mental health than healthy controls. Patient control differences in mental health were fully or partially mediated by differences in PTSD symptoms. Patients with fibromyalgia differed most greatly from healthy controls on the arousal subscale of trauma symptoms. This high degree of arousal symptoms might suggest that central sensitization may bear some relevance to understanding fibromyalgia and PTSD connections. Clinicians who care for patients with fibromyalgia should be aware of the role of trauma as management of trauma symptoms may be one strategy for improving mental health. (222) Fatigue mediates the relationship between pain and cognitive dysfunction in fibromyalgia T Bell and J Shelley Tremblay; University of South Alabama, Mobile, AL Fibromyalgia affects 2% of the world's population and is characterized by significant pain, in particular, allodynia and hyperalgesia. Self report and performance measures also indicate significant impairments in both cognition and attention, often termed 'fibrofog. Pain has been linked to fibrofog but the mechanisms underlying this relationship are not well understood. One possible mechanism may be fatigue from pain perception, which may be indicative of over use of attentional resources. Fatigue may therefore lead to the sense of 'fogginess' and 'poor concentration' caused by cognitive depletion. The current study recruited ninetysix persons with fibromyalgia (all female, Mage 42.59, SD 10.67) from both the local community and internet support groups. Pain wasmeasured using a visual analogue scale and fatiguewas assessed by the Profile of Mood States. Fibrofog was measured using the Mental Clutter Scale, which has been shown to have high reliability and validity. Bootstrappingwith 5000 resamples was used to test the mediating effects of fatigue and to produce bias corrected confidence intervals. Looking at linear regression, pain intensity was significantly associated with fibrofog (b 0.35, SE 0.10, 95% BC .18 to .53) and fatigue (b 1.23, SE .22, 95% BC CI 0.79 to1.67) However, when fibrofog was regressed on both pain intensity and fatigue, only fatigue remained significant (b 0.16, SE .04, 95% BC CI .08 to .23) Bootstrap analysis concluded that fatigue significantly mediated the effect of pain intensity on fibrofog (b .19, SEboot .06, 95% BC CI .10 to .32) Thus, fatigue may not only be a result of pain, but also serve as a possible marker of depleted cognitive resources. (223) Circadian activity rhythms in women with fibromyalgia A Neikrug, E Iacob, A Okifuji, Y Nakamura, and G Donaldson; University of Utah, Salt Lake City, UT Depression is common in fibromyalgia syndrome (FMS) and in patients with a delayed circadian phase (tendency for later sleep and wakeup time) Little is known regarding circadian activity rhythms (CAR) of FMS and the relationship between circadian phase, depression, and pain. We hypothesized that FMS patients with delayed CAR will report increased depressive symptomology and pain. 274 women (mean age=45.1yrs, SD=11.0, range=21 54yrs) with FMS were assessed for activity (7 day actigraphy) depressive symptomology (Center for Epidemiologic Studies Depression Scale, CESD) and pain (tender point (TP) pain severity) Acrophase (time of the day of the peak of the activity curve) which is one of the indicators of CAR, was derived from actigraphy data using a cosine model that was fit independently for each participant. There was a weak, yet significant linear relationship between acrophase and CESD score (r=0.17, p=0.005) and between acrophase and TP pain severity (r=0.20, p=0.002) Patients were then grouped into CAR phases based on observed percentile rank of acrophase within this sample: advanced acrophase <25th percentile: acrophase earlier than 2:38PM) average acrophase (25 75th percentile: acrophase between 2:38PM 4:39PM) or delayed acrophase >75th percentile: acrophase after 4:39PM) Mean CESD scores were 23.9, 25.6, 28.9 for advanced, average, and delayed phase, respectively (F=3.82, p=0.023) and a mean TP pain severity were 5.1, 5.2, 5.9 respectively (F=5.26, p=0.006) These data provide preliminary evidence for a relationship between delayed acrophase and FMS related pain and mood. Patients with progressively more delayed CAR showed increased depressive symptomology and greater pain response. The results suggest that CAR may be an important factor in FMS and merit further investigation. (224) Differences in plasma levels of heat shock proteins between persons with and without fibromyalgia N Lukkahatai, K Kaur, B Walitt, J Kawi, A Espina, and L Saligan; University of Nevada Las Vegas, Las Vegas, NV The authors aimed to examine plasma levels of heat shock protein (HSP99AA1) between persons with and without fibromyalgia syndrome (FMS) FMS is a chronic condition characterized by chronic, persistent muscular pain, fatigue, extreme tenderness, insomnia and cognitive dysfunction. The etiology of FMS is unknown. Recent study reported higher expression ofHSP99AA1 gene and higher level of plasma heat shock protein (HSP99AA1) among women with FMS compared to gender, age, race matched healthy controls. Persons with FMS met the 1990 or 2010 FMS diagnostic criteria. They were 20 years or older and were age, gender, and race matched with pain free volunteers. During their single visit at a local rheumatology
The journal of pain official journal of the American Pain Society