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The role of interoception in the mechanism of pain and fatigue in fibromyalgia and myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS)

Published online by Cambridge University Press:  13 August 2021

H. Sharp*
Affiliation:
Department Of Neuroscience, Brighton and Sussex Medical School, PX, United Kingdom Psychiatry, Sussex Partnership NHS Foundation Trust, EP, United Kingdom
K. Themelis
Affiliation:
Department Of Neuroscience, Brighton and Sussex Medical School, PX, United Kingdom Department Of Psychology, University of Warwick, AL, United Kingdom
M. Amato
Affiliation:
Department Of Neuroscience, Brighton and Sussex Medical School, PX, United Kingdom
A. Barritt
Affiliation:
Department Of Neuroscience, Brighton and Sussex Medical School, PX, United Kingdom
K. Davies
Affiliation:
Department Of Clinical And Experimental Medicine, Brighton and Sussex Medical School, PX, United Kingdom
N. Harrison
Affiliation:
Department Of Neuroscience, Brighton and Sussex Medical School, PX, United Kingdom Cardiff University Brain Research Imaging Centre, University of Cardiff, HQ, United Kingdom
H. Critchley
Affiliation:
Department Of Neuroscience, Brighton and Sussex Medical School, PX, United Kingdom Psychiatry, Sussex Partnership NHS Foundation Trust, EP, United Kingdom
S. Garfinkel
Affiliation:
Department Of Neuroscience, Brighton and Sussex Medical School, PX, United Kingdom Institute Of Cognitive Neuroscience, University College London, AZ, United Kingdom
J. Eccles
Affiliation:
Department Of Neuroscience, Brighton and Sussex Medical School, PX, United Kingdom Psychiatry, Sussex Partnership NHS Foundation Trust, EP, United Kingdom
*
*Corresponding author.

Abstract

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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.

Type
Abstract
Creative Commons
Creative Common License - CCCreative Common License - BY
This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Copyright
© The Author(s), 2021. Published by Cambridge University Press on behalf of the European Psychiatric Association
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