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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.
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.
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.
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.
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.
The distribution of land and its relief differs markedly between the two hemispheres. This influences both the potential extent of the tree-ring data base and the nature of the climatic and atmospheric circulation features that are to be reconstructed. The atmospheric circulation of the Northern Hemisphere does not have the year-round vigour of the Southern Hemisphere. Pronounced seasonal changes in climate and the strength and position of the major circulation features occur, particularly in the continental interiors. Kelly discusses climatological points of relevance to dendroclimatic analysis.
The Arctic area, reported on by Jacoby, Brubaker and Garfinkel, and Lawson and Kuivinen, is of special interest as climatic variations in high latitudes are particularly marked and may indicate changes over a much wider region. As these authors show, there has been a considerable amount of work undertaken in high latitudes, particularly in Alaska where a clear climate signal in tree rings has been demonstrated. This region has its special problems related to access to sites and the properties of the tree-ring series themselves. It is an area with great potential and one especially requiring international cooperation.
Western North America, reported on by Brubaker, is one of the most heavily worked areas of the globe. It is the source of most climate reconstructions so far. The range of species, the altitudinal gradients, and the latitudinal range have all contributed to this success, although there is much still to be done.
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