Alexithymia, the term for when a person has difficulty identifying and expressing emotions, was present in approximately half of patients with fibromyalgia (FM), according to a study published in European Journal of Pain.1 This percentage was substantially higher in patients when compared with healthy controls and was linked to pain and psychological distress, leading investigators to emphasize the importance of interventions designed to improve emotional awareness, processing, and expression in this patient population.
“Numerous studies indicate that stressful life events or interpersonal conflicts are elevated in patients with FM, and such difficulties not only result from having a painful, often invalidated condition, but also precede FM and likely contribute to its onset or severity,” investigators explained. “There are substantial individual differences in response to stressful life experiences, however, and a key mechanism is people’s capacity for emotional regulation. People who have difficulty adaptively processing and resolving stressful experiences are more susceptible to the effects of these stressors, whereas being able to identify, label, express, and reflect on one’s emotions is adaptive emotion regulation.
To determine the prevalence of alexithymia in FM and its association with pain intensity, depression, and anxiety, investigators conducted a systemic review, including databases such as PubMed, Scopus, Embase, Google Scholar, Web of Science, and PsycINFO. The quality was evaluated using The Joanna Briggs Institute (JBI) tools for cross-sectional studies and STATA:17 for meta-analyses. Of the 763 articles originally identified, 32 studies were ultimately included in the study.
Roughly half (n = 14 of 32) studies examined the prevalence of alexithymia in patients with FM and 19 studies compared FM with control groups. The presence of alexithymia, which was determined based on the percentage of people who had a self-reported Toronto Alexithymia Scale-20 (TAS-20) total score of at least 61, was observed in 48% of patients with FM (95% CI = 0.37 to 0.59). Further, patients with FM had significantly higher rates of alexithymia when compared with both healthy controls (SMD = 1.00; 95% CI: 0.79 to 1.22) and other pain-related conditions (SMD = 0.35, 95% CI = 0.04 to 0.65), including rheumatoid arthritis (SMD = 0.49; 95% CI: 0.08 – .91). The condition was positively associated with pain intensity (r = 0.24), anxiety (r = 0.50), and depression (r = 0.41) in patients with FM.
Article exclusion, such as those not written in English, may have limited the study. Although FM is more prevalent in women when compared with men, only 12 of the studies included both men and women participants. Additionally, solely using a self-reported measure to determine alexithymia may have skewed the observed associations. Investigators also note that alexithymia is correlated with the presence and severity of FM, and therefore causality should not be assumed. The condition may develop as a result of serious pain, depression, disability, or developmental trauma.
“It is recommended that clinicians attend not only to pain, depression, and anxiety in people with FM, but especially to the life stressors and interpersonal conflicts in their lives and the emotional processes (eg, awareness, identification, and expression) such people use,” investigators concluded. “Better outcomes of intervention are likely to occur by targeting such emotional processes.”
Habibi Asgarabad M, Salehi Yegaei P, Jafari F, Azami-Aghdash S, Lumley MA. The Relationship of Alexithymia to Pain and Other Symptoms in Fibromyalgia: A Systematic Review and Meta-analysis [published online ahead of print, 2022 Dec 5]. Eur J Pain. 2022;10.1002/ejp.2064. doi:10.1002/ejp.2064