Fibromyalgia as a heterogeneous conditionSubgroups of patients based on physical symptoms and cognitive-affective variables related to pain

  1. M. Pilar Martínez 1
  2. Ana I. Sánchez 1
  3. Germán Prados 1
  4. Maria José Lami Hernández 1
  5. Beatriz Villar 1
  6. Elena Miró 1
  1. 1 Universidad de Granada
    info

    Universidad de Granada

    Granada, España

    ROR https://ror.org/04njjy449

Revista:
The Spanish Journal of Psychology

ISSN: 1138-7416

Año de publicación: 2021

Número: 24

Tipo: Artículo

DOI: 10.1017/SJP.2021.30 DIALNET GOOGLE SCHOLAR lock_openAcceso abierto editor

Otras publicaciones en: The Spanish Journal of Psychology

Resumen

Fibromyalgia (FM) is a chronic syndrome characterized by heterogeneous clinical manifestations, and knowing this variability can help to develop tailored treatments. To understand better the heterogeneity of FM the present crosssectional study analyzed the role of several physical symptoms (pain, fatigue and poor sleep quality) and cognitiveaffective variables related to pain (pain catastrophizing, pain vigilance, self-efficacy in pain management, and pain acceptance) in the configuration of clinical profiles. A sample of 161 women with FM fulfilled an interview and several self-report measures to explore physical symptoms, cognitive-affective variables, disability and psychopathology. To establish FM groups a hierarchical cluster analysis was performed. The findings revealed three clusters that differed in the grouping variables, Wilks’ λ = .17, F(14, 304) = 31.50, p < .001, ηp2 = .59. Group 1 (n = 72) was characterized by high physical and psychological affectation, Group 2 (n = 19) by low physical affectation and high pain self-efficacy, and Group 3 (n = 70) by moderate physical affectation and low pain catastrophizing. The external validation of the clusters was confirmed, Wilks’ λ = .72, F(4, 314) = 14.09, p < .001, ηp2 = .15, showing Group 1 the highest levels ofFMimpact and psychopathological distress. Considering the distinctive clinical characteristics of each subgroup therapeutic strategies addressed to the specific needs of each group were suggested. Assessing FM profiles may be key for a better understanding and approach of this syndrome.

Referencias bibliográficas

  • Alonso-Tapia, J., Garrido-Hernansaiz, H., Rodríguez-Rey, R., Ruiz Díaz, M., & Nieto, C. (2018). Evaluating resilience: Development and validation of the situated subjective resilience questionnaire for adults (SSRQA). The Spanish Journal of Psychology, 21, Article E39. https://doi.org/ 10.1017/sjp.2018.44.
  • Anderson, K. O., Dowds, B. N., Pelletz, R. E., Edwards,W. T., & Peeters-Asdourian, C. (1995). Development and initial validation of a scale to measure self-efficacy beliefs in patients with chronic pain. Pain, 63(1), 77–83. https:// doi.org/10.1016/0304-3959(95)00021-J.
  • Arco García, L., González Pérez, R., Henares Extremera, A., García León, M. A., & Peralta-Ramírez, M. I. (2020). Psychological and sociodemographic variables related to cortisol in hair in Spanish healthy population. The Spanish Journal of Psychology, 23, Article E14. https://doi.org/ 10.1017/SJP.2020.16.
  • Auvinet, B., & Chaleil, D. (2012). Identification of subgroups among fibromyalgia patients. Reumatismo, 64(4), 250–260. https://doi.org/10.4081/reumatismo.2012.250.
  • Bartley, E. J., Robinson, M. E., & Staud, R. (2018). Pain and fatigue variability patterns distinguish subgroups of fibromyalgia patients. The Journal of Pain, 19(4), 372–381. https://doi.org/10.1016/j.jpain.2017.11.014.
  • Belenguer, R., Ramos-Casals, M., Siso, A., & Rivera, J. (2009). Clasificación de la fibromialgia: Revisión sistemática de la literatura [Classification of fibromyalgia: A systematic review of the literature]. Reumatología Clínica, 5(2), 55–62. https://doi.org/10.1016/j.reuma.2008.07.001.
  • Bellato, E., Marini, E., Castoldi, F., Barbasetti, N., Mattei, L., Bonasia,D. E.,&Blonna,D. (2012). Fibromyalgia syndrome: Etiology, pathogenesis, diagnosis, and treatment. Pain Research and Treatment, 2012, Article ID 426130. https:// doi.org/10.1155/2012/426130.
  • Bennett, R. M., Bushmakin, A. G., Cappelleri, J. C., Zlateva, G., & Sadosky, A. B. (2009). Minimal clinically important difference in the Fibromyalgia Impact Questionnaire. The Journal of Rheumatology, 36(6), 1304–1311. https://doi.org/ 10.3899/jrheum.081090.
  • Bernardy, K., Klose, P., Welsch, P., & Häuser, W. (2018). Efficacy, acceptability and safety of cognitive behavioural therapies in fibromyalgia syndrome: A systematic review and meta-analysis of randomized controlled trials. European Journal of Pain, 22(2), 242–260. https://doi.org/10.1002/ ejp.1121.
  • Bucourt, E., Martaillé, V., Goupille, P., Joncker-Vannier, I., Huttenberger, B., Réveillère, C.,Mulleman,D., &Courtois, R. (2019). A comparative study of fibromyalgia, rheumatoid arthritis, spondyloarthritis, and Sjögren’s syndrome: Impact of the disease on quality of life, psychological adjustment, and use of coping strategies. Pain Medicine, 22, 372–381. https://doi.org/10.1093/pm/pnz255.
  • Burckhardt, C. S., Clark, S. R., & Bennett, R. M. (1991). The Fibromyalgia Impact Questionnaire: Development and validation. Journal of Rheumatology, 18(5), 728–733.
  • Buysse, D. J., Reynolds, C. F., III, Monk, T. H., Berman, S. R., &Kupfer, D. J. (1989). The Pittsburgh SleepQuality Index: A new instrument for psychiatric practice and research. Psychiatry Research, 28(2), 193–213. https://doi.org/ 10.1016/0165-1781(89)90047-4.
  • Calandre, E. P., García-Carrillo, J., García-Leiva, J. M., RicoVillademoros, F., Molina-Barea, R., & Rodríguez-López, C. M. (2011). Subgrouping patients with fibromyalgia according to the results of the Fibromyalgia Impact Questionnaire: A replication study. Rheumatology International, 31, 1555–1559. https://doi.org/10.1007/ s00296-010-1521-3.
  • Cheng, S.-T., Leung, C.M. C., Chan, K. L., Chen, P. P., Chow, Y. F., Chung, J. W. Y., Law, A. C. B., Lee, J. S. W., Leing, E. M. F., & Tam, C. W. C. (2018). The relationship of selfefficacy to catastrophizing and depressive symptoms in community-dwelling older adults with chronic pain: A moderated mediation model. PLOS ONE, 13(9), Article e0203964. https://doi.org/10.1371/journal.pone.0203964.
  • Collado, A., Gómez, E., Coscolla, R., Sunyol, R., Solé, E., Rivera, J., Altarriba, E., Carbonell, J., & Castells, X. (2014). Work, family and social environment in patients with fibromyalgia in Spain: An epidemiological study. EPIFFAC study. BMC Health Services Research, 14, Article 513. https:// doi.org/10.1186/s12913-014-0513-5.
  • Crombez,G., Eccleston, C., VanDamme, S., Vlaeyen, J.W. S., & Karoly, P. (2012). Fear-avoidance model of chronic pain: The next generation. The Clinical Journal of Pain, 28(6), 475–485. https://doi.org/10.1097/AJP.0b013e3182385392.
  • Crombez, G., Eccleston, C., van den Broeck, A., Goubert, L., & van Houdenhove, B. (2004). Hypervigilance to pain in fibromyalgia: The mediating role of pain intensity and catastrophic thinking about pain. The Clinical Journal of Pain, 20(2), 98–102. http://doi.org/10.1097/00002508-200403000- 00006.
  • Derogatis, L. R. (1994). SCL–90–R. Symptom Checklist–90– Revised. Administration, scoring and procedures manual. NCS Pearson.
  • deSouza, J. B.,Goffaux, P., Julien,N., Potvin, S., Charest, J.,& Marchand, S. (2009). Fibromyalgia subgroups: Profiling distinct subgroups using the Fibromyalgia Impact Questionnaire: A preliminary study. Rheumatology International, 29, 509–515. https://doi.org/10.1007/s00296- 008-0722-5.
  • Docampo, E., Collado, A., Escaramís, G., Carbonell, J., Rivera, J., Vidal, J., Alegre, J., Rabionet, R., & Estivill, X. (2013). Cluster analysis of clinical data identifies fibromyalgia subgroups. PLOS ONE, 8(9), Article e74873. https://doi.org/10.1371/journal.pone.0074873.
  • Écija, C., Luque-Reca, O., Suso-Ribera, C., Catala, P., & Peñacoba, C. (2020). Associations of cognitive fusion and pain catastrophizing with fibromyalgia impact through fatigue, pain severity, and depression: An exploratory study using structural equation modeling. Journal of Clinical Medicine, 9(6), Article 1763. https://doi.org/10.3390/ jcm9061763.
  • Estévez-López, F., Segura-Jiménez, V., Álvarez-Gallardo, I. C., Borges-Cosic, M., Pulido-Martos, M., CarbonellBaeza, A., Aparicio, V. A., Geenen, R., & DelgadoFernández, M. (2017). Adaptation profiles comprising objective and subjective measures in fibromyalgia: The Al-Andalus project. Rheumatology, 56(11), 2015–2024. https://doi.org/10.1093/rheumatology/kex302.
  • Fillion, L., Gélinas, C., Simard, S., Savard, J., & Gagnon, P. (2003). Validation evidence for the French Canadian adaptation of the Multidimensional Fatigue Inventory as a measure of cancer-related fatigue. Cancer Nursing, 26(2), 143–154. http://doi.org/10.1097/00002820-200304000- 00008.
  • Follick, B. T., Cherry, B. J., Rutledge, D.N., Zettel-Watson, L., & Jones, C. J. (2016). Heterogeneity in fibromyalgia based upon cognitive and physical performance and psychological symptomology. Journal of the American Association of Nurse Practitioners, 28(1), 19–30. https://doi.org/10.1002/2327- 6924.12270.
  • Font, T., Bordoy, C., Mas, A. J., Seoane-Mato, D., Álvarez, F., Delgado, M., Martínez, C., Sánchez-Fernández, S. A., Rojas, L. M., García, P. V., Olivé, A., Rubio, P., Larrosa, M.,
  • Navarro, N., Sánchez-Piedra, C., Díaz-González, F., Bustabad-Reyes, S., & the Working Group Proyecto EPISER2016. (2020). Prevalence of fibromyalgia and associated factors in Spain. Clinical and Experimental Rheumatology, 38(123), S47–S52.
  • Formann, A. K. (1984).Die latent-class-analyse: Einfuhrung in die theorie und anwendung [Class-latent analysis: Introduction to theory and application]. Beltz.
  • Galvez-Sánchez, C. M., & Reyes del Paso, G. A. (2020). Diagnostic criteria for fibromyalgia: Critical review and future perspectives. Journal of Clinical Medicine, 9(4), Article 1219. https://doi.org/10.3390/jcm9041219.
  • García-Campayo, J., Rodero, R., Alda, M., Sobradiel, N., Montero, J., & Moreno, S. (2008). Validación de la versión española de la Escala de la Catastrofización ante el Dolor (Pain Catastrophizing Scale) en la fibromialgia [Validation of the Spanish version of the Pain Catastrophizing Scale in fibromyalgia]. Medicina Clínica, 131(13), 487–492. https:// doi.org/10.1157/13127277.
  • Giesecke, T.,Williams,D.A.,Harris, R. E., Cupps, T. R., Tian, X., Tian, T. X., Gracely, R. H., & Clauw, D. J. (2003). Subgrouping of fibromyalgia patients on the basis of pressure-pain thresholds and psychological factors. Arthritis & Rheumatism, 48(10), 2916–2922. https://doi.org/10.1002/ art.11272.
  • Gonzalez, B., Novo, R., & Peres, R. (2020). Personality and psychopathology heterogeneity in MMPI–2 and healthrelated features infibromyalgia patients. Scandinavian Journal of Psychology. https://doi.org/10.1111/sjop.12694.
  • González de Rivera, J. L., de las Cuevas, C., RodríguezAbuín, M., & Rodríguez-Pulido, F. (2002). SCL–90–R. Cuestionario de 90 síntomas [SCL–90–R. Symptom Checklist– 90–Revised]. TEA Ediciones.
  • Häuser, W., Perrot, S., Clauw, D. J., & Fitzcharles, M. A. (2018). Unravelling fibromyalgia-steps toward individualized management. The Journal of Pain, 19(2), 125–134. https://doi.org/10.1016/j.jpain.2017.08.009.
  • Hegarty, R. S.M., Fletcher, B. D., Conner, T. S., Stebbings, S., & Treharne, G. J. (2020). Acceptance and commitment therapy for peoplewith rheumatic disease: Existing evidence and future directions. Musculoskeletal Care, 18(3), 330–341. https://doi.org/10.1002/msc.1464.
  • Hita-Contreras, F., Martínez-López, E., Latorre-Román, P. A., Garrido, F., Santos, M. A., & Martínez-Amat, A. (2014). Reliability and validity of the Spanish version of the Pittsburgh Sleep Quality Index (PSQI) in patients with fibromyalgia. Rheumatology International, 34, 929–936. https://doi.org/10.1007/s00296-014-2960-z.
  • Horta-Baas, G., & Romero-Figueroa, M. d. S. (2019). Selfreported disability in women with fibromyalgia from a tertiary care center. Advances in Rheumatology, 59, Article 45. https://doi.org/10.1186/s42358-019-0086-4.
  • Lami, M. J., Martínez, M. P., Miró, E., Sánchez, A. I., & Guzmán, M. A. (2018). Catastrophizing, acceptance, and coping as mediators between pain and emotional distress and disability in fibromyalgia. Journal of Clinical Psychology in Medical Settings, 25(1), 80–92. https://doi.org/10.1007/ s10880-018-9543-1.
  • Leeuw, M., Goossens, M. E. J. B., Linton, S. J., Crombez, G., Boersma, K., & Vlaeyen, J. W. S. (2007). The fear-avoidance model of musculoskeletal pain: Current state of scientific evidence. Journal of Behavioral Medicine, 30(1), 77–94. https:// doi.org/10.1007/s10865-006-9085-0.
  • Loevinger, B. L., Shirtcliff, E. A., Muller, D., Alonso, C., & Coe, C. L. (2012). Delineating psychological and biomedical profiles in a heterogeneous fibromyalgia population using cluster analysis. Clinical Rheumatology, 31(4), 677–685. https://doi.org/10.1007/s10067-011-1912-1.
  • Luciano, J. V., García-Forero, C., Cerdà-Lafont, M., Peñarrubia-María, M. T., Fernández-Vergel, R., Cuesta- Vargas, A. I., Ruíz, J. M., Rozadilla-Sacanell, A., SirventAlierta, E., Santo-Panero, P., García-Campayo, J., SerranoBlanco, A., Pérez-Aranda, A., & Rubio-Valera, M. (2016). Functional status, quality of life, and costs associated with fibromyalgia subgroups: A latent profile analysis. The Clinical Journal of Pain, 32(10), 829–840. https://doi.org/ 10.1097/AJP.0000000000000336.
  • Lledó-Boyer, A., Pastor-Mira,M., Pons-Calatayud,N., LópezRoig, S., Rodríguez-Marín, J., & Bruehl, S. (2010). Control beliefs, coping and emotions: Exploring relationships to explain fibromyalgia health outcomes. International Journal of Clinical and Health Psychology, 10(3), 459–476.
  • Marques, A. P., Assumpção, A., Matsutani, L. A., Pereira, C. A. B., & Lage, L. (2008). Pain in fibromyalgia and discriminative power of the instruments: Visual analog scale, dolorimetry and the McGill Pain Questionnaire. Acta Reumatologica Portuguesa, 33, 345–351.
  • Martín-Aragón, M., Pastor, M. A., Rodríguez-Marín, J., March, M. J., Lledó, A., López-Roig, S., & Terol, M. C. (1999). Percepción de autoeficacia en dolor crónico. Adaptación y validación de la Chronic Pain Self-efficacy Scale [Perceived self-efficacy in chronic pain. Adaptation and validation of the Chronic Pain Self-efficacy Scale]. Revista de Psicología de la Salud, 11(1), 53–75.
  • Martínez, M. P., Miró, E., Sánchez, A. I., Díaz-Piedra, C., Cáliz, R., Vlaeyen, J. W. S., & Buela-Casal, G. (2014). Cognitive-behavioral therapy for insomnia and sleep hygiene in fibromyalgia: A randomized controlled trial. Journal of Behavioral Medicine, 37, 683–697. https://doi.org/ 10.1007/s10865-013-9520-y.
  • Martínez, M. P., Miró, E., Sánchez, A. I., Lami, M. J., Prados, G., & Ávila, D. (2014). Spanish version of the Pain Vigilance and Awareness Questionnaire: Psychometric properties in a sample of women with fibromyalgia. The Spanish Journal of Psychology, 17, Article E105. https://doi.org/10.1017/ sjp.2014.108.
  • McCracken, L. M. (1997). “Attention” to pain in persons with chronic pain: A behavioral approach. Behavior Therapy, 28(2), 271–284. https://doi.org/10.1016/S0005-7894(97) 80047-0.
  • McCracken, L. M., & Morley, S. (2014). The psychological flexibility model: A basis for integration and progress in psychological approaches to chronic pain management. Journal of Pain, 15(3), 221–234. https://doi.org/10.1016/ j.jpain.2013.10.014.
  • McCracken, L. M., Vowles, K. E., & Eccleston, C. (2004). Acceptance of chronic pain: Component analysis and revised assessment method. Pain, 107(1–2), 159–166. https:// doi.org/10.1016/j.pain.2003.10.012.
  • Melzack, R. (1987). The Short-FormMcgill PainQuestionnaire. Pain, 30(2), 191–197. https://doi.org/10.1016/0304-3959(87) 91074-8.
  • Muller, V., Chan, F., Iwanaga, K., Wu, J.-R., Chen, X., Lee, B., Tao, J., Rumrill, P., & Bezyak, J. (2020). An empirically derived taxonomy of biopsychosocial factors of adjustment to fibromyalgia: Results of a multivariate analysis. Rehabilitation Counseling Bulletin, 64(1), 3–16. https:// doi.org/10.1177%2F0034355220925157.
  • Munguía-Izquierdo, D., Segura-Jiménez, V., CamilettiMoirón, D., Pulido-Martos, M., Álvarez-Gallardo, I. C., Romero, A., Aparicio, V. A., Carbonell-Baeza, A., & Delgado-Fernández, M. (2012). Multidimensional Fatigue Inventory: Spanish adaptation and psychometric properties for fibromyalgia patients. The Al-Andalus study. Clinical & Experimental Rheumatology, 30, S94–S102.
  • Okifuji, A., &Hare, B. D. (2013).Management of fibromyalgia syndrome: Review of evidence. Pain & Therapy, 2, 87–104. https://doi.org/10.1007/s40122-013-0016-9.
  • Pardos-Gascón, E.M.,Narambuena, L., Leal-Costa, C.,&vander Hofstadt-Román, C. J. (2021). Differential efficacy between cognitive-behavioral therapy and mindfulnessbased therapies for chronic pain: Systematic review. International Journal of Clinical and Health Psychology, 21(1), Article 100197. https://doi.org/10.1016/j.ijchp.2020.08.001.
  • Pérez-Aranda, A., Andrés-Rodríguez, L., Feliu-Soler, A., Núñez, C., Stephan-Otto, C., Pastor-Mira, M. A., LópezRoig, S., Peñacoba, C., Calandre, E. P., Slim, M., Salgueiro, M., Feixas, G., & Luciano, J. V. (2019). Clustering a large Spanish sample of patients with fibromyalgia using the Fibromyalgia Impact Questionnaire-Revised: Differences in clinical outcomes, economic costs, inflammatory markers, and gray matter volumes. Pain, 160(4), 908–921. https:// doi.org/10.1097/j.pain.0000000000001468.
  • Plazier,M.,Ost, J., Stassijns,G., deRidder,D.,&Vanneste, S. (2015). Pain characteristics in fibromyalgia: Understanding the multiple dimensions of pain. Clinical Rheumatology, 34, 775–783. https://doi.org/10.1007/s10067-014-2736-6.
  • Prados, G., Miró, E., Martínez, M. P., Sánchez, A. I., Lami, M. J., & Cáliz, R. (2020). Combined cognitive-behavioral therapy for fibromyalgia: Effects on polysomnographic parameters and perceived sleep quality. International Journal of Clinical and Health Psychology, 20(3), 232–242. https:// doi.org/10.1016/j.ijchp.2020.04.002.
  • Rehm, S. E., Koroschetz, J., Gockel, U., Brosz, M., Freynhagen, R., Tölle, T. R., & Baron, R. (2010). A crosssectional survey of 3035 patients with fibromyalgia: Subgroups of patients with typical comorbidities and sensory symptom profiles. Rheumatology, 49(6), 1146–1152. https://doi.org/10.1093/rheumatology/keq066.
  • Rivera, J., & González, T. (2004). The Fibromyalgia Impact Questionnaire: A validated Spanish version to assess the health status in women with fibromyalgia. Clinical & Experimental Rheumatology, 22, 554–560.
  • Rodero, B., García-Campayo, J., Casanueva, B., López del Hoyo, Y., Serrano-Blanco, A., & Luciano, J. V. (2010). Validation of the Spanish version of the Chronic Pain Acceptance Questionnaire (CPAQ) for the assessment of acceptance in fibromyalgia.Health &Quality of Life Outcomes, 8, Article 37. https://doi.org/10.1186/1477-7525-8-37.
  • Sahar, K., Thomas, S. A., & Clarke, S. P. (2016). Adjustment to fibromyalgia: The role of domain-specific self-efficacy and acceptance. Australian Journal of Psychology, 68(1), 29–37. https://doi.org/10.1111/ajpy.12089.
  • Salaffi, F.,Mozzani, F., Draghessi, A., Atzeni, F., Catellani, R., Ciapetti, A., Di Carlo, M., & Sarzi-Puttini, P. (2016). Identifying the symptom and functional domains in patients withfibromyalgia: Results of a cross-sectional Internet-based survey in Italy. Journal of Pain Research, 9, 279–286. http:// doi.org/10.2147/JPR.S100829.
  • Salgueiro, M., Aira, Z., Buesa, I., Bilbao, J., & Azkue, J. J. (2012). Is psychological distress intrinsic to fibromyalgia syndrome? Cross-sectional analysis in two clinical presentations. Rheumatology International, 32, 3463–3469. https://doi.org/10.1007/s00296-011-2199-x.
  • Smets, E. M. A., Garssen, B., Bonke, B., & de Haes, J. C. J. M. (1995). The Multidimensional Fatigue Inventory (MFI): Psychometric qualities of an instrument to assess fatigue. Journal of Psychosomatic Research, 39(3), 315–325. https:// doi.org/10.1016/0022-3999(94)00125-O.
  • Sullivan, M. J. L., Bishop, S. R., & Pivik, J. (1995). The Pain Catastrophizing Scale: Development and validation. Psychological Assessment, 7(4), 524–532. https://doi.org/ 10.1037/1040-3590.7.4.524.
  • Tangen, S. F., Helvik, A.-S., Eide, H., & Fors, E. A. (2020). Pain acceptance and its impact on function and symptoms in fibromyalgia. Scandinavian Journal of Pain, 20(4), 727–736. https://doi.org/10.1515/sjpain-2020-0049.
  • Thieme, K., & Turk, D. C. (2006). Heterogeneity of psychophysiological stress responses in fibromyalgia syndrome patients. Arthritis Research&Therapy, 8, Article R9. https://doi.org/10.1186/ar1863.
  • Thieme, K., Mathys, M., & Turk, D. C. (2017). Evidencedbased guidelines on the treatment of fibromyalgia patients: Are they consistent and if not, why not? Have effective psychological treatments been overlooked? The Journal of Pain, 18(7), 747–756. https://doi.org/10.1016/ j.jpain.2016.12.006.
  • Thieme, K., Turk, D. C., & Flor, H. (2004). Comorbid depression and anxiety in fibromyalgia syndrome: Relationship to somatic and psychosocial variables. Psychosomatic Medicine, 66(6), 837–844. https://doi.org/ 10.1097/01.psy.0000146329.63158.40.
  • Thieme, K., Turk, D. C., Gracely, R. H., Maixner, W., & Flor, H. (2015). The relationship among psychological and psychophysiological characteristics of fibromyalgia patients. Journal of Pain, 16(2), 186–196. https://doi.org/10.1016/ j.jpain.2014.11.009.
  • Thompson, M., & McCracken, L. M. (2011). Acceptance and related processes in adjustment to chronic pain. Current Pain & Headache Reports, 15, 144–151. https://doi.org/10.1007/ s11916-010-0170-2.
  • Torres, X., Bailles, E., Valdés, M., Gutiérrez, F., Peri, J.-M., Arias, A., Gómez, E., & Collado, A. (2013). Personality does not distinguish people with fibromyalgia but identifies subgroups of patients. General Hospital Psychiatry, 35(6), 640–648. https://doi.org/10.1016/ j.genhosppsych.2013.07.014.
  • Trainor, H., Baranoff, J., Henke, M., & Winefield, H. (2019). Functioning with fibromyalgia: The role of psychological flexibility and general psychological acceptance. Australian Psychologist, 54(3), 214–224. https://doi.org/10.1111/ ap.12363.
  • Triñanes, Y., González-Villar, A., Gómez-Perretta, C., & Carrillo de la Peña, M. T. (2014). Profiles in fibromyalgia: Algometry, auditory evoked potentials and clinical characterization of different subtypes. Rheumatology International, 34, 1571–1580. https://doi.org/10.1007/ s00296-014-3007-1.
  • Turk, D. C., Okifuji, A., Sinclair, J. D., & Starz, T. W. (1996). Pain, disability, and physical functioning in subgroups of patients with fibromyalgia. Journal of Rheumatology, 23(7), 1255–1262.
  • Turk, D. C., Okifuji, A., Sinclair, J. D., & Starz, T. W. (1998). Differential responses by psychosocial subgroups of fibromyalgia syndrome patients to an interdisciplinary treatment. Arthritis Care & Research, 11(5), 397–404. https:// doi.org/10.1002/art.1790110511.
  • Veehof, M. M., Trompetter, H. R., Bohlmeijer, E. T., & Schreurs, K. M. G. (2016). Acceptance-and mindfulnessbased interventions for the treatment of chronic pain: A meta-analytic review. Cognitive Behaviour Therapy, 45(1), 5–31. https://doi.org/10.1080/16506073.2015.1098724.
  • Velasco-Furlong, L.,Gutiérrez-Hermoso, L.,Mateos-Pintado, B., Garvi-de Castro, D., Blanco-Rico, S., SanrománCanelada, L., López-Roig, S., Pastor-Mira, M. A., & Peñacoba-Puente, C. (2020). The 4 U’s rule of fibromyalgia: A proposed model for fatigue in a sample of women with fibromyalgia: A qualitative study. International Journal of Environmental Research and Public Health, 17(17), Article 6224. https://doi.org/10.3390/ijerph17176224.
  • Verra, M. L., Angst, F., Brioschi, R., Lehmann, S., Keefe, F. J., Staal, J. B., de Bie, R. A., & Aeschlimann, A. (2009). Does classification of persons with fibromyalgia into Multidimensional Pain Inventory subgroups detect differences in outcome after a standard chronic pain management program? Pain Research & Management, 14(6), Article ID 137901. https://doi.org/10.1155/2009/137901.
  • Vincent, A., Hoskin, T. L., Whipple, M. O., Clauw, D. J., Barton, D. L., Benzo, R. P., & Williams, D. A. (2014). OMERACT-based fibromyalgia symptom subgroups: An exploratory cluster analysis. Arthritis Research & Therapy, 16, Article 463. https://doi.org/10.1186/s13075-014-0463-7.
  • Wilson, H. D., Robinson, J. P., & Turk, D. C. (2009). Toward the identification of symptom patterns in people with fibromyalgia. Arthritis Care & Research, 61(4), 527–534. https://doi.org/10.1002/art.24163.
  • Wolfe, F., Clauw, D. J., Fitzcharles, M.-A., Goldenberg, D. L., Katz, R. S., Mease, P., Russell, A. S., Russell, I. J., Winfield, J. B., & Yunus, M. B. (2010). The American College of Rheumatology preliminary diagnostic criteria for fibromyalgia and measurement of symptom severity. Arthritis Care and Research, 62(5), 600–610. https://doi.org/ 10.1002/acr.20140.
  • Wolfe, F., Smythe, H. A., Yunus, M. B., Bennett, R. M., Bombardier, C., Goldenberg, D. L., Tugwell, P., Campbell, S. M., Abeles, M., Clark, P., Fam, A. G., Farber, S. J., Fiechtner, J. J., Franklin, C. M., Gatter, R. A., Hamaty, D., Lessard, J., Lichtbroun, A. S., Masi, A. T., … Sheon, R. P. (1990). The American College of Rheumatology 1990 criteria for the classification of fibromyalgia.Arthritis & Rheumatism, 33(2), 160–172. https://doi.org/10.1002/art.1780330203.
  • Yim, Y.-R., Lee, K.-E., Park, D. J., Kim, S.-H., Nah, S.-S., Lee, J. H., Kim, S.-K., Lee, Y.-A., Hong, S. J., Kim, H. A., Lee, H. S., Kim, H. A., Joung, C. I., Kim, S. H., & Lee, S. S. (2017). Identifying fibromyalgia subgroups using cluster analysis: Relationships with clinical variables. European Journal of Pain, 21(2), 374–384. https://doi.org/10.1002/ejp.935.
Fuente de los datos: Dialnet