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Impaired Pain Modulation in Fibromyalgia Patients in Response to Social Distress Manipulation

Canaipa, Rita MS, PhD*,†; Castro-Caldas, Alexandre MD, PhD; Moreira, João Manuel PhD; Pimentel-Santos, Fernando MD, PhD§; Branco, Jaime Cunha MD, PhD§; Treister, Roi PhD

The Clinical Journal of Pain: July 2017 - Volume 33 - Issue 7 - p 611–619
doi: 10.1097/AJP.0000000000000447
Original Articles

Objectives: Fibromyalgia (FM), a chronic pain condition, is associated with abnormalities in pain modulation. A growing body of evidence has shown that social distress modulates pain sensitivity. The current study aimed to assess the effects of social distress manipulation on pain in FM patients compared with positive (rheumatoid arthritis, RA) and negative (pain-free) controls.

Materials and Methods: FM, RA patients and pain-free controls (PFC) were recruited. Demographic, medical, and psychological data were collected. Each participant was exposed to 3 study conditions in a random order: the inclusion (positive social effects) and exclusion (negative social effects) conditions of Cyberball, a game that manipulates social distress, and a control condition. Pain sensitivity in response to nociceptive electrical and thermal (cold) stimuli was assessed before and during each study condition.

Results: In response to electrical stimuli, pain decreased in both the inclusion and exclusion conditions in PFC and RA groups, whereas inclusion conditions significantly increased pain in the FM group. Social manipulation (inclusion or exclusion) did not affect pain sensitivity as measured in response to thermal stimulation.

Discussion: These results are in line with previous studies demonstrating altered pain inhibition in FM patients, and suggest that unlike PFC or other non-“stress–related” chronic pain conditions, being socially included may increase pain perception in FM patients. Possible underlying mechanisms and clinical relevance are discussed.

*Faculty of Medicine

Faculty of Psychology, University of Lisbon

Health Science Institute, Portuguese Catholic University, Portuguesa

§Rheumatology Department, CEDOC, NOVA Medical School, Faculty of Medical Sciences, NOVA University of Lisbon, CHLO, Hospital Egas Moniz, Lisboa, Protugal

Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel

Supported by a Portuguese Foundation for Science and Technology PhD grant SFRH/BD/42709/2008 (R.C.). The authors declare no conflict of interest.

Reprints: Rita Canaipa, MS, PhD, Instituto de Ciências da Saúde, Universidade Católica Portuguesa, Edifício da Biblioteca João Paulo II, 5° piso, Palma de Cima, Lisboa 1649-023, Portugal (e-mail:

Received March 29, 2016

Received in revised form November 30, 2016

Accepted October 1, 2016

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