Skip to main content Accessibility help

Neuropsychological Function, Anxiety, Depression and Pain Impact in Fibromyalgia Patients

  • Ana Mª Cuevas-Toro (a1), Francisca López-Torrecillas (a2), Mª Carmen Díaz-Batanero (a1) and Mª Nieves Pérez-Marfil (a2)

Cognitive deficits have a significant impact on the daily performance of fibromyalgia patients. This paper analyzes executive functioning and decision-making performance, and the relationships between these functions and pain, anxiety, depression and medication in fibromyalgia patients. A group of fibromyalgia patients (FG) (n = 85) was compared with a healthy control group (CG) (n = 85) in their performance in the Wisconsin Card Sorting Test (WCST) and the Iowa Gambling Task (IGT). In the WCST, results showed a percentage of non-perseverative errors significantly higher in the CG than in the FG (p = .026), the other variables (percentage of perseverative errors, number of categories and failures to maintain set) showed no significant differences. In relation to decision-making (IGT), once the rules had been learnt, the FG made fewer advantageous choices than the CG, but these differences were not statistically significant (p = .325). In the FG, pain severity (p = .010) and impact on daily activities (p = .016) interfered with decision-making, unlike anxiety, depression or medication, which did no relate to it. In executive function, pain and impact on daily activities were associated with the percentage of perseverative errors (p = .051) and the number of categories (p = .031), whereas pain severity was related to failures to maintain set (p = .039), indicative of increased distractibility and poor attentional ability. In conclusion, FG showed normal performance in executive functioning and decision-making. Moreover, pain was associated with neuropsychological functioning whereas anxiety, depression and medication were not.

Corresponding author
*Correspondence concerning this article should be addressed to Ana Mª Cuevas Toro. Universidad de Huelva. Facultad de Ciencias de la Educación. Departamento de Psicología Evolutiva y de la Educación. Campus de El Carmen. Avda. Tres de Marzo, s/n. 21071. Huelva (Spain). E-mail:
Hide All
American Psychiatric Association (2000). Diagnostic and statistical manual of mental disorders (4 th Rev. Ed.). Washington, DC: APA.
Apkarian, A. V., Sosa, Y., Krauss, B. R., Thomas, P. S., Fredrickson, B. E., Levy, R. E., … & Chialvo, D. R. (2004). Chronic pain patients are impaired on an emotional decision-making task. Pain, 108, 129136.
Bechara, A., Damasio, A. R., Damasio, H., & Anderson, S. W. (1994). Insensitivity to future consequences following damage to human prefrontal cortex. Cognition, 50, 715.
Bechara, A., Damasio, H., & Damasio, A. R. (2000). Emotion, decision making and the orbitofrontal cortex. Cerebral Cortex, 10, 295307.
Bechara, A., Dolan, S., & Hindes, A., (2002). Decisions-making and addiction (part II): Myotpia for the future or hipersensitivity to reward? Neuropsychologia, 40, 16901705.
Calandre, E. P., García-Carrillo, J., García-Leiva, J. M., Rico-Villademoros, 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, 15551559.
Correa, A., Miró, E., Martínez, M. P., Sánchez, A. I., & Lupiáñez, J. (2011). Temporal preparation and inhibitory deficit in fibromyalgia syndrome. Brain and Cognition; 75, 211216.
De la Cruz, M. V. (1997). Test de Clasificación de Tarjetas de Wisconsin [Wisconsin Cards Sorting Test]. Madrid, Spain: TEA Ediciones.
Dick, B., Eccleston, C., & Crombez, G. (2002). Attentional functioning in fibromyalgia, rheumatoid arthritis, and musculoskeletal pain patients. Arthritis Care and Research, 47, 639644.
Eccleston, C., & Crombez, G. (1999). Pain demands attention: A cognitive-affective model of the interruptive function of pain. Psychological Bulletin, 125, 356366.
Gelonch, O., Garolera, M., Rosselló, L., & Pifarré, J. (2013). Disfunción cognitiva en la fibromialgia [Cognitive dysfunction in fibromyalgia]. Revista de Neurología, 56, 573588.
González, A., Fernández, P., & Torres, I. (2010). Aceptación del dolor crónico en pacientes con fibromialgia: Adaptación del Chronic Pain Acceptance Questionnaire (CPAQ) a una muestra española. [Acceptance of chronic pain in fibromyalgia patients: Adaptation of Chronic Pain Acceptance Questionnaire (CPAQ) in a Spanish population]. Psicothema, 22, 9971003.
Glass, J. M. (2008). Fibromyalgia and cognition. The Journal of Clinical Psychiatry, 69, 2024.
Glass, J. M. (2009). Review of cognitive dysfunction in fibromyalgia: A convergence on working memory and attentional control impairments. Rheumatic Diseases Clinics of North America, 35, 299311.
Glass, J. M. (2010). Cognitive dysfunction in fibromyalgia syndrome. Journal of Musculoskeletal Pain, 18, 367372.
Glass, J. M., Williams, D. A., Fernández-Sánchez, M. L., Kairys, A, Barjola, P., Heitzeg, M. M., … & Schmidt-Wilcke, T. (2011). Executive function in chronic pain patients and healthy controls: Different cortical activation during response inhibition in fibromyalgia. The Journal of Pain, 12, 12191229.
Grace, G. M., Roach, A. R., & Segerstrom, M. A. (1999). Concentration and memory deficits in patients with fibromyalgia syndrome. Journal of Clinical and Experimental Neuropsychology, 21, 477487.
Grisart, J. M., & van der Linden, M. (2001). Conscious and automatic uses of memory in chronic pain patients. Pain, 94, 305313.
Grisart, J., van der Linden, M., & Masquelier, E. (2002). Controlled processes and automaticity in memory functioning in fibromyalgia patients: Relation with emotional distress and hypervigilance. Journal of Clinical and Experimental Neuropsychology, 24, 9941009.
Haeton, R. K., Chelune, G. C., Talley, J. L., Kay, G. G., & Curtiss, G. (1993). The Wisconsin Card Sorting Test Manual (revised and expanded). Odessa, Fl: Psychological Assessment Resources.
Huber, A., Suman, A. L., Biasi, G., & Carli, G. (2008). Predictors of psychological distress and well-being in women with chronic musculoskeletal pain: Two sides of the same coin? Journal of Psychosomatic Research, 64, 169175.
Iezzi, T., Duckworth, M. P., Vuong, L. N., Archibald, Y. M., & Klinck, A. (2004). Predictors of neurocognitive performance in chronic pain patients. International Journal of Behavioral Medicine, 11, 56161.
Kaplan, G. B., Sengör, N. S., Gürvit, H., Genç, I., & Güzelis, C. (2006). A composite neural network model for perseveration and distractibility in the Wisconsin card sorting test. Neural Networks, 19, 375387.
Kim, S. H., Kim, S. H., Kim, S. K., Nam, E. J., Han, S. W., & Lee, S. J. (2012). Spatial versus verbal memory impairments in patients with fibromyalgia. International Journal of Rheumatology, 32, 11351142.
Lázaro, C., Bosch, F., Torrubia, R., & Baños, J. E. (1994). The development of a Spanish Questionnaire for assessing pain: Preliminary data concerning reliability and validity. European Journal of Psychological Assessment, 10, 191200.
Leavitt, F., & Katz, R. S. (2009) Normalizing memory recall in fibromyalgia with rehearsal: A distraction-counteracting effect. Arthritis and Rheumatism, 61, 740744.
Luerding, R., Weigand, T., Bogdahn, U. & Schmidt-Wilcke, T. (2008). Working memory performance is correlated with local brain morphology in the medial frontal and anterior cingulate cortex in fibromyalgia patients: structural correlates of pain cognition interaction. Brain, 131, 32223231.
Mercado, F., González, J. L., Barjola, P., Fernández-Sánchez, M., López-López, A., Alonso, M. & Gómez-Esquer, F. (2013). Brain correlates of cognitive inhibition in fibromyalgia: Emotional intrusion of symptom-related words, International Journal of Psychophysiology 88, 182192.
Miró, E., Lupiáñez, J., Martínez, M. P., Sánchez, A. I., Díaz-Piedra, C., Guzmán, M. A., M. A., & Buela-Casal, G. (2011). Cognitive-behavioral therapy for insomnia improves attentional function in fibromyalgia syndrome: A pilot, randomized controlled trial. Journal of Health Psychology, 16, 770782.
Miró, E., Lupiáñez, J., Hita, E., Martínez, M. P., Sánchez, A. I., & Buela-Casal, G. (2011). Attentional deficits in fibromyalgia and its relationships with pain, emotional distress and sleep dysfunction complaints. Psychology and Health, 26, 765780.
Mongini, F., Keller, R., Deregibus, A., Barbalonga, E., & Mongini, T. (2005). Frontal lobe dysfunction in patients with chronic migraine: A clinical neuropsychological study. Psychiatry Research, 133, 101106.
Munguía-Izquierdo, D., Legaz-Arrese, A., Moliner-Urdiales, D., & Reverter-Masía, J. (2008). Neuropsicología de los pacientes con síndromes de fibromialgia: Relación con dolor y ansiedad. [Neuropsychological performance in patients with fibromyalgia syndrome: Relation to pain and anxiety]. Psicothema, 20, 427431.
Pastor, M. A., López, S., Rodríguez, J., Terol, M. C., & Sánchez, S. (1995). Evaluación Multidimensional del dolor crónico en enfermos reumáticos [Multidimensional Assesstment of chronic pain in rheumatic patients]. Revista de Psicología de la Salud, 7, 79106.
Pastor, M. A., Lledó, A., López-Roig, S., Pons, N., & Martín-Aragón, M. (2010). Predictores de la utilización de recursos sanitarios en la fibromialgia [Predictors of healthcare resource use in Fibromyalgia]. Psicothema, 22, 549555.
Park, D. C., Glass, J. M., Minear, M., & Crofford, L. J. (2001). Cognitive function in fibromyalgia patients. Arthritis and Rheumatology, 44, 21252133.<2125::AID-ART365>3.0.CO;2–1
Prados, G., & Miró, E. (2012). Fibromialgia y sueño: Una revisión [Fibromyalgia and sleep: A review]. Revista de Neurología, 54, 227240.
Quintana, J. M., Padierna, A., Esteban, C., Arostegui, I., Bilbao, A., & Ruiz, I. (2003). Evaluation of the psychometric characteristics of the Spanish version of the Hospital Anxiety and Depression Scale. Acta Psychiatrica Scandinavica, 107, 216221.
Reyes del Paso, G. A., Pulgar, Á., Duschek, S., & Garrido, S. (2012). Cognitive impairment in fibromyalgia syndrome: The impact of cardiovascular regulation, pain, emotional disorders and medication. European Journal of Pain, 16, 421429.
Sánchez, A. I., Martínez, M. P., Miró, E., & Medina, A. (2011). Predictors of the pain perception and self-efficacy for pain control in patients with fibromyalgia. The Spanish Journal of Psychology, 14, 366373.
Schmeichel, B. J. (2007). Attention control, memory updating, and emotion regulation temporarily reduce the capacity of executive control. Journal of Experimental Psychology General, 136, 241255.
Seo, J., Kim, S-H., Kim, Y-T., Song, H-j., Lee, J-j., Kim, S-H., … & Chang, Y. (2012). Working memory impairment in fibromyalgia patients associated with altered frontoparietal. Memory Network. Plos one, 7, e37808.
Sephton, S. E., Studts, J. L., Hoover, K., Weissbecker, I., Lynch, G., Ho, I., … & Salmon, P. (2003). Biological and psychological factors associated with memory function in fibromyalgia syndrome. Health Psychology, 22, 592597.
Solberg, L., Roach, A. R., & Segerstrom, S. C. (2009). Executive functions, self-regulation, and chronic pain: A review. Annuals and Behavioral Medical, 37, 173183.
Suhr, J. A. (2003). Neuropsychological impairment in fibromyalgia: Relation to depression, fatigue, and pain. Journal of Psychosomatic Research, 55, 321329.
Verdejo-García, A., López-Torrecillas, F., Pita, E., Delgado-Rodríguez, A., & Bechara, A. (2009). Executive function and decision-making in women with fibromyalgia. Archives of Clinical Neuropsychology, 24, 113122.
Verbunt, J. A., Pernot, D., & Smeets, R. (2008). Disability and quality of life in patients with fibromyalgia. Health and Quality of Life Outcomes, 6, 8.
Walitt, B., Roebuck-Spencer, T., Bleiberg, J., Foster, G., & Weinstein, A. (2008). Automated neuropsychiatric measurements of information processing in Fibromyalgia. Rheumatology International, 28, 561566.
Walteros, C., Sánchez-Navarro, J. P., Muñoz, M. A., Martínez-Selva, J. M., Chialvo, D., & Montoya, P. (2011). Altered associative learning and emotional decision making in fibromyalgia. Journal of Psychosomatic Research, 70, 294301.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

The Spanish Journal of Psychology
  • ISSN: 1138-7416
  • EISSN: 1988-2904
  • URL: /core/journals/spanish-journal-of-psychology
Please enter your name
Please enter a valid email address
Who would you like to send this to? *



Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed