Generalized hypervigilance in chronic pain patients

by McDermid, Ann J.

Fibromyalgia is a chronic pain disorder of undetennined etiology that affects the musculoskeletal system. Previous research has indicated that fibromyalgia patients have an increased sensitivity to painful stimulation compared to normal controI subjects. These kdings are in keeping with the hypervigilance mode1 of pain perception (Chapman, 1978) which States that ce& chronic pain patients have a heightened responsiveness to experimentally induced pain, showing increased attention to external stimulation and a preoccupation with pain sensations, More recent research has demonsnated that the pattem of hypervigilance observed in some fibromyalgia patients extends to other sensory domains, suggesthg a generalized pattern of hypervigilance which is marked by the amplification of a variety of external and interna1 noxious sensations (McDermid, Rollman, & ~VcCain, 1996). Rollman and Lautenbacher (1993) refer to this altered perceptual style as " generalized hype~gilance " . Although this concept provides a useful fiamework for conceptualizing the behaviour of some patients, it is understood poorly at the present time because it is still in its preliminary stages of development. Accordingly, the purpose of this study is to clan@ the nature of generalized hypervigilance. Two main issues were addressed: 1) 1s a pattern of generalized hypervigïlance unique to patients with pain disorders of undetermined origin, like fibromyalgia, or does this pattern extend to patients who have conditions with a known etiology? Generalized hypervigilance was measured by the Somatosensory Amplification Scale, 3) What variables contribute to generalized hypervigilance? There have been no pnor anempts at identifj4r.g the underlying contributing mechanisms for this concept. The roles that anxiety, monitoring, symptom attribution, and maladaptive pain coping style may play in the prediction of generalized hypervigilance were assessed. Tm-three fibrornyalgia patients, 29 rheurnatoid arthritis patients, 26 temporomandibular joint dysfunction patients, and 34 healthy volunteen participated in rhis study. The fibromyalgia and the temporomandibular joint dysfünction patients represented conditions of undetemüned etiologies whereas patients with rhe~oid arthritis represented a condition with a known organk basis. Contrary to hypotheses, the results iliustrated that the groups of chronic pain patients with disorders ofundetemiined origin did not differ fiorn those with a disorder of determined etiology on the measure of generalized hypervi,oilance. Multiple regression analyses revealed that different variables are involved in the prediction of generalized hype~@ance for the various groups of chronic pain patients- Trait anxiety was shown to be the best predictor for the fibromyalgia patients whereas bodily monitoring was the strongest predictor for the arthritis patients and the patients. The results of this study are discussed in terms of the clinical and research implications.