Cognitive and Behavioral Factors in Fibromyalgia: Mood, Goals, and Task Performance

Abstract

Objectives: This paper reviews the existing theoretical models explaining task persistence in chronic pain, pointing at its strengths and weaknesses.

Findings: For chronic musculoskeletal pain, purely biomedical models appear insufficient. The prevailing Fear-Avoidance model postulates that catastrophic misinterpretations of pain give rise to fear of pain, subsequently leading to a cycle of avoidance of activity, disuse, and disability. For pain disability associated with task persistence and overuse often seen in patients with fibromyalgia syndrome, cognitive behavioral mechanisms have been a neglected area in pain research and are just beginning to be scrutinized. One promising theoretical model is the so-called Mood-as-Input model, which predicts that task performance results from the interaction between current mood and certain stop-rules. The novel feature of the Mood-as-Input model is that the effects of mood on task performance are dependent on motivational context variables [As-Many-As-Can [AMAC] and Feel-Like-Discontinuing [FLDC] contexts]. In the AMAC context, negative mood signals the individual that not enough progress on the task has been made, leading to continuation with the task. In the FLDC context, the opposite pattern is found. A negative mood here signals that continuing with the task is no longer appropriate, thereby disengaging from the task. Thus, with different stop-rules, the same mood can have different motivational effects.

Conclusions: The literature suggests that the Mood-as-Input model may provide a framework to enhance our understanding of disability both due to avoidance behavior and activity overuse. Suggestions for further research in this novel area are made.

KEYWORDS:

• Chronic pain
• task persistence
• overuse
• cognitive behavioral mechanisms