Women with fibromyalgia reported worsening of symptoms and weakness in daily activities during the COVID-19 pandemic, which supports the idea that mental health was more affected in this population when compared with those without fibromyalgia, according to a study published in Medicines.1
“Recent research has mentioned many modulating factors, such as climate change, degree of physical activity, and high stress levels, which can alter the intensity of fibromyalgia symptoms,” investigators explained. “Such factors were similar to those experienced throughout the year 2020 with the fight against the global pandemic of COVID-19, especially regarding the confinement stage, when an increase in anxious and depressive episodes, adjustment disorders, and post-traumatic stress occurred as a consequence of reduced social contact and leisure activities, financial concerns, and apprehensions about the health of friends and family members.”
PubMed, Springer Link, and ScienceDirect databases were used to identify eligible fibromyalgia studies in which the effects of COVID-19 were analyzed between 2020 and 2022. Studies were included if patients had fibromyalgia symptoms prior to the quarantine, if the study population was mostly female , if it focused on how quarantine and the pandemic affected their fibromyalgia, and if they had a cohort or cross-sectional study design. The Joanna Briggs Institute critical appraisal tools were used to examine the methodological quality of the studies and minimize bias.
In total, 6 studies were included, most cross-sectional in design and conducted online using questionnaires, data collection, and scales. Studies focused on how women with fibromyalgia fared during the pandemic in terms of mental health and the evolution of symptoms, including anxiety, fear, and sleep patterns. Results generally indicated a worsening in mental health during the pandemic for women with fibromyalgia, which also impacted the patients’ physical health.
In one study, the Index of Severity of Fibromyalgia (ICAF) was used to analyze the patient’s global impression of change, as well as depression, anxiety, and the ability to perform daily-life tasks. After splitting patients into 2 groups (those that had worsened and those with either improvements or no changes), investigators discovered that a worsening of symptoms was related to how patients coped with their disease rather than a clinical impact.
Another study found a significant increase in pain severity in women with fibromyalgia, which led to an increase in catastrophic thinking. The psychosocial impact was examined in another study using the perceived stress scale (PSS). Worse PSS was linked to women, overweight people, younger patients, and those with anxiety. Patients with fibromyalgia scored higher on all scales when compared with other populations. One study performed a 3-phase approach to examining the impact of COVID-19 in women with fibromyalgia, with the first questionnaire sent out pre-pandemic and the 2 subsequent questionnaires sent between March and May 2020, extending into 2021. Patients had worse health scores than standard values, but there was a slight improvement in pain and physical role in the second survey. Finally, when patients with fibromyalgia were compared with healthy controls, COVID-19 anxiety and fear contributed to worse outcomes in the severity of symptoms, mood, and sleep quality.
The small number of studies ultimately included limited the systematic review as investigators were not able to provide an overview of this patient population. Although many studies examined how COVID-19 affects patients with rheumatic diseases, most did not take the psychological aspect and changes in lifestyle into account. Another limitation was that the studies used different measurement instruments when determining the impact of the pandemic on patients.
“Although the evolution of COVID-19 is favorable worldwide, multiple variables related to psychological health and the response to stressors seem to have triggered symptomatologic responses in fibromyalgia patients,” investigators concluded. “Therefore, further studies on the relationship of mental health and fibromyalgia are needed to be able to conclude more accurate results.”
Núñez-Recio I, García-Iglesias JJ, Martín-López C, et al. Modulating factors of fibromyalgia in women during the COVID-19 pandemic: A protocol for systematic review. Medicine (Baltimore). 2022;101(52):e32577. doi:10.1097/MD.0000000000032577