TOPLINE:

Patients with newly diagnosed fibromyalgia who had prominent symptoms of depression and anxiety had more severe disease and a poorer response to initial treatment than those without prominent symptoms. In this group, remission of depression, rather than pain reduction alone, predicted clinical improvement.

METHODOLOGY:

• Researchers prospectively enrolled 112 patients with newly diagnosed fibromyalgia and 110 healthy control individuals between June 2021 and December 2022 at a hospital in Taiwan to investigate the impact of psychological symptoms on disease manifestations and therapeutic responses.
• All patients received pregabalin (75 mg, twice daily) with or without imipramine (25 mg, once daily) and completed at least 1 month of follow-up; the mean follow-up duration was 9 months.
• Interviews were conducted and questionnaires completed at baseline to assess pain and psychological symptoms; follow-up assessments were scheduled at 2 and 4 weeks to monitor patients’ therapeutic responses.
• Assessment tools included the Hospital Anxiety and Depression Scale for psychological symptoms, the Numeric Rating Scale for pain intensity, the Widespread Pain Index to measure the extent of pain across the body, and the Revised Fibromyalgia Impact Questionnaire for disease severity.
• The primary outcome was a change in the severity of fibromyalgia.

TAKEAWAY:

• Patients were classified into two groups on the basis of psychological symptoms: fibromyalgia with prominent symptoms of anxiety and depression (FM-AD, n = 53) and fibromyalgia with less severe psychological symptoms (FM-nAD, n = 59).
• The FM-AD group reported a significantly higher pain intensity and disease severity than the FM-nAD group (P < .001 for both); even after initial treatment, the FM-AD group continued to have a significantly higher pain intensity than the FM-nAD group (P = .003).
• Remission of pain significantly predicted reduced disease severity scores for all patients with fibromyalgia (P < .001); however, in the FM-AD group, depression was the sole significant predictor of disease severity (P = .039), whereas pain did not reach statistical significance.
• A mediation analysis revealed that remission of depression directly improved disease outcomes independent of pain reduction.

IN PRACTICE:

“Pain reduction did not necessarily lead to an improvement in disease severity in those with prominent anxiety and depression features….Instead, it was the alleviation of depression that predicted disease improvement in these patients. This finding highlighted the necessity of prompt depression management in treating [fibromyalgia],” the authors of the study wrote.

SOURCE:

The study was led by Kuo-Wei Lee, MD, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan. It was published online on January 17, 2026, in Seminars in Arthritis and Rheumatism.

LIMITATIONS:

The restricted sample size may not appropriately represent the general population. Additionally, psychological symptoms were assessed using self-reported measures instead of psychiatric interviews. Various confounding factors influencing phenotypes and therapeutic outcomes were not included in the analysis.

DISCLOSURES:

The study was supported by grants from the National Science and Technology Council in Taiwan and Kaohsiung Medical University Chung-Ho Memorial Hospital. Additional funding was provided by Kaohsiung Municipal Siaogang Hospital. One author reported receiving financial support from some of the funding sources.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.