Clinical and psychological features of patients with fibromyalgia: a case study

Background. The heterogeneity of fibromyalgia manifestations requires interdisciplinary study of clinical and psychological features and the patient’s ability to cope with stress load (coping intelligence), which influence adherence to treatment and preservation of health potential.
Objective: a pilot study of integrative medical and psychological analysis and presentation of clinical cases reflecting individual manifestations of coping intelligence in association with genetic factors and biochemical indicators in patients with fibromyalgia.
Design and methods. Complex stress load was simulated under experimental conditions. Baevsky’s Stress Index and the level of subjective comfort were recorded in patients with fibromyalgia. Laboratory diagnostics of such biochemical markers as cortisol, adrenaline, norepinephrine, serotonin, dopamine, Il-4, Il-6, and Il-10 are performed before and after the experiment. The presence of BDNF and COMT gene polymorphism was also studied. Psychodiagnostics included assessment of temperament and coping in patients. Three clinical cases of fibromyalgia reveal different clinical and psychological features in manifestations of coping intelligence.
Results. The study confirms the heterogeneity of patients with fibromyalgia. Three patients with severe hypochondria, reactive anxiety or personal anxiety were examined. Their temperamental emotionality varied, namely, low, medium, and high. Physical, mental, and communicative loads revealed the features of the regulatory systems of these patients. Regardless of phenotype, we found a decrease in cortisol and adrenaline levels in all patients after complex exercise. The concentration of serotonin in these patients remained virtually unchanged. While the change in dopamine levels was diverse. Noteworthy is the fourfold increase in the concentration of interleukin-4 in a patient with a high Baevsky’s Stress Index.
Conclusions. Comprehensive studies of the genesis of fibromyalgia reveal unique characteristics of the patient necessary for the selection of drug therapy and regulation the emotional state.

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