Traumatic experiences and defensive mechanisms: examining the influence of psychological factors in women with fibromyalgia and chronic pain syndromes in comorbidity

Background. Fibromyalgia (FM) patients frequently experience multiple chronic pain (CP) comorbidities, recently included among chronic nociplastic syndromes. “Nociplastic pain” (NP) results from altered function of pain-related sensory pathways in the nervous system, leading to pain hypersensitivity. NP-characterized conditions share neurophysiological mechanisms; this framework allows a new understanding of the co-occurrence of different CPs and the role of related psychological factors. Among these, the literature highlights traumatic experiences and defense mechanisms (DM). However, these variables are understudied. Objective. To investigate whether FM and FM with different CP conditions show differences regarding childhood traumatic experiences and DM. Methods. 528 women (n=201 FM; n=327 FM with comorbidities) completed a self-administered online protocol consisting of Traumatic Experience Checklist (TEC), Defense Mechanism Rating Scales (DMRS), and socio-anamnestic information. Results. Data analysis shows significant differences in TEC emotional abuse scale (F=3.976; df=2; p=0.006) and total score (F=2.938; df=2; p=0.019) with FM with comorbidities group reporting higher scores. About DMRS the groups differ only in the scale of immature defenses (F=6.648; df=2; p=0.039), with the FM group with comorbidities scoring higher. Conclusion. Greater childhood emotional abuse and immature DM seem to characterize FMs with comorbidities. It can be speculated that greater exposure to traumatic events may have hindered the development of more mature DM. This could be a risk factor for both the development and management of a complex and disabling disease such as FM, especially when associated with other CP syndromes. Physicians should consider psychological variables as they may contribute to the symptomatology of CP.