PURPOSE Fibromyalgia (FM) is typically associated with the experience of diffuse pain and physical impairment. Depression also commonly co-exists in patients with FM, and has been correlated with pain intensity and physical functioning. Previous research suggests an association between pain intensity and physical functioning; however, the direct causal relationship between improvements in pain intensity and in functioning is not observed in many FM patients. This may suggest that another factor such as depression is mediating this relationship. The present work examined mediating role of depression. METHODS 216 patients with FM completed measures of pain intensity, depression, and physical function as part of a larger longitudinal study. Assessments were completed at baseline, 12, 24, and 36 weeks. RESULTS Longitudinal mediational analyses indicated that depression is a partial mediator of the relationship between pain intensity and physical functioning at all four assessment points. Beta coefficients for the path from pain to physical functioning ranged from 0.18 - 0.36, with attenuated path coefficients ranging from 0.03 - 0.08, still showing significant but decreased associations when depression was added as a mediator. CONCLUSIONS Clinical implication includes the importance of treating co-morbid depression in patients with fibromyalgia early in the course of treatment to prevent engagement in the cycle of disability.

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纤维肌痛中疼痛强度与身体机能之间的复杂关系：抑郁症的中介作用

目的 纤维肌痛 (FM) 通常与弥漫性疼痛和身体损伤的经历有关。抑郁症通常也与 FM 患者共存，并且与疼痛强度和身体机能相关。先前的研究表明疼痛强度与身体机能之间存在关联；然而，在许多 FM 患者中并未观察到疼痛强度改善与功能改善之间的直接因果关系。这可能表明另一个因素如抑郁症正在调节这种关系。目前的工作研究了抑郁症的中介作用。方法 作为大型纵向研究的一部分，216 名 FM 患者完成了疼痛强度、抑郁和身体功能的测量。评估在基线、第 12、24 和 36 周完成。结果纵向中介分析表明，在所有四个评估点，抑郁是疼痛强度和身体机能之间关系的部分中介。从疼痛到身体机能的路径的 Beta 系数范围为 0.18 - 0.36，衰减路径系数范围为 0.03 - 0.08，当抑郁症被添加为中介时，仍然显示出显着但减少的关联。结论 临床意义包括在治疗过程中早期治疗纤维肌痛患者的共病抑郁症以防止参与残疾循环的重要性。18 - 0.36，衰减路径系数范围为 0.03 - 0.08，当抑郁症被添加为中介时，仍然显示出显着但减少的关联。结论 临床意义包括在治疗过程中早期治疗纤维肌痛患者的共病抑郁症以防止参与残疾循环的重要性。18 - 0.36，衰减路径系数范围为 0.03 - 0.08，当抑郁症被添加为中介时，仍然显示出显着但减少的关联。结论 临床意义包括在治疗过程中早期治疗纤维肌痛患者的共病抑郁症以防止参与残疾循环的重要性。