POS1174 ALEXITHYMIA IS HIGHLY PREVALENT AMONG PATIENTS WITH CHRONIC PAIN SYNDROMES BUT DOES NOT DIMINISH MULTIMODAL PROGRAM TREATMENT EFFICACY
Authors: P. Ming Azevedo, J. Mettler, M. R. Suter, A. Le Thanh, G. Marillier, T. Hügle
Journal: Annals of the Rheumatic Diseases (2024)

<h3>Background:</h3> Alexithymia, also called "emotion blindness", is defined as a difficulty in recognizing, expressing, and describing one's own emotions. It is believed that 5 to 19% of the population bares alexithymia and that those with high degree of the condition have more of several dysfunctions, including chronic pain syndromes (CPS), in which it may aggravate severity. <h3>Objectives:</h3> a) to evaluate alexithymia's prevalence among patients participating in a tertiary center multimodal inpatient program (MMP) for CPS in Switzerland; b) to evaluate the performance of the Toronto Alexithymia Score-20 (TAS-20) against a formal psychiatric evaluation in this population; C) to evaluate clinical characteristics and response to MMP treatment of CPS patients with high levels of alexithymia. <h3>Methods:</h3> 318 patients with CPS who concluded the 2-weeks inpatient MMP held in a tertiary center in Lausanne, Switzerland were included. Detailed clinical and epidemiological data was collected and sleep efficacy was assessed by actigraphy. Before and after MMP we evaluated patients' pain (Brief Pain Index - BPI intensity and impact), function (Oswestry Disability Index - ODI), kinesiophobia (Tampa scale - TSK), catastrophism (Pain Catastrophizing Scale - PCS), fears and beliefs about their pain (Fear-Avoidance Beliefs Physical and at Work - FABQ-P and FABQ-W), specific behavioral profiles associated with pain (Patterns Of Activity Measure for avoidance, pacing and overdoing), depression and anxiety (Hospital Depression and Anxiety Scales – HDS and HAS). We then determined the delta change for every questionnaire from those two points in time. Patients also answered once the 2010 version of the American College of Rheumatology (ACR) criteria for fibromyalgia, the Fibromyalgia Rapid Screening Questionnaire (FiRST), the Toronto Alexithymia Scale-20 (TAS-20), and the Pain Disability Questionnaire (PDI) at entry and 3 months after the program, being the latter our primary endpoint. Alexithymia was evaluated by psychiatrists in 276 and by TAS-20 in 130 patients. In 110 patients both evaluations were performed. Correlations were drawn with alexythymia, clinical and epidemiological variables and MMP outcome measures. <h3>Results:</h3> We confirm a high prevalence of alexithymia among this severe cohort of CPS patients despite methods of investigation (48.9% according to psychiatric evaluation against 55.7% with TAS-20). TAS-20 seams to perform poorly in relation to psychiatric evaluation as diagnostic method (Figure 1) and selects patients with a different clinical profile (Table 1). Fibromyalgia (ACR 2010), sleep disorders and an avoidant behavioral profile are the only variable associated with alexithymia by both methods (Table 1). Alexithymia by either method does not diminish the effectiveness of MMP treatment on any of the 9 endpoints (the main being delta PDI at 3 months: p=0.1 for psychiatric evaluation and 0.2 for TAS-20). <h3>Conclusion:</h3> Alexithymia is highly prevalent among CPS patients. Although it may have pathophysiological and prognostic implications for these patients, it does not diminish the effectiveness of MMP treatment in the medium term. A reliable and fast method of screening is lacking. <h3>REFERENCES:</h3> <b>NIL.</b> <b>Table 1.</b> Variables and outcomes associated with alexithymia according to psychiatric evaluation and TAS-20 &gt; 52. Asterisk indicates common associations between the two alexithymia screening methods. <h3>Acknowledgements:</h3> <b>NIL.</b> <h3>Disclosure of Interests:</h3> <b>None declared.</b>