Fibromyalgia as a Heterogeneous Condition: Subgroups of Patients Based on Physical Symptoms and Cognitive-Affective Variables Related to Pain
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Fibromyalgia (FM) is a chronic syndrome characterized by heterogeneous clinical manifestations, and knowing this variability can help to develop tailored treatments. To understand better the heterogeneity of FM the present cross-sectional study analyzed the role of several physical symptoms (pain, fatigue and poor sleep quality) and cognitive-affective variables related to pain (pain catastrophizing, pain vigilance, self-efficacy in pain management, and pain acceptance) in the configuration of clinical profiles. A sample of 161 women with FM fulfilled an interview and several self-report measures to explore physical symptoms, cognitive-affective variables, disability and psychopathology. To establish FM groups a hierarchical cluster analysis was performed. The findings revealed three clusters that differed in the grouping variables, Wilks' λ = .17, F(14, 304) = 31.50, p < .001, ηp2 = .59. Group 1 (n = 72) was characterized by high physical and psychological affectation, Group 2 (n = 19) by low physical affectation and high pain self-efficacy, and Group 3 (n = 70) by moderate physical affectation and low pain catastrophizing. The external validation of the clusters was confirmed, Wilks' λ = .72, F(4, 314) = 14.09, p < .001, ηp2 = .15, showing Group 1 the highest levels of FM impact and psychopathological distress. Considering the distinctive clinical characteristics of each subgroup therapeutic strategies addressed to the specific needs of each group were suggested. Assessing FM profiles may be key for a better understanding and approach of this syndrome.
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Different studies have pointed out the need to identify subgroups within the heterogeneity of patients with fibromyalgia.
“In fact, different studies have pointed out the need to identify subgroups within the heterogeneity of patients with fibromyalgia in order to rationalize and clearly define the most appropriate interventions [27,28].”
From Does Pain Acceptance Contribute to Improved Functionality through Walking in Women with Fibromyalgia? Looking at Depressive Comorbidity (2023) · cites this paper as [27]
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Moustafa, I. M., Khowailed, I. A., Zadeh, S. A. M., Ozsahin, D. U., Mustapha, M. T., Oakley, P. A., & Harrison, D. E. (2025) · Scientific Reports · doi:10.1038/s41598-025-05390-6 · Cited by 5 · see citing works
Peñacoba, C., Ecija, C., Gutiérrez, L., & Catalá, P. (2023) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph20065005 · Cited by 2 · see citing works
Pasini, I., Donisi, V., Veneziani, E., Perlini, C., Nizzero, M., Lippolis, I., Polati, E., Schweiger, V., & Piccolo, L. D. (2024) · Frontiers in Medicine · doi:10.3389/fmed.2024.1408693 · Cited by 2 · see citing works
Manavi, D., Tunks, A., Diment, W., Bortoluzzi, A., Bourgeois, J. A., Calderwood, L., Yan, X., & Sloan, M. A. (2026) · Rheumatology International · doi:10.1007/s00296-026-06143-y · Cited by 2 · see citing works
Hackshaw, K. V., Osuna-Diaz, M. M., Sebastian, K. R., Nuguri, S. M., Castellví, S. D. L., Yu, L., Giusti, M. M., Mikulik, Z., & RODRIGUEZ‐SAONA, L. E. (2026) · CNS Spectrums · doi:10.1017/s1092852926101199 · Cited by 3 · see citing works
Świdrak, J., Rodríguez-Araya, T. L., Polino, L., Arias, A., Torres, X., & Sanchez-Vives, M. V. (2024) · Psychology Health & Medicine · doi:10.1080/13548506.2024.2424997 · Cited by 2 · see citing works
Doreste, A., Pujol, J., Penelo, E., Pérez, V., Blanco‐Hinojo, L., Martínez‐Vilavella, G., Pardina-Torner, H., Ojeda, F., Monfort, J., & Deus, J. (2025) · European Journal of Investigation in Health Psychology and Education · doi:10.3390/ejihpe15010002 · Cited by 2 · see citing works
Experience of Trauma and Pain in Women and Men: A Study in the General Population
de Vaca, P. M. N.-C., Pagola, N. N., Sánchez, A. I. N., Aguerre, N. V., Aguirre, C. N., & Miró, E. (2025) · Behavioral Psychology/Psicología Conductual · doi:10.31083/bp49437 · Cited by 1 · see citing works
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Exploring the clinical usefulness of an electronic diary in fibromyalgia patients: A pilot study
Martínez, M. P., García, R., Sánchez, A. I., Prados, G., Benghazi, K., Garrido, J. L. G., & Miró, E. (2021) · Revista de Psicopatología y Psicología Clínica · doi:10.5944/rppc.28630
L’adaptation à la fibromyalgie : le rôle de la représentation de la maladie face à la douleur
Macabrey, E., Sordes, F., & Doglioni, D. O. (2026) · Annales Médico-psychologiques revue psychiatrique · doi:10.1016/j.amp.2026.03.009
Saini, U., Wanders, R., Oldehinkel, A. J., Rosmalen, J. G. M., & van Loo, H. M. (2026) · General Hospital Psychiatry · doi:10.1016/j.genhosppsych.2026.08.006
Miller, H. W., Abousaway, R. B., Luong, M. N., Osuna-Diaz, M. M., Sebastian, K. R., Yu, L., Mikulik, Z., RODRIGUEZ‐SAONA, L. E., & Hackshaw, K. V. (2026) · Disability and Rehabilitation · doi:10.1080/09638288.2026.2734243 · Cited by 1 · see citing works
Edwin, E. R., Bharathy, P., & Chandrasekar, J. (2026) · SN Comprehensive Clinical Medicine · doi:10.1007/s42399-026-02814-w
- Authors
- Martínez, M. P., Sánchez, A. I., Prados, G., Lami, M. J., Villar, B., & Miró, E.
- Affiliations
- Universidad de Granada (ES)
- Venue
- The Spanish Journal of Psychology
- Publisher
- Cambridge University Press (CUP)
- Published
- 2021
- Volume
- 24
- Pages
- e33-e33
- ISSN
- 1138-7416 (ISSN-L)
- 1988-2904
- OpenAlex
- W3162008750
- Cited by
- 24
- References
- 82
- Citations by year
- 2026: 7 · 2025: 3 · 2024: 6 · 2023: 3 · 2022: 4 · 2021: 1
- FWCI
- 2.51
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- The Spanish Journal of Psychology (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- Institutional Repository of the University of Granada (University of Granada) (submittedVersion, cc-by-nc-nd)
- Funders
- Ministerio de Economía y Competitividad (PID2019, PSI2014, PSI2014-58379-P, 13039/501100011033)
- Agencia Estatal de Investigación (AEI//10.13039/501100011033/, 501100011033, 10.13039/501100011033, 13039, .13039/501100011033, 10.13039, PID2019)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Fibromyalgia and Chronic Fatigue Syndrome Research
- Health Sciences › Medicine › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
- Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
- Keywords
- fibromyalgia, patient heterogeneity, clinical subgroups, pain catastrophizing, pain vigilance, pain self-efficacy, pain acceptance, fatigue, sleep quality, psychopathology, disability, women, personalized treatment
- MeSH terms
- Cognition, Cross-Sectional Studies, Female, Fibromyalgia, Humans, Pain, Catastrophization
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