Metacognition and pain in patients with fibromyalgia: the role of psychological distress

Background: Fibromyalgia (FM) is a syndrome characterised by chronic and widespread musculoskeletal pain that is often accompanied by psychological distress. Another psychological aspect associated with FM is metacognition. Metacognition is a process that enables a person to understand themselves and others in terms of intentional mental states. The aim of the present study was to investigate the relationship between metacognitive functioning, psychological distress and pain intensity in a sample of FM patients. Methods: Sixty-one females with FM were asked to complete the following questionnaires after signing informed consent: the pain intensity item of the Fibromyalgia Impact Questionnaire-Revised (FIQ-R), the Hospital Anxiety and Depression Scale (HADS), and the Metacognitive Functions Screening Scale (MFSS-30). Results: The pain intensity item of the FIQ-R was negatively associated with metacognitive abilities (MFSS-30) and positively related to psychological distress (HADS total). The mediation analysis showed that the HADS total score mediated the relationship between the MFSS total score and the pain intensity item of the FIQ-R. This result suggests that reduced metacognitive abilities were associated with higher levels of psychological distress, which in turn were associated with greater pain intensity. Conclusions: These findings have important clinical implications. The suggestion of a psychological intervention targeting metacognitive processes could reduce the degree of psychological distress and consequently the intensity of pain.