Fibromyalgia (FM) is an idiopathic chronic musculoskeletal pain disorder affecting approximately 5 million adults in the United States.1-4 Though pain is typically considered the cardinal symptom of FM, most people experience a constellation of symptoms, including fatigue, sleep disturbances, depression, anxiety, morning stiffness, and cognitive problems.4-8 The latter, cognitive problems, are reported by approximately 70% of those with FM, and are rated as one of the most troubling FM symptoms.4,7-9 However, cognitive problems are rarely addressed by clinicians and are critically understudied. Commonly called fibrofog, this dyscognition has been described by patients as problems with concentration, memory, confusion, and speaking.4,6,8,10 Anecdotally, fibrofog is linked to devastating effects on quality of life and functioning; contributing to difficulties maintaining relationships, working, communicating, driving, organizing planning, and initiating activities of daily life.6,8 Distressingly little is known about the natur of fibrofog, despite its acknowledged prevalence and impact. Because the research that has examined difficulty on cognitive tests in FM is limited in scope and rigor, there are ongoing questions as to whether fibrofog is just a problem with attention and memory, or whether other areas of cognition are affected. Previous studies have also not adequately assessed or controlled for the effects of coexisting symptoms or compared FM to other clinical groups, such as depressed individuals; therefore, it is not known whether fibrofog is a manifestation of other FM symptoms (e.g. depression, fatigue) or a unique set of problems. Because there has been very limited neuroimaging research in FM, there is a lack of understanding of the neurological processes that might be contributing to fibrofog. Finally, there have been no efforts to examine the validity and utility of existing cognitive assessment tools in FM; so, researchers and clinicians have no direction as to which tools to use to assess fibrofog severity. The overarching goal of this proposal is to provide education and training to the Principal Investigator (PI), Anna Kratz, PhD, so that she has the requisite knowledge and skills to address these limitations in the scientific evidence on fibrofog. Dr. Kratz is a clinical psychologist whose research has focused on chronic pain in medical conditions such as arthritis, fibromyalgia, and multiple sclerosis. The proposed training plan will allow her to extend her knowledge from chronic pain into the areas of cognitive dysfunction, neuroimaging, and outcomes measurement. The PI has demonstrated commitment to a career in clinical health research, and a history of scholarship and research productivity. The University of Michigan provides her with a supportive, stimulating, and collaborative environment that offers an abundance of resources and support for early career scientists and clinical research. A diverse and accomplished mentoring team has been assembled to guide the PI toward expertise in cognitive dysfunction in FM, neurocognitive and self-report assessment technologies, and functional magnetic resonance imaging. Dr. Kratz's short-term career goals are to gain expertise in the nature of fibrofog, neurobiological functioning, neuroimaging, and evaluating and developing contemporary measures of fibrofog. These short-term goals will support her progression toward her long-term plan to develop an independent research program that makes significant contributions to the understanding and treatment of cognitive problems in other medical conditions where dyscognition is present but not the central focus of the condition. Ultimately, the skills that she acquires through the proposed training and research may be used to identify mechanisms of cognitive dysfunction that are common across medical diagnoses. The scientific objectives of this application are to methodically describe the phenotypic nature of fibrofog, examine the neurobiological processes underlying these cognitive problems, and test the utility of cognitive measures in fibrofog. First, to characterize the major areas of cognitive problems in fibrofog, a comprehensive set of contemporary (NIH Toolbox of Neurological and Behavioral Function) and gold standard neuropsychological tests will be administered to a sample of individuals with FM and an age- and sex-matched depressed control group. Second, functional magnetic resonance imaging will be conducted on individuals with FM and depressed controls while they are completing cognitive tasks. This will examine the dynamic connectivity of relevant brain regions that might provide insight about neurobiological mechanisms underlying fibrofog. Comparisons to depressed controls in terms of neuropsychological test performance and neurobiological functioning will provide insight about how fibrofog may be distinct from depression-related cognitive problems. Third, newly-developed and traditional measures of cognitive dysfunction will be submitted to psychometric analyses to determine their validity, reliability, and utility in detecting fibrofog. The ultimate aim of this study is to improve the clinical care of individuals wth fibrofog through the advancement of our understanding and assessment of this troubling set of symptoms. This award will enable Dr. Kratz to acquire the expertise and skills necessary to become an independent researcher capable of achieving the overall goal of elucidating the scope and mechanisms of cognitive dysfunction in FM.

Public Health Relevance

Pain may be the cardinal symptom of fibromyalgia (FM), but patients consider cognitive dysfunction (e.g., memory, attention, and mental clarity problems) to be among the most distressing and under-treated aspects of FM. Little is known about the nature and etiology of cognitive dysfunction in FM; thus the overarching objective of this K award is to train a clinical psychologist in the methods needed to rigorously characterize and identify the underlying mechanisms of cognitive dysfunction in FM. The research methodology will use and require training in multiple assessment methods including objective neuropsychological performance testing, self-reported assessment of cognitive dysfunction, and neuroimaging techniques (e.g., functional connectivity). Assessing multiple domains of cognitive dysfunction along with their neurobiological correlates will help prepare the candidate for a career in the assessment and treatment of cognitive problems in individuals with FM or other complex chronic illnesses.

National Institute of Health (NIH)
National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)
Research Scientist Development Award - Research & Training (K01)
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Study Section
Arthritis and Musculoskeletal and Skin Diseases Special Grants Review Committee (AMS)
Program Officer
Wang, Yan Z
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University of Michigan Ann Arbor
Physical Medicine & Rehab
Schools of Medicine
Ann Arbor
United States
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Kratz, Anna L; F Murphy 3rd, John; Kalpakjian, Claire Z et al. (2018) Medicate or Meditate? Greater Pain Acceptance is Related to Lower Pain Medication Use in Persons With Chronic Pain and Spinal Cord Injury. Clin J Pain 34:357-365
Geisser, Michael E; Kratz, Anna L (2018) How condition-specific do measures of pain intensity need to be? Pain 159:1001-1002
Carlozzi, Noelle E; Schilling, Stephen; Freedman, Jenna et al. (2018) The reliability of end of day and ecological momentary assessments of pain and pain interference in individuals with spinal cord injury. Qual Life Res 27:3003-3012
Geisser, Michael E; Kratz, Anna L (2018) Cognitive dysfunction and pain: considerations for future research. Pain 159:189-190
Lai, Jin-Shei; Goodnight, Siera; Downing, Nancy R et al. (2018) Evaluating cognition in individuals with Huntington disease: Neuro-QoL cognitive functioning measures. Qual Life Res 27:811-822
Kratz, Anna L; Murphy, Susan L; Braley, Tiffany J (2017) Pain, Fatigue, and Cognitive Symptoms Are Temporally Associated Within but Not Across Days in Multiple Sclerosis. Arch Phys Med Rehabil 98:2151-2159
Kratz, Anna L; Braley, Tiffany J; Foxen-Craft, Emily et al. (2017) How Do Pain, Fatigue, Depressive, and Cognitive Symptoms Relate to Well-Being and Social and Physical Functioning in the Daily Lives of Individuals With Multiple Sclerosis? Arch Phys Med Rehabil 98:2160-2166
Kratz, Anna L; Sander, Angelle M; Brickell, Tracey A et al. (2017) Traumatic brain injury caregivers: A qualitative analysis of spouse and parent perspectives on quality of life. Neuropsychol Rehabil 27:16-37
Daunter, Alecia K; Kratz, Anna L; Hurvitz, Edward A (2017) Long-term impact of childhood selective dorsal rhizotomy on pain, fatigue, and function: a case-control study. Dev Med Child Neurol 59:1089-1095
Kratz, Anna L; Murphy, Susan L; Braley, Tiffany J (2017) Ecological Momentary Assessment of Pain, Fatigue, Depressive, and Cognitive Symptoms Reveals Significant Daily Variability in Multiple Sclerosis. Arch Phys Med Rehabil 98:2142-2150

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