584feb894dff6d3f8223e1718b4aa357 pmc_10604090.pdf 8fe6de7e63ca86cd56c76d45b9204233a2723010 pmc_10604090.pdf 79680698d58b7ba2de0e642cc9351bf731f0f06d0b111b9f588881015d6e9d6b pmc_10604090.pdf Title: Hierarchical Cluster Analysis Based on Clinical and Neuropsychological Symptoms Reveals Distinct Subgroups in Fibromyalgia: A Population-Based Cohort Study Subject: Fibromyalgia (FM) is a condition characterized by musculoskeletal pain and multiple comorbidities. Our study aimed to identify four clusters of FM patients according to their core clinical symptoms and neuropsychological comorbidities to identify possible therapeutic targets in the condition. We performed a population-based cohort study on 251 adult FM patients referred to primary care according to the 2010 ACR case criteria. Patients were aggregated in clusters by a K-medians hierarchical cluster analysis based on physical and emotional symptoms and neuropsychological variables. Four different clusters were identified in the FM population. Global cluster analysis reported a four-cluster profile (cluster 1: pain, fatigue, poorer sleep quality, stiffness, anxiety/depression and disability at work; cluster 2: injustice, catastrophizing, positive affect and negative affect; cluster 3: mindfulness and acceptance; and cluster 4: surrender). The second analysis on clinical symptoms revealed three distinct subgroups (cluster 1: fatigue, poorer sleep quality, stiffness and difficulties at work; cluster 2: pain; and cluster 3: anxiety and depression). The third analysis of neuropsychological variables provided two opposed subgroups (cluster 1: those with high scores in surrender, injustice, catastrophizing and negative affect, and cluster 2: those with high scores in acceptance, positive affect and mindfulness). These empirical results support models that assume an interaction between neurobiological, psychological and social factors beyond the classical biomedical model. A detailed assessment of such risk and protective factors is critical to differentiate FM subtypes, allowing for further identification of their specific needs and designing tailored personalized therapeutic interventions. Keywords: chronic pain; fibromyalgia; cluster analysis; neuropsychological symptoms; fatigue;mindfulness Author: Sara Maurel, Lydia Giménez-Llort, Jose Alegre-Martin and Jesús Castro-Marrero Creator: LaTeX with hyperref Producer: pdfTeX-1.40.21 CreationDate: Mon Oct 23 11:51:43 2023 CEST ModDate: Mon Oct 23 11:54:03 2023 CEST Tagged: no UserProperties: no Suspects: no Form: none JavaScript: no Pages: 15 Encrypted: no Page size: 595.276 x 841.89 pts (A4) Page rot: 0 File size: 1189687 bytes Optimized: no PDF version: 1.7 name type encoding emb sub uni object ID ------------------------------------ ----------------- ---------------- --- --- --- --------- PKKOBI+VnURWPalladioL Type 1 Custom yes yes no 10 0 MRUBED+URWPalladioL-Bold Type 1 Custom yes yes no 15 0 ZWMAKZ+URWPalladioL-Roma Type 1 Custom yes yes no 20 0 MQSHUC+URWPalladioL-Ital Type 1 Custom yes yes no 24 0 MQFYIK+VnURWPalladioL-Bold Type 1 Custom yes yes no 28 0 EBFBTV+TimesNewRomanPS-BoldItalicMT Type 1C WinAnsi yes yes no 46 0 GQWIGS+CMSY10 Type 1 Builtin yes yes no 74 0 URYLRZ+URWPalladioL-BoldItal Type 1 Custom yes yes no 81 0 IIJBCD+PalatinoLinotype,Bold TrueType WinAnsi yes yes no 98 0 IIJBCE+PalatinoLinotype CID TrueType Identity-H yes yes yes 101 0 IIJBCF+PalatinoLinotype TrueType WinAnsi yes yes no 107 0 IIJBCH+PalatinoLinotype,Italic TrueType WinAnsi yes yes no 110 0 IIJBPD+PalatinoLinotype TrueType MacRoman yes yes no 113 0 IIJBCD+PalatinoLinotype,Bold TrueType WinAnsi yes yes no 127 0 IIJBCE+PalatinoLinotype CID TrueType Identity-H yes yes yes 130 0 IIJBCF+PalatinoLinotype TrueType WinAnsi yes yes no 136 0 IIJBCH+PalatinoLinotype,Italic TrueType WinAnsi yes yes no 139 0 IIJBPD+PalatinoLinotype TrueType MacRoman yes yes no 142 0 IIJBCD+PalatinoLinotype,Bold TrueType WinAnsi yes yes no 159 0 IIJBCE+PalatinoLinotype CID TrueType Identity-H yes yes yes 162 0 IIJBCF+PalatinoLinotype TrueType WinAnsi yes yes no 168 0 IIJBCH+PalatinoLinotype,Italic TrueType WinAnsi yes yes no 171 0 IIJBPD+PalatinoLinotype TrueType MacRoman yes yes no 174 0 Jhove (Rel. 1.28.0, 2023-05-18) Date: 2024-02-02 02:32:45 CET RepresentationInformation: pmc_10604090.pdf ReportingModule: PDF-hul, Rel. 1.12.4 (2023-03-16) LastModified: 2024-02-01 02:44:58 CET Size: 1189687 Format: PDF Version: 1.7 Status: Well-Formed and valid SignatureMatches: PDF-hul MIMEtype: application/pdf PDFMetadata: Objects: 336 FreeObjects: 1 IncrementalUpdates: 0 DocumentCatalog: PageLayout: SinglePage PageMode: UseNone Outlines: Item: Title: Introduction Destination: section.1 Item: Title: Methods Destination: section.2 Children: Item: Title: Study Participants Destination: subsection.2.1 Item: Title: Measures Destination: subsection.2.2 Item: Title: Health Status Variables Destination: subsection.2.3 Item: Title: Neuropsychological Variables Destination: subsection.2.4 Item: Title: Statistical Analysis Destination: subsection.2.5 Item: Title: Results Destination: section.3 Children: Item: Title: Participants’ Demographic and Clinical Characteristics Destination: subsection.3.1 Item: Title: Cluster Analysis of Clinical and Neuropsychological Parameters Destination: subsection.3.2 Item: Title: Combination of Rescaled Distance Clusters Destination: subsection.3.3 Item: Title: Discussion Destination: section.4 Item: Title: Conclusions and Future Directions Destination: section.5 Item: Title: References Destination: section.6 Info: Title: Hierarchical Cluster Analysis Based on Clinical and Neuropsychological Symptoms Reveals Distinct Subgroups in Fibromyalgia: A Population-Based Cohort Study Author: Sara Maurel, Lydia Giménez-Llort, Jose Alegre-Martin and Jesús Castro-Marrero Subject: Fibromyalgia (FM) is a condition characterized by musculoskeletal pain and multiple comorbidities. Our study aimed to identify four clusters of FM patients according to their core clinical symptoms and neuropsychological comorbidities to identify possible therapeutic targets in the condition. We performed a population-based cohort study on 251 adult FM patients referred to primary care according to the 2010 ACR case criteria. Patients were aggregated in clusters by a K-medians hierarchical cluster analysis based on physical and emotional symptoms and neuropsychological variables. Four different clusters were identified in the FM population. Global cluster analysis reported a four-cluster profile (cluster 1: pain, fatigue, poorer sleep quality, stiffness, anxiety/depression and disability at work; cluster 2: injustice, catastrophizing, positive affect and negative affect; cluster 3: mindfulness and acceptance; and cluster 4: surrender). The second analysis on clinical symptoms revealed three distinct subgroups (cluster 1: fatigue, poorer sleep quality, stiffness and difficulties at work; cluster 2: pain; and cluster 3: anxiety and depression). The third analysis of neuropsychological variables provided two opposed subgroups (cluster 1: those with high scores in surrender, injustice, catastrophizing and negative affect, and cluster 2: those with high scores in acceptance, positive affect and mindfulness). These empirical results support models that assume an interaction between neurobiological, psychological and social factors beyond the classical biomedical model. A detailed assessment of such risk and protective factors is critical to differentiate FM subtypes, allowing for further identification of their specific needs and designing tailored personalized therapeutic interventions. Keywords: chronic pain; fibromyalgia; cluster analysis; neuropsychological symptoms; fatigue;mindfulness Creator: LaTeX with hyperref Producer: pdfTeX-1.40.21 CreationDate: Mon Oct 23 11:51:43 CEST 2023 ModDate: Mon Oct 23 11:54:03 CEST 2023 ID: 0x1bcad1ce4b860bbf5b23e7b245971339, 0x1bcad1ce4b860bbf5b23e7b245971339 Filters: FilterPipeline: FlateDecode Fonts: Type1: Font: BaseFont: URYLRZ+URWPalladioL-BoldItal FontSubset: true FirstChar: 110 LastChar: 110 FontDescriptor: FontName: URYLRZ+URWPalladioL-BoldItal Flags: Symbolic FontBBox: -170, -300, 1073, 935 FontFile: true EncodingDictionary: Differences: true Font: BaseFont: ZWMAKZ+URWPalladioL-Roma FontSubset: true FirstChar: 2 LastChar: 233 FontDescriptor: FontName: ZWMAKZ+URWPalladioL-Roma Flags: Symbolic FontBBox: -166, -283, 1021, 943 FontFile: true EncodingDictionary: Differences: true Font: BaseFont: MQSHUC+URWPalladioL-Ital FontSubset: true FirstChar: 39 LastChar: 121 FontDescriptor: FontName: MQSHUC+URWPalladioL-Ital Flags: Symbolic FontBBox: -170, -305, 1010, 941 FontFile: true EncodingDictionary: Differences: true Font: BaseFont: PKKOBI+VnURWPalladioL FontSubset: true FirstChar: 177 LastChar: 225 FontDescriptor: FontName: PKKOBI+VnURWPalladioL Flags: Symbolic FontBBox: -166, -283, 1021, 943 FontFile: true EncodingDictionary: Differences: true Font: BaseFont: GQWIGS+CMSY10 FontSubset: true FirstChar: 0 LastChar: 21 FontDescriptor: FontName: GQWIGS+CMSY10 Flags: Symbolic FontBBox: -29, -960, 1116, 775 FontFile: true Font: BaseFont: MQFYIK+VnURWPalladioL-Bold FontSubset: true FirstChar: 178 LastChar: 243 FontDescriptor: FontName: MQFYIK+VnURWPalladioL-Bold Flags: Symbolic FontBBox: -152, -301, 1000, 935 FontFile: true EncodingDictionary: Differences: true Font: BaseFont: MRUBED+URWPalladioL-Bold FontSubset: true FirstChar: 2 LastChar: 122 FontDescriptor: FontName: MRUBED+URWPalladioL-Bold Flags: Symbolic FontBBox: -152, -301, 1000, 935 FontFile: true EncodingDictionary: Differences: true Pages: Page: Sequence: 1 Annotations: Annotation: Subtype: Link Rect: 34, 279, 152, 288 Annotation: Subtype: Link Rect: 34, 269, 105, 276 Annotation: Subtype: Link Rect: 34, 164, 96, 186 Annotation: Subtype: Link Rect: 126, 90, 154, 99 Annotation: Subtype: Link Rect: 34, 78, 147, 87 Annotation: Subtype: Link Rect: 34, 756, 197, 792 Annotation: Subtype: Link Rect: 515, 756, 560, 792 Annotation: Subtype: Link Rect: 210, 642, 221, 655 Annotation: Subtype: Link Rect: 456, 642, 467, 655 Annotation: Subtype: Link Rect: 361, 130, 368, 139 ActionDest: 185 Annotation: Subtype: Link Rect: 321, 93, 328, 102 ActionDest: 185 Annotation: Subtype: Link Rect: 130, 17, 302, 28 Annotation: Subtype: Link Rect: 389, 17, 560, 28 Annotation: Subtype: Link Rect: 34, 388, 87, 407 Page: Sequence: 2 Annotations: Annotation: Subtype: Link Rect: 288, 698, 295, 707 ActionDest: 185 Annotation: Subtype: Link Rect: 298, 698, 305, 707 ActionDest: 185 Annotation: Subtype: Link Rect: 289, 660, 296, 669 ActionDest: 185 Annotation: Subtype: Link Rect: 364, 660, 371, 669 ActionDest: 185 Annotation: Subtype: Link Rect: 460, 647, 467, 657 ActionDest: 185 Annotation: Subtype: Link Rect: 467, 647, 474, 657 ActionDest: 185 Annotation: Subtype: Link Rect: 262, 622, 274, 631 ActionDest: 185 Annotation: Subtype: Link Rect: 274, 623, 286, 631 ActionDest: 185 Annotation: Subtype: Link Rect: 344, 572, 356, 581 ActionDest: 185 Annotation: Subtype: Link Rect: 356, 572, 368, 581 ActionDest: 185 Annotation: Subtype: Link Rect: 348, 484, 359, 493 ActionDest: 185 Annotation: Subtype: Link Rect: 185, 472, 197, 481 ActionDest: 185 Annotation: Subtype: Link Rect: 198, 472, 210, 481 ActionDest: 188 Annotation: Subtype: Link Rect: 504, 472, 516, 481 ActionDest: 188 Annotation: Subtype: Link Rect: 519, 472, 531, 481 ActionDest: 188 Annotation: Subtype: Link Rect: 274, 371, 286, 380 ActionDest: 188 Annotation: Subtype: Link Rect: 548, 220, 555, 229 ActionDest: 185 Page: Sequence: 3 Annotations: Annotation: Subtype: Link Rect: 400, 534, 412, 543 ActionDest: 188 Annotation: Subtype: Link Rect: 439, 383, 451, 392 ActionDest: 185 Annotation: Subtype: Link Rect: 452, 383, 464, 392 ActionDest: 188 Annotation: Subtype: Link Rect: 188, 270, 200, 279 ActionDest: 188 Annotation: Subtype: Link Rect: 358, 120, 369, 128 ActionDest: 188 Page: Sequence: 4 Annotations: Annotation: Subtype: Link Rect: 416, 673, 428, 682 ActionDest: 188 Annotation: Subtype: Link Rect: 391, 447, 403, 456 ActionDest: 188 Annotation: Subtype: Link Rect: 372, 334, 384, 343 ActionDest: 188 Annotation: Subtype: Link Rect: 403, 258, 414, 267 ActionDest: 188 Annotation: Subtype: Link Rect: 457, 171, 469, 180 ActionDest: 188 Annotation: Subtype: Link Rect: 350, 95, 362, 104 ActionDest: 188 Annotation: Subtype: Link Rect: 362, 95, 374, 104 ActionDest: 188 Page: Sequence: 5 Annotations: Annotation: Subtype: Link Rect: 214, 440, 221, 452 ActionDest: 85 Page: Sequence: 6 Annotations: Annotation: Subtype: Link Rect: 506, 285, 513, 297 ActionDest: 88 Annotation: Subtype: Link Rect: 503, 185, 510, 197 ActionDest: 88 Page: Sequence: 7 Annotations: Annotation: Subtype: Link Rect: 393, 208, 400, 220 ActionDest: 117 Annotation: Subtype: Link Rect: 467, 133, 474, 145 ActionDest: 117 Annotation: Subtype: Link Rect: 399, 83, 406, 95 ActionDest: 117 Page: Sequence: 8 Page: Sequence: 9 Annotations: Annotation: Subtype: Link Rect: 515, 720, 522, 732 ActionDest: 146 Annotation: Subtype: Link Rect: 297, 536, 304, 548 ActionDest: 146 Annotation: Subtype: Link Rect: 534, 166, 541, 178 ActionDest: 149 Annotation: Subtype: Link Rect: 387, 104, 394, 116 ActionDest: 149 Page: Sequence: 10 Annotations: Annotation: Subtype: Link Rect: 398, 93, 405, 102 ActionDest: 185 Page: Sequence: 11 Annotations: Annotation: Subtype: Link Rect: 385, 723, 397, 732 ActionDest: 188 Annotation: Subtype: Link Rect: 300, 710, 312, 719 ActionDest: 188 Annotation: Subtype: Link Rect: 233, 673, 245, 682 ActionDest: 188 Annotation: Subtype: Link Rect: 487, 497, 499, 506 ActionDest: 188 Annotation: Subtype: Link Rect: 319, 472, 331, 481 ActionDest: 188 Annotation: Subtype: Link Rect: 332, 472, 344, 481 ActionDest: 188 Annotation: Subtype: Link Rect: 484, 447, 496, 456 ActionDest: 188 Annotation: Subtype: Link Rect: 496, 447, 508, 456 ActionDest: 188 Annotation: Subtype: Link Rect: 393, 371, 405, 380 ActionDest: 188 Annotation: Subtype: Link Rect: 332, 359, 344, 368 ActionDest: 188 Annotation: Subtype: Link Rect: 262, 321, 274, 330 ActionDest: 185 Annotation: Subtype: Link Rect: 356, 296, 368, 305 ActionDest: 188 Annotation: Subtype: Link Rect: 409, 271, 421, 280 ActionDest: 188 Annotation: Subtype: Link Rect: 516, 246, 528, 255 ActionDest: 188 Annotation: Subtype: Link Rect: 275, 208, 287, 217 ActionDest: 188 Annotation: Subtype: Link Rect: 382, 83, 393, 92 ActionDest: 188 Page: Sequence: 12 Annotations: Annotation: Subtype: Link Rect: 318, 698, 330, 707 ActionDest: 188 Annotation: Subtype: Link Rect: 326, 271, 338, 280 ActionDest: 191 Annotation: Subtype: Link Rect: 338, 271, 350, 280 ActionDest: 191 Page: Sequence: 13 Annotations: Annotation: Subtype: Link Rect: 433, 492, 559, 503 Annotation: Subtype: Link Rect: 135, 380, 173, 390 Annotation: Subtype: Link Rect: 316, 345, 352, 356 Annotation: Subtype: Link Rect: 520, 333, 557, 344 Annotation: Subtype: Link Rect: 59, 323, 94, 333 Annotation: Subtype: Link Rect: 521, 299, 557, 310 Annotation: Subtype: Link Rect: 201, 276, 239, 287 Annotation: Subtype: Link Rect: 197, 253, 235, 264 Annotation: Subtype: Link Rect: 277, 230, 315, 241 Annotation: Subtype: Link Rect: 397, 207, 434, 218 Annotation: Subtype: Link Rect: 171, 184, 209, 195 Annotation: Subtype: Link Rect: 397, 161, 434, 172 Annotation: Subtype: Link Rect: 142, 127, 180, 137 Annotation: Subtype: Link Rect: 186, 127, 222, 137 Annotation: Subtype: Link Rect: 363, 103, 400, 114 Annotation: Subtype: Link Rect: 406, 103, 443, 114 Annotation: Subtype: Link Rect: 109, 81, 146, 91 Annotation: Subtype: Link Rect: 96, 58, 133, 68 Page: Sequence: 14 Annotations: Annotation: Subtype: Link Rect: 291, 722, 328, 733 Annotation: Subtype: Link Rect: 335, 722, 371, 733 Annotation: Subtype: Link Rect: 504, 676, 542, 687 Annotation: Subtype: Link Rect: 512, 652, 550, 664 Annotation: Subtype: Link Rect: 371, 606, 409, 617 Annotation: Subtype: Link Rect: 415, 606, 451, 617 Annotation: Subtype: Link Rect: 143, 573, 180, 583 Annotation: Subtype: Link Rect: 186, 573, 222, 583 Annotation: Subtype: Link Rect: 423, 549, 459, 560 Annotation: Subtype: Link Rect: 247, 526, 285, 537 Annotation: Subtype: Link Rect: 332, 503, 370, 514 Annotation: Subtype: Link Rect: 445, 480, 482, 491 Annotation: Subtype: Link Rect: 95, 446, 133, 456 Annotation: Subtype: Link Rect: 448, 411, 486, 422 Annotation: Subtype: Link Rect: 418, 388, 456, 399 Annotation: Subtype: Link Rect: 138, 366, 176, 376 Annotation: Subtype: Link Rect: 462, 342, 499, 353 Annotation: Subtype: Link Rect: 520, 330, 557, 341 Annotation: Subtype: Link Rect: 59, 320, 95, 330 Annotation: Subtype: Link Rect: 214, 297, 252, 307 Annotation: Subtype: Link Rect: 258, 297, 294, 307 Annotation: Subtype: Link Rect: 522, 273, 557, 284 Annotation: Subtype: Link Rect: 288, 250, 326, 261 Annotation: Subtype: Link Rect: 454, 215, 492, 226 Annotation: Subtype: Link Rect: 415, 192, 453, 203 Annotation: Subtype: Link Rect: 297, 158, 335, 169 Annotation: Subtype: Link Rect: 350, 135, 388, 146 Annotation: Subtype: Link Rect: 214, 113, 252, 123 Annotation: Subtype: Link Rect: 258, 113, 294, 123 Page: Sequence: 15 Annotations: Annotation: Subtype: Link Rect: 95, 711, 133, 721 Annotation: Subtype: Link Rect: 139, 711, 175, 721 Annotation: Subtype: Link Rect: 355, 687, 393, 698 Checksum: 361a7e1d Type: CRC32 Checksum: 584feb894dff6d3f8223e1718b4aa357 Type: MD5 Checksum: 8fe6de7e63ca86cd56c76d45b9204233a2723010 Type: SHA-1 Checksum: 79680698d58b7ba2de0e642cc9351bf731f0f06d0b111b9f588881015d6e9d6b Type: SHA-256