• Tella Marialaura Di MD Department of Psychology, University of Turin, Turin, Italy., Ivan Enrici, Lorys Castelli, Fabrizio Colonna, Enrico Fusaro, Ada Ghiggia, Annunziata Romeo, Valentina Tesio, and Mauro Adenzato.
• Department of Psychology, University of Turin, Turin, Italy.
• J Affect Disord. 2018 Feb 1; 227: 272-279.

BackgroundFibromyalgia (FM) is a syndrome characterized by chronic, widespread musculoskeletal pain, occurring predominantly in women. Previous studies have shown that patients with FM display a pattern of selective processing or cognitive bias which fosters the encoding of pain-related information. The present study tested the hypothesis of an increased attribution of pain to facial expressions of emotions (FEE), in patients with FM. As previous studies have shown that alexithymia influences the processing of facial expressions, independent of specific clinical conditions, we also investigated whether alexithymia, rather than FM per se, influenced attribution of pain to FEE.MethodsOne hundred and twenty-three women (41 with FM, 82 healthy controls, HC) were enrolled in this cross-sectional case-control study. We adopted two pain-attribution tasks, the Emotional Pain Estimation and the Emotional Pain Ascription, both using a modified version of the Ekman 60 Faces Test. Psychological distress was assessed using the Hospital Anxiety and Depression Scale, and alexithymia was assessed using the Toronto Alexithymia Scale.ResultsPatients with FM did not report increased attribution of pain to FEE. Alexithymic individuals demonstrated no specific problem in the recognition of basic emotions, but attributed significantly more pain to angry facial expression.LimitationsOur study involved a relatively small sample size. The use of self-reported instruments might have led to underestimation of the presence of frank alexithymia in individuals having borderline cut-off scores.ConclusionsAlexithymia, rather than FM per se, plays a key role in explaining the observed differences in pain attribution to anger-related facial expressions.Copyright © 2017 Elsevier B.V. All rights reserved.

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