Facial Emotion Recognition and Executive Functions in Fibromyalgia

Pain Med. 2021 Jul 25;22(7):1619-1629. doi: 10.1093/pm/pnab024.


Objective: The ability to accurately identify facial expressions of emotions is crucial in human interaction. Although a previous study suggested deficient emotional face recognition in patients with fibromyalgia, not much is known about the origin of this impairment. Against this background, the present study investigated the role of executive functions. Executive functions refer to cognitive control mechanisms enabling implementation and coordination of basic mental operations. Deficits in this domain are prevalent in fibromyalgia.

Methods: Fifty-two fibromyalgia patients and thirty-two healthy individuals completed the Ekman-60 Faces Test, which requires classification of facial displays of happiness, sadness, anger, fear, surprise, and disgust. They also completed eight tasks assessing the executive function components of shifting, updating, and inhibition. Effects of comorbid depression and anxiety disorders, as well as medication use, were tested in stratified analyses of patient subgroups.

Results: Patients made more errors overall than controls in classifying the emotional expressions. Moreover, their recognition accuracy correlated positively with performance on most of the executive function tasks. Emotion recognition did not vary as a function of comorbid psychiatric disorders or medication use.

Conclusions: The study supports impaired facial emotion recognition in fibromyalgia, which may contribute to the interaction problems and poor social functioning characterizing this condition. Facial emotion recognition is regarded as a complex process, which may be particularly reliant on efficient coordination of various basic operations by executive functions. As such, the correlations between cognitive task performance and recognition accuracy suggest that deficits in higher cognitive functions underlie impaired emotional communication in fibromyalgia.

Keywords: Cognition; Emotion; Executive Functions; Facial Emotion Recognition; Fibromyalgia.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Emotions
  • Executive Function
  • Facial Expression
  • Facial Recognition*
  • Fibromyalgia*
  • Humans