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Hedman-Lagerlöf M, Buhrman M, Hedman-Lagerlöf E, Ljótsson B, Axelsson E. Shared and distinct effect mediators in exposure-based and traditional cognitive behavior therapy for fibromyalgia: Secondary analysis of a randomized controlled trial. Behav Res Ther 2024; 178:104546. [PMID: 38685153 DOI: 10.1016/j.brat.2024.104546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2024] [Revised: 04/19/2024] [Accepted: 04/19/2024] [Indexed: 05/02/2024]
Abstract
Fibromyalgia is a chronic pain condition associated with substantial suffering and societal costs. Traditional cognitive behavior therapy (T-CBT) is the most evaluated psychological treatment, but exposure therapy (Exp-CBT) has shown promise with a pronounced focus on the reduction of pain-related avoidance behaviors. In a recent randomized controlled trial (N = 274), we found that Exp-CBT was not superior to T-CBT (d = -0.10) in reducing overall fibromyalgia severity. This study investigated pain-related avoidance behaviors, pain catastrophizing, hypervigilance, pacing, overdoing and physical activity as potential mediators of the treatment effect. Mediation analyses were based on parallel process growth models fitted on 11 weekly measurement points, and week-by-week time-lagged effects were tested using random intercepts cross-lagged panel models. Results indicated that a reduction in avoidance behaviors, pain catastrophizing, and hypervigilance were significant mediators of change in both treatments. An increase in pacing and a reduction in overdoing were significant mediators in T-CBT only. Physical activity was not a mediator. In the time-lagged analyses, an unequivocal effect on subsequent fibromyalgia severity was seen of avoidance and catastrophizing in Exp-CBT, and of overdoing in T-CBT. Exposure-based and traditional CBT for fibromyalgia appear to share common treatment mediators, namely pain-related avoidance behavior, catastrophizing and hypervigilance.
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Affiliation(s)
- Maria Hedman-Lagerlöf
- Center for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet & Stockholm Health Care Services, Stockholm, Region Stockholm, Sweden.
| | - Monica Buhrman
- Division of Clinical Psychology, Department of Psychology, Uppsala University, Uppsala, Sweden
| | - Erik Hedman-Lagerlöf
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Gustavsberg University Primary Health Care Center, Academic Primary Health Care Center, Stockholm, Region Stockholm, Sweden
| | - Brjánn Ljótsson
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Erland Axelsson
- Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden; Liljeholmen University Primary Health Care Center, Academic Primary Health Care Center, Stockholm, Region Stockholm, Sweden
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Kachaner A, Lemogne C, Ranque B. [Psychocorporal approach to functional somatic disorders]. Rev Med Interne 2024:S0248-8663(24)00632-5. [PMID: 38876948 DOI: 10.1016/j.revmed.2024.05.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Revised: 04/25/2024] [Accepted: 05/25/2024] [Indexed: 06/16/2024]
Abstract
Functional somatic disorders (FSD) are common conditions that result in a significant deterioration of the quality of life. Their origin is multifactorial and poorly understood, and their management is often inadequately defined. Medications typically show limited effectiveness, while mind-body approaches play a central role, guided by three key principles: establishing an empathetic, respectful, and sincere doctor-patient relationship; promoting regular and gradual physical activity; and implementing cognitive behavioral therapy (CBT). Special attention must be devoted to establishing a trustworthy relationship between the physician and the patient. Recognizing the reality and severity of symptoms and providing a positive diagnosis as well as an explanatory model to account for them rationally are fundamental aspects of patient management. Cognitive and behavioral maintenance factors should be investigated and constitute therapeutic targets. Cognitive factors include focused attention on body functioning and catastrophizing. Patients frequently display avoidance behaviors, particularly in relation to physical exertion, and it is crucial to motivate them to reintroduce gradual physical activity customized to their abilities. This approach has demonstrated efficacy in improving fatigue, pain, and the physical and mental quality of life for patients with FSD. Among psychotherapeutic approaches, the benefit of CBT is well-established. The combination of gradual physical activity and CBT appears to be complementary. Other mind-body approaches such as mindfulness meditation might help although their level of evidence is weaker. Given the prevalence of FSD in the general population, it seems necessary for all physicians to be trained in managing this condition.
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Affiliation(s)
- A Kachaner
- Service de médecine interne, hôpital européen Georges-Pompidou, AP-HP, Paris, France; Inserm, UMS 011 « Population-based Cohorts Unit », Paris-Saclay University, UVSQ, Paris, France.
| | - C Lemogne
- Inserm, INRAE, Center for Research in Epidemiology and Statistics (CRESS), université Paris-Cité, université Sorbonne-Paris-Nord, Paris, France; Service de psychiatrie de l'adulte, hôpital Hôtel-Dieu, AP-HP, Paris, France
| | - B Ranque
- Service de médecine interne, hôpital européen Georges-Pompidou, AP-HP, Paris, France; Inserm, INRAE, Center for Research in Epidemiology and Statistics (CRESS), université Paris-Cité, université Sorbonne-Paris-Nord, Paris, France; Unité CASPer, hôpital Hôtel-Dieu, AP-HP, Paris, France
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Sarzi-Puttini P, Giorgi V, Sirotti S, Bazzichi L, Lucini D, Di Lascio S, Pellegrino G, Fornasari D. Pharmacotherapeutic advances in fibromyalgia: what's new on the horizon? Expert Opin Pharmacother 2024:1-19. [PMID: 38853631 DOI: 10.1080/14656566.2024.2365326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2024] [Accepted: 06/04/2024] [Indexed: 06/11/2024]
Abstract
INTRODUCTION This review delves into Fibromyalgia Syndrome (FMS), a chronic pain condition demanding thorough understanding for precise diagnosis and treatment. Yet, a definitive pharmacological solution for FMS remains elusive. AREAS COVERED In this article, we systematically analyze various pharmacotherapeutic prospects for FMS treatment, organized into sections based on the stage of drug development and approval. We begin with an overview of FDA-approved drugs, discussing their efficacy in FMS treatment. Next, we delve into other medications currently used for FMS but still undergoing further study, including opioids and muscle relaxants. Further, we evaluate the evidence behind medications that are currently under study, such as cannabinoids and naltrexone. Lastly, we explore new drugs that are in phase II trials. Our research involved a thorough search on PUBMED, Google Scholar, and clinicaltrials.gov. We also discuss the action mechanisms of these drugs and their potential use in specific patient groups. EXPERT OPINION A focus on symptom-driven, combination therapy is crucial in managing FMS. There is also a need for ongoing research into drugs that target neuroinflammation, immunomodulation, and the endocannabinoid system. Bridging the gap between benchside research and clinical application is challenging, but it holds potential for more targeted and effective treatment strategies.
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Affiliation(s)
- Piercarlo Sarzi-Puttini
- Rheumatology Unit, IRCCS Ospedale Galeazzi Sant'Ambrogio, Milan, Italy
- Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Valeria Giorgi
- Unità di Ricerca Clinica, Gruppo Ospedaliero Moncucco, Lugano, Switzerland
| | - Silvia Sirotti
- Rheumatology Unit, IRCCS Ospedale Galeazzi Sant'Ambrogio, Milan, Italy
| | - Laura Bazzichi
- Rheumatology Unit, IRCCS Ospedale Galeazzi Sant'Ambrogio, Milan, Italy
| | - Daniela Lucini
- BIOMETRA Department, University of Milan, Milan, Italy
- IRCCS Istituto Auxologico Italiano, Exercise Medicine Unit, Milan, Italy
| | - Simona Di Lascio
- Department of Medical Biotechnology and Translational Medicine, Università degli Studi di Milano, Milan, Italy
| | - Greta Pellegrino
- Rheumatology Unit, IRCCS Ospedale Galeazzi Sant'Ambrogio, Milan, Italy
| | - Diego Fornasari
- Department of Medical Biotechnology and Translational Medicine, Università degli Studi di Milano, Milan, Italy
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Olivero A, Cuniberti F, Leombruni P. Well-Being Therapy for Fibromyalgia: A Case Report. J Nerv Ment Dis 2024; 212:352-357. [PMID: 38810099 DOI: 10.1097/nmd.0000000000001773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/31/2024]
Abstract
ABSTRACT Fibromyalgia syndrome (FMS) is characterized by chronic widespread pain, fatigue, anxiety, depression, and sleep disturbances, significantly impairing quality of life and psychological well-being. Well-being therapy (WBT) is a brief psychotherapeutic intervention aimed at increasing well-being and optimizing functioning, which has proven effective in treating various conditions involving pain and psychological or psychiatric symptoms. We describe a case study of a 22-year-old university student experiencing FMS, highlighting the far-reaching effects of the condition on her quality of life. After eight sessions of WBT, there was a marked improvement in subjective well-being and euthymia, as well as a decrease in pain perception, improved ability to manage stress, reduced allostatic overload despite the presence of stressors, improved social relationships, and increased self-efficacy. The positive effects of WBT continued at 3-month follow-up, suggesting that WBT may represent a short-term effective intervention for patients with FMS.
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Affiliation(s)
- Alberto Olivero
- "Rita Levi Montalcini" Department of Neuroscience, Università degli Studi di Torino, Torino, Italy
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Hedman-Lagerlöf M, Gasslander N, Ahnlund Hoffmann A, Bragesjö M, Etzell A, Ezra S, Frostell E, Hedman-Lagerlöf E, Ivert C, Liliequist B, Ljótsson B, Hoppe JM, Palmgren J, Spansk E, Sundström F, Särnholm J, Tzavara G, Buhrman M, Axelsson E. Effect of exposure-based vs traditional cognitive behavior therapy for fibromyalgia: a two-site single-blind randomized controlled trial. Pain 2024; 165:1278-1288. [PMID: 38131181 PMCID: PMC11090030 DOI: 10.1097/j.pain.0000000000003128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 09/13/2023] [Accepted: 10/13/2023] [Indexed: 12/23/2023]
Abstract
ABSTRACT Fibromyalgia is a debilitating pain condition for which treatment effects are typically modest. The most evaluated psychological treatment is traditional cognitive behavior therapy (T-CBT), but promising effects have recently been seen in exposure-based cognitive behavior therapy (Exp-CBT). We investigated whether Exp-CBT was superior to T-CBT in a randomized controlled trial. Self-referred participants with fibromyalgia (N = 274) were randomized (1:1) to 10 weeks of Exp-CBT or T-CBT. Treatments were delivered online and presented as "CBT for fibromyalgia." Participants were assessed at baseline, weekly during treatment, posttreatment, and at 6- and 12-month follow-up. Primary outcome was the difference in reduction in fibromyalgia severity as measured using the Fibromyalgia Impact Questionnaire (FIQ) over 11 assessment points from baseline to posttreatment, modelled within an intention-to-treat framework using linear mixed effects models fitted on multiple imputed data. Approximately 91% of weekly FIQ scores were collected over the main phase. There was no significant difference between Exp-CBT and T-CBT in the mean reduction of fibromyalgia severity from pretreatment to posttreatment (b = 1.3, 95% CI -3.0 to 5.7, P = 0.544, d = -0.10). Minimal clinically important improvement was seen 60% in Exp-CBT vs 59% in T-CBT. Effects were sustained up to 12 months posttreatment. This well-powered randomized trial indicated that Exp-CBT was not superior to T-CBT for fibromyalgia. Both treatments were associated with a marked reduction in fibromyalgia severity, and the online treatment format might be of high clinical utility. T-CBT can still be regarded a reference standard treatment that remains clinically relevant when compared to novel treatment approaches.
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Affiliation(s)
- Maria Hedman-Lagerlöf
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet & Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Nils Gasslander
- Division of Clinical Psychology, Department of Psychology, Uppsala University, Uppsala, Sweden
| | - Alice Ahnlund Hoffmann
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet & Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Maria Bragesjö
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet & Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Amanda Etzell
- Division of Clinical Psychology, Department of Psychology, Uppsala University, Uppsala, Sweden
| | - Simon Ezra
- Division of Clinical Psychology, Department of Psychology, Uppsala University, Uppsala, Sweden
| | - Elsa Frostell
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Erik Hedman-Lagerlöf
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Gustavsberg Primary Health Care Center, Region Stockholm, Stockholm, Sweden
| | - Caroline Ivert
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Björn Liliequist
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Brjánn Ljótsson
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Johanna M. Hoppe
- Division of Clinical Psychology, Department of Psychology, Uppsala University, Uppsala, Sweden
| | - Josefin Palmgren
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Edward Spansk
- Division of Clinical Psychology, Department of Psychology, Uppsala University, Uppsala, Sweden
| | - Felicia Sundström
- Division of Clinical Psychology, Department of Psychology, Uppsala University, Uppsala, Sweden
| | - Josefin Särnholm
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Georgia Tzavara
- Division of Clinical Psychology, Department of Psychology, Uppsala University, Uppsala, Sweden
| | - Monica Buhrman
- Division of Clinical Psychology, Department of Psychology, Uppsala University, Uppsala, Sweden
| | - Erland Axelsson
- Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Liljeholmen Primary Health Care Center, Region Stockholm, Stockholm, Sweden
- Academic Primary Health Care Center, Region Stockholm, Stockholm, Sweden
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Eastwood F, Godfrey E. The efficacy, acceptability and safety of acceptance and commitment therapy for fibromyalgia - a systematic review and meta-analysis. Br J Pain 2024; 18:243-256. [PMID: 38751564 PMCID: PMC11092929 DOI: 10.1177/20494637231221451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/18/2024] Open
Abstract
Background Fibromyalgia (FM) is a chronic pain disorder characterised by widespread pain, fatigue and cognitive symptoms. Acceptance and commitment therapy (ACT) aims to improve psychological flexibility and has been found to be beneficial in treating chronic pain; however, there are few studies evaluating its efficacy in treating FM. Aim This systematic review and meta-analysis evaluated the efficacy of acceptance and commitment therapy in patients with fibromyalgia. Methods PubMed, Embase and PsychInfo databases were searched. Randomised Controlled Trials (RCTs) were eligible for inclusion if participants had FM, and the intervention was based on the ACT framework/model, and not combined with any other active therapy; any non-ACT control was accepted. A meta-analysis was performed, with the primary outcomes pain acceptance (chronic pain acceptance questionnaire, CPAQ), health-related quality of life (fibromyalgia impact questionnaire, FIQ), attrition rate and frequency of adverse events, and the secondary outcomes pain intensity, disability, depression, anxiety, and fatigue. Results Six RCTs, with a total of 384, mostly-female, participants were included, with ACT being delivered online, in a group setting, or one-to-one. ACT was superior to controls in improving FIQ score at post-intervention (SMD -1.05, 95% CI -2.02, -0.09) and follow-up (SMD -1.43, 95% CI -2.17, -0.69) and CPAQ post-intervention (SMD 1.05, 95% CI 0.61, 1.49) and at follow-up (SMD 0.95, 95% CI 0.40, 1.49). Attrition was below 20% in 4/6 studies and no adverse events were reported as attributable to ACT. All secondary outcomes showed large-to-moderate pooled effect estimates post-intervention, indicating improvement in anxiety, depression, pain and disability. Fatigue also improved, with a large negative effect. Conclusions The results suggest ACT improved outcomes in patients with FM: there was an overall improvement in all outcomes post-intervention, with most maintained at follow-up. This review was, however, limited by the small body of evidence and differing methodologies of included studies.
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Affiliation(s)
- Florence Eastwood
- Department of Psychology, School of Mental Health & Psychological Sciences, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- Mid and South Essex NHS Foundation Trust, Chelmsford, UK
| | - Emma Godfrey
- Department of Psychology, School of Mental Health & Psychological Sciences, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- Department of Population Health Sciences, School of Life Course & Population Sciences, Faculty of Life Sciences and Medicine, King’s College London, London, UK
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Wilson JM, Franqueiro AR, Edwards RR, Chai PR, Schreiber KL. Individuals with fibromyalgia report greater pain sensitivity than healthy adults while listening to their favorite music: the contribution of negative affect. PAIN MEDICINE (MALDEN, MASS.) 2024; 25:352-361. [PMID: 38291916 PMCID: PMC11063746 DOI: 10.1093/pm/pnae005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 12/18/2023] [Accepted: 01/04/2024] [Indexed: 02/01/2024]
Abstract
OBJECTIVE We investigated the impact of favorite music on pain processing among individuals with fibromyalgia. We also examined differences in pain processing between individuals with fibromyalgia and healthy controls (HC) while listening to favorite music and explored whether psychosocial factors contributed to these differences. METHODS Individuals with fibromyalgia and HC completed baseline psychosocial questionnaires and then underwent quantitative sensory testing (QST) during 3 randomized music conditions (meditative music, favorite music, white noise). Among individuals with fibromyalgia, Friedman tests were used to investigate differences in QST across conditions. Analyses of Covariance were used to examine group (HC vs fibromyalgia) differences in QST during favorite music. Correlations were conducted to explore associations of baseline psychosocial factors with QST during favorite music. Mediation analyses were conducted to explore whether psychosocial factors contributed to greater pain sensitivity among individuals with fibromyalgia compared to HC during favorite music. RESULTS Individuals with fibromyalgia were less sensitive to pressure pain while listening to their favorite music compared to white noise. Compared to HC, individuals with fibromyalgia reported higher baseline negative affect and lower pain thresholds and tolerances during favorite music. Negative affect partially mediated the relationship between pain status (HC vs fibromyalgia) and pain sensitivity during favorite music. CONCLUSIONS Individuals with fibromyalgia were less pain sensitive while listening to favorite music than white noise, although they were more sensitive than HC. Greater negative affect endorsed by individuals with fibromyalgia contributed to their greater pain sensitivity. Future studies should explore the impact of favorite music on clinical pain. CLINICAL TRAILS REGISTRATION This study was registered with ClinicalTrials.gov (NCT04087564) and began on 6/13/2019.
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Affiliation(s)
- Jenna M Wilson
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women’s Hospital, Boston, MA 02115, United States
| | - Angelina R Franqueiro
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women’s Hospital, Boston, MA 02115, United States
| | - Robert R Edwards
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women’s Hospital, Boston, MA 02115, United States
| | - Peter R Chai
- Division of Medical Toxicology, Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA 02115, United States
- Department of Psychosocial Oncology and Palliative Care, Dana Farber Cancer Institute, Boston, MA 02215, United States
- The Koch Institute for Integrated Cancer Research, Massachusetts Institute of Technology, Boston, MA 02139, United States
- The Fenway Institute, Boston, MA 02215, United States
| | - Kristin L Schreiber
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women’s Hospital, Boston, MA 02115, United States
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Couëpel B, Daneau C, Tremblay M, Javelot T, Abboud J, Pagé I, Descarreaux M. Effect of physical activity education on shoulder girdle pain and muscle strength in participants with fibromyalgia: a pilot experimental study. FRONTIERS IN PAIN RESEARCH 2024; 5:1328796. [PMID: 38751494 PMCID: PMC11094234 DOI: 10.3389/fpain.2024.1328796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 04/17/2024] [Indexed: 05/18/2024] Open
Abstract
Background In patients with fibromyalgia, exercise and education are recommended to decrease pain level and improve pain management. The latest scientific evidence recommends to focus interventions on the upper limb. The aim of this pilot study was to compare the immediate effect of physical activity education vs. a control group on pain and muscle capacity in fibromyalgia patients. Method Fifty-six participants with fibromyalgia were randomized into an experimental group and a control group. The intervention consisted in watching a five-minute video that provided information about fibromyalgia, pain, kinesiophobia and physical activity. The control group watched a neutral five-minute video about beavers in Quebec. Following the video, participants performed a muscular fatigue task consisting of a repeated unilateral shoulder abduction task. At baseline and following the muscular fatigue task, maximal voluntary contraction (MVC) in shoulder abduction was assessed as well as pain level and pressure pain threshold (PPT) in the upper limb. Electromyographic activity was also assessed for upper trapezius and middle deltoid muscles. Two-way repeated measures analysis of variance was used to compare the MVC, PPT, and pain level before and after the muscular fatigue task between groups. Results The experimental group showed a significantly lower increase in pain than the control group in the middle deltoid muscle (p = 0.002) when assessed by verbal pain rating scale. No significant interaction or main effect of Group and Time were observed for the pain level at the upper trapezius and elbow extensor muscles nor for any of the PPT measures. According to electromyographic data, the median frequency values indicate that neither group experienced muscle fatigue during the repeated contraction task. Conclusions The preliminary results suggest that a short physical activity education video positively influenced middle deltoid pain following repeated abduction in participants with fibromyalgia. Electromyographic analysis showed no evidence of objective muscle fatigue, suggesting that there might be a partial disconnection between the perception of muscle fatigue and the physiological biomarkers associated with muscle fatigue.
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Affiliation(s)
- Bastien Couëpel
- Department of Human Kinetics, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
- Research Group on Neuromusculoskeletal Disorders (GRAN), Trois-Rivières, QC, Canada
| | - Catherine Daneau
- Research Group on Neuromusculoskeletal Disorders (GRAN), Trois-Rivières, QC, Canada
- Department of Anatomy, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
| | - Mathieu Tremblay
- Department of Human Kinetics, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
- Research Group on Neuromusculoskeletal Disorders (GRAN), Trois-Rivières, QC, Canada
| | - Thomas Javelot
- Research Group on Neuromusculoskeletal Disorders (GRAN), Trois-Rivières, QC, Canada
- Department of Anatomy, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
| | - Jacques Abboud
- Department of Human Kinetics, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
- Research Group on Neuromusculoskeletal Disorders (GRAN), Trois-Rivières, QC, Canada
| | - Isabelle Pagé
- Research Group on Neuromusculoskeletal Disorders (GRAN), Trois-Rivières, QC, Canada
- Department of Chiropractic, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (Cirris), Centre Intégré Universitaire de Santé et de Services Sociaux de La Capitale-Nationale (CIUSSS-CN), Quebec, QC, Canada
| | - Martin Descarreaux
- Department of Anatomy, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
- Department of Chiropractic, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
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Martinez-Calderon J, García-Muñoz C, Rufo-Barbero C, Matias-Soto J, Cano-García FJ. Acceptance and Commitment Therapy for Chronic Pain: An Overview of Systematic Reviews with Meta-Analysis of Randomized Clinical Trials. THE JOURNAL OF PAIN 2024; 25:595-617. [PMID: 37748597 DOI: 10.1016/j.jpain.2023.09.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 09/08/2023] [Accepted: 09/18/2023] [Indexed: 09/27/2023]
Abstract
This overview of reviews aimed to summarize the evidence from systematic reviews and meta-analyses of randomized clinical trials of the efficacy of acceptance and commitment therapy (ACT) for adults with chronic pain in relation to pain intensity, pain-related functioning, quality of life, and psychological factors. The Cumulative Index of Nursing and Allied Health Literature (CINAHL), Embase, PsycINFO, PubMed, and the Cochrane Library databases were searched from inception to July 2, 2023. AMSTAR 2 was used to assess the methodological quality of systematic reviews. The overlap among reviews was calculated. Nine reviews comprising 84 meta-analyses of interest were included. At post-treatment, some meta-analyses mainly showed that ACT can reduce depression symptoms, anxiety symptoms, psychological inflexibility, and pain catastrophizing; and can improve mindfulness, pain acceptance, and psychological flexibility. At three-month follow-up, ACT can reduce depression symptoms and psychological inflexibility, as well as improve pain-related functioning and psychological flexibility. At six-month follow-up, ACT can improve mindfulness, pain-related functioning, pain acceptance, psychological flexibility, and quality of life. At six-twelve-month follow-up, ACT can reduce pain catastrophizing and can improve pain-related functioning. Some methodological and clinical issues are identified in the reviews, such as a very high overlap between systematic reviews, the fact that the certainty of the evidence is often not rated and specific details needed to replicate the interventions reviewed are often not reported. Overall, however, randomized clinical trials and systematic reviews show that ACT can improve outcomes related to chronic pain (eg, pain-related functioning). Future systematic reviews should address the methodological and clinical concerns identified here to produce higher-quality findings. PERSPECTIVE: Despite certain methodological and clinical issues, randomized clinical trials and systematic reviews of ACT appear to show that it can improve outcomes related to chronic pain (eg, psychological factors).
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Affiliation(s)
- Javier Martinez-Calderon
- Instituto de Biomedicina de Sevilla, IBiS, Departamento de Fisioterapia, Universidad de Sevilla, Sevilla, Spain; CTS 1110: Uncertainty, Mindfulness, Self, and Spirituality (UMSS) Research Group, Andalusia, Spain
| | - Cristina García-Muñoz
- CTS 1110: Uncertainty, Mindfulness, Self, and Spirituality (UMSS) Research Group, Andalusia, Spain; Universidad Loyola de Andalucía, Sevilla, Spain
| | - Carmen Rufo-Barbero
- Departamento de Personalidad, Evaluación y Tratamiento Psicológicos, Universidad de Sevilla, Sevilla, Spain
| | - Javier Matias-Soto
- CTS 1110: Uncertainty, Mindfulness, Self, and Spirituality (UMSS) Research Group, Andalusia, Spain; Universidad de Malaga, Faculty of Health Sciences, Department of Physical Therapy, Malaga, Spain
| | - Francisco J Cano-García
- Departamento de Personalidad, Evaluación y Tratamiento Psicológicos, Universidad de Sevilla, Sevilla, Spain
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Borst M, Moeyaert M, van Rood Y. The effect of eye movement desensitization and reprocessing on fibromyalgia: A multiple-baseline experimental case study across ten participants. Neuropsychol Rehabil 2024:1-33. [PMID: 38385531 DOI: 10.1080/09602011.2024.2314883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 01/16/2024] [Indexed: 02/23/2024]
Abstract
Fibromyalgia (FM) is a chronic pain disorder characterized by widespread musculoskeletal pain, fatigue, and stiffness in muscles and joints. Traumatic life experiences and post-traumatic stress symptoms play a role in its development and persistence. Although previous research suggests that pain and FM symptoms decrease after eye movement desensitization and reprocessing (EMDR) therapy, its effectiveness has not been investigated in a controlled manner. The present study investigated the effectiveness of a six-session, 90-minute EMDR therapy using a multiple baseline single-case experimental design (SCED) across ten adult females with FM. The SCED involved a baseline, intervention, one- and three-month follow-up phase. The primary outcome was pain. Secondary outcomes included post-traumatic stress symptoms, other FM symptoms (fatigue, stiffness in muscles and joints), and the impact of FM on daily activities and sleep. Data were statistically analyzed by primarily testing means across phases on an individual and group level. Post-traumatic stress symptoms improved significantly in seven participants. Pain severity decreased significantly in six participants, with three of them maintaining significant improvement three months later. One participant showed clinically relevant change one month later. Furthermore, improvements were observed in secondary outcome measures. The findings support the efficacy of EMDR in reducing FM symptoms.
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Affiliation(s)
- Michiel Borst
- Social and Specialist Division, GGZ Noord-Holland-Noord, Heiloo, Netherlands
| | - Mariola Moeyaert
- Department of Educational Psychology and Methodology, University at Albany - State University of New York, New York, USA
| | - Yanda van Rood
- Department of Psychiatry, University Medical Center of Leiden, Leiden, Netherlands
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11
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Gungormus DB, Fernández-Martín M, Ortigosa-Luque ME, Pérez-Mármol JM. Effects of Nature-Based Multisensory Stimulation on Pain Mechanisms in Women with Fibromyalgia Syndrome: A Randomized Double-Blind Placebo-Controlled Trial. Pain Manag Nurs 2024; 25:46-55. [PMID: 37495473 DOI: 10.1016/j.pmn.2023.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 06/20/2023] [Accepted: 06/30/2023] [Indexed: 07/28/2023]
Abstract
BACKGROUND The term "nature-based sensory stimuli" refers to the sensory information produced by biotic and abiotic agents from natural environments. The literature has reported the beneficial effects of these agents on various pain dimensions in non-clinical populations. AIMS To evaluate the potential analgesic effects of nature-based multisensory stimulation in women with fibromyalgia syndrome. METHODS A randomized, double-blind, placebo-controlled, parallel-group trial with a 1:1 allocation ratio was conducted. Forty-two women with fibromyalgia syndrome interacted with either different plant species with flowers, stones, and soil organic matter or their synthetic imitations for 30 minutes. Outcome measurements were performed before and after the intervention, including clinical pain intensity using the Numeric Rating Scale, cold pain thresholds using the Cold Pressor Test, mechanical hyperalgesia and wind-up using a monofilament, and pressure pain thresholds using a pressure algometer. RESULTS Analyses revealed group × time interactions for clinical pain intensity (F = 7.915, p = .008), cold-water immersion time (F = 7.271, p = .010), mechanical hyperalgesia (F = 4.701, p = .036), and pressure pain threshold (p ≤ .017). Between-group differences were found in clinical pain intensity (p = .012), cold pain thresholds (p = .002), and pressure pain thresholds (p < .05). The experimental group exhibited reduced clinical pain intensity (p = .001) and increased pressure pain thresholds (p ≤ .034). CONCLUSIONS Women with fibromyalgia syndrome may benefit from multisensory stimulation using biotic and abiotic agents from natural environments for 30 minutes. Interacting with flowering plants and soil components appears to induce analgesic effects.
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Affiliation(s)
- Dogukan Baran Gungormus
- Department of Physiotherapy, Faculty of Health Sciences, University of Granada, Granada, Spain; Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain.
| | - Mónica Fernández-Martín
- Department of Physiotherapy, Faculty of Health Sciences, University of Granada, Granada, Spain.
| | | | - José Manuel Pérez-Mármol
- Department of Physiotherapy, Faculty of Health Sciences, University of Granada, Granada, Spain; Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain.
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12
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Santos VS, Fandim JV, Silva FG, Hatakeyama BA, Fioratti I, Costa LOP, Saragiotto BT, Yamato TP. Evaluation of methodological and reporting quality of systematic reviews on conservative non-pharmacological musculoskeletal pain management in children and adolescents: A methodological analysis. Musculoskelet Sci Pract 2024; 69:102902. [PMID: 38211435 DOI: 10.1016/j.msksp.2023.102902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 12/11/2023] [Accepted: 12/15/2023] [Indexed: 01/13/2024]
Abstract
BACKGROUND There are no studies investigating the methodological and report quality of systematic reviews of non-pharmacological interventions for musculoskeletal pain management among children and adolescents. OBJECTIVE To evaluate the methodological and reporting quality of systematic reviews on conservative non-pharmacological pain management in children and adolescents with musculoskeletal pain. METHODS Searches were conducted on the Cochrane Database of Systematic Reviews, Medline, Embase, and three other databases. Two pairs of reviewers independently assessed each article according to the predetermined selection criteria. We assessed the methodological quality of systematic reviews, using the AMSTAR 2 checklist and the quality of reporting, using PRISMA checklist. Descriptive analysis was used to summarise the characteristics of all included systematic reviews. The percentage of systematic reviews achieving each item from the AMSTAR 2, PRISMA checklist and the overall confidence in the results were described. RESULTS We included 17 systematic reviews of conservative non-pharmacological pain management for musculoskeletal pain in children and adolescents. Of the 17 systematic reviews included, nine (53%) were rated as "critically low", seven (41%) were rated as "low", and one (6%) was rated as "high" methodological quality by AMSTAR-2. The reporting quality by items from PRISMA range from 17.6% (95% CI 6.2 to 41) to 100% (95% CI 81.6 to 100). CONCLUSION This systematic review of physical interventions in children and adolescents showed overall 'very low' to 'high' methodological quality and usually poor reporting quality.
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Affiliation(s)
- Veronica Souza Santos
- Masters and Doctoral Program in Physical Therapy, Universidade Cidade de São Paulo (UNICID), São Paulo, SP, Brazil
| | - Junior V Fandim
- Masters and Doctoral Program in Physical Therapy, Universidade Cidade de São Paulo (UNICID), São Paulo, SP, Brazil
| | - Fernanda Gonçalves Silva
- Masters and Doctoral Program in Physical Therapy, Universidade Cidade de São Paulo (UNICID), São Paulo, SP, Brazil
| | - Bruna Alves Hatakeyama
- Masters and Doctoral Program in Physical Therapy, Universidade Cidade de São Paulo (UNICID), São Paulo, SP, Brazil
| | - Iuri Fioratti
- Masters and Doctoral Program in Physical Therapy, Universidade Cidade de São Paulo (UNICID), São Paulo, SP, Brazil
| | - Leonardo Oliveira Pena Costa
- Masters and Doctoral Program in Physical Therapy, Universidade Cidade de São Paulo (UNICID), São Paulo, SP, Brazil
| | - Bruno T Saragiotto
- Masters and Doctoral Program in Physical Therapy, Universidade Cidade de São Paulo (UNICID), São Paulo, SP, Brazil; Discipline of Physiotherapy, Graduate School of Health, University of Technology Sydney, Sydney, Australia
| | - Tiê P Yamato
- Masters and Doctoral Program in Physical Therapy, Universidade Cidade de São Paulo (UNICID), São Paulo, SP, Brazil; Faculty of Medicine and Health, University of Sydney, Australia; Nepean Blue Mountains Local Health District, NSW, Australia.
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13
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Bidonde J, Fisher E, Perrot S, Moore RA, Bell RF, Makri S, Häuser W. Effectiveness of non-pharmacological interventions for fibromyalgia and quality of review methods: an overview of Cochrane Reviews. Semin Arthritis Rheum 2023; 63:152248. [PMID: 37598586 DOI: 10.1016/j.semarthrit.2023.152248] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Accepted: 07/25/2023] [Indexed: 08/22/2023]
Abstract
BACKGROUND Fibromyalgia syndrome (FMS) is defined as chronic widespread pain associated with sleep disorders, cognitive dysfunction, and somatic symptoms present for at least three months and cannot be better explained by another diagnosis. OBJECTIVES To examine efficacy and safety of non-pharmacological interventions for FMS in adults reported in Cochrane Reviews, and reporting quality of reviews. METHODS Systematic reviews of randomised controlled trials (RCTs) of non-pharmacological interventions for FMS were identified from the Cochrane Database of Systematic Reviews (CDSR 2022, Issue 3 and CDSR 2023 Issue 6). Methodological quality was assessed using the AMSTAR-2 tool and a set of methodological criteria critical for analgesic effects. The primary efficacy outcomes of interest were clinically relevant pain relief, improvement in health-related quality of life (HRQoL), acceptability, safety, and reduction of mobility difficulties as reported by study participants. No pooled analyses were planned. We assumed a clinically relevant improvement was a minimal clinically important difference (MCID) between interventions and controls of 15%, or a SMD of more than 0.2, or a MD of more than 0.5, on a 0 to 10 scale. RESULTS Ten Cochrane reviews were eligible, reporting 181 randomized or quasi- randomized trials (11,917 participants, average trial size 66 participants). The reviews examined exercise training, acupuncture, transcutaneous electrical nerve stimulation, and psychological therapies. One review was rated moderate according to AMSTAR 2, seven were rated low and two were rated critically low. All reviews met most of the additional methodological quality criteria. All reviews included studies with patient-reported outcomes for pain. We found low certainty evidence of clinically relevant positive effects of aerobic and mixed exercise training and for cognitive behavioural therapies (CBTs) at reducing mobility difficulties and for mixed exercise training and CBTs for improving HRQoL at the end of the intervention. Number needed to treat for an additional beneficial outcome (NNTB) values for a MCID of 15% ranged between 4 and 9. We found low certainty evidence that was clinically relevant for mixed exercise and CBTs for reducing mobility difficulties at an average follow up of 24 weeks. We found low certainty evidence of clinically relevant positive effects of mixed exercise on HRQoL at an average follow up of 24 weeks. NNTB values for a MCID of 15% ranged from 5 to 11. The certainty of evidence of the acceptability (measured by dropouts) of the different non-pharmacological interventions ranged from very low to moderate and the dropout rate for any reason did not differ across the interventions or the controls, except for biofeedback and movement therapies. All the systematic reviews stated that the reporting of adverse events was inconsistent in the studies analysed (very low certainty evidence). AUTHORS' CONCLUSIONS There is low certainty evidence of clinically relevant reduction of mobility difficulties and of improvement of HRQoL among individuals with FMS by aerobic and mixed exercise training and by CBTs at the end of the intervention. There is low certainty evidence that CBTs and mixed exercise training reduces mobility difficulties post-treatment and that mixed exercise training improves HRQoL at follow-up by clinically meaningful scores.
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Affiliation(s)
- Julia Bidonde
- Norwegian Institute of Public Health, Oslo, Norway; School of Rehabilitation Science, College of Medicine, University of Saskatchewan, Saskatoon, Canada.
| | - Emma Fisher
- Centre for Pain Research, University of Bath, UK
| | - Serge Perrot
- Centre de la Douleur, Hôpital Cochin, Université Paris Cité, INSERM U987, Paris, France
| | | | - Rae Frances Bell
- Regional Centre of Excellence in Palliative Care Haukeland University Hospital, Bergen, Norway
| | - Souzi Makri
- Cyprus League for People with Rheumatism, Nicosia, Cyprus
| | - Winfried Häuser
- Department of Psychosomatic Medicine and Psychotherapy, Technische Universität München, München, Germany
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14
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Turcotte K, Oelke ND, Whitaker G, Holtzman S, O'Connor B, Pearson N, Teo M. Multi-disciplinary community-based group intervention for fibromyalgia: a pilot randomized controlled trial. Rheumatol Int 2023; 43:2201-2210. [PMID: 37566253 PMCID: PMC10587329 DOI: 10.1007/s00296-023-05403-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 07/20/2023] [Indexed: 08/12/2023]
Abstract
Fibromyalgia is characterized by widespread pain, fatigue, sleep disturbances, mood disturbances, and cognitive impairment. Most individuals with fibromyalgia experience poorly managed symptoms and increased healthcare service use. Multicomponent therapies, with a focus on nonpharmacological modalities, are increasingly supported in the literature. However, given the limited resources available, implementation in smaller communities remains a challenge. This research tested a community-based multidisciplinary group intervention for individuals diagnosed with FM living in a small urban centre. The primary outcome was perceptions of quality of care and secondary outcomes included disease-related functioning, anxious and depressive symptoms, pain beliefs, and health service utilization. A pilot randomized control trial was conducted in which 60 patients diagnosed with fibromyalgia were randomized into a 10-week community-based multidisciplinary group intervention program or usual care. Treatment components included twice-weekly exercise sessions and weekly education sessions (e.g., pain education, cognitive behavioral strategies for stress, nutrition, peer support). The trial (NCT03270449) was registered September 1 2017. Statistically significant post-intervention improvements were found in the primary outcome, perceived quality of care (Cohen's d = 0.61, 0.66 for follow up care and goal setting, respectively). Secondary outcomes showing statistically significant improvements were disease-related daily functioning (Cohen's d = 0.70), depressive symptoms (Cohen's d = 0.87), and pain beliefs (Cohen's d = 0.61, 0.67, 0.82 for harm, disability and control, respectively). No adverse events were reported. Community-based multidisciplinary group interventions for fibromyalgia show promise for improving satisfaction with quality of care, disease-related functioning, and depression, and fostering more adaptive pain beliefs.
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Affiliation(s)
- Kara Turcotte
- Department of Nursing, Western University, London, ON, Canada
| | - Nelly D Oelke
- Faculty of Health and Social Development, School of Nursing, The University of British Columbia, 3333 University Way, Kelowna, BC, V1V 1V7, Canada.
| | - Gina Whitaker
- Faculty of Health and Social Development, School of Nursing, The University of British Columbia, 3333 University Way, Kelowna, BC, V1V 1V7, Canada
| | - Susan Holtzman
- Department of Psychology, University of British Columbia, Kelowna, BC, Canada
| | - Brian O'Connor
- Department of Psychology, University of British Columbia, Kelowna, BC, Canada
| | - Neil Pearson
- Faculty of Medicine, School of Physical Therapy, University of British Columbia, Kelowna, BC, Canada
| | - Michelle Teo
- Department of Medicine, Faculty of Medicine, University of British Columbia, Kelowna, BC, Canada
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15
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Climent-Sanz C, Hamilton KR, Martínez-Navarro O, Briones-Vozmediano E, Gracia-Lasheras M, Fernández-Lago H, Valenzuela-Pascual F, Finan PH. Fibromyalgia pain management effectiveness from the patient perspective: a qualitative evidence synthesis. Disabil Rehabil 2023:1-16. [PMID: 37965900 PMCID: PMC11093884 DOI: 10.1080/09638288.2023.2280057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Accepted: 11/01/2023] [Indexed: 11/16/2023]
Abstract
PURPOSE This qualitative evidence synthesis aimed to identify and integrate findings where adults with fibromyalgia discussed how they managed their pain, and their perceptions of prescribed treatments from healthcare professionals. MATERIALS AND METHODS A comprehensive search strategy was implemented in PubMed, Scopus, ISI Web of Science, and Cinahl Plus databases. The GRADE-CERQual framework was used to evaluate the findings confidence. The findings were analyzed using an inductive thematic analysis approach. RESULTS A total of 35 studies (N = 728) were included. The confidence in the findings ranged from high to low confidence. Patients with fibromyalgia often do not benefit from seeking medical attention due to provider stigma, and have varying views on medication effectiveness commonly reporting feeling like "walking chemists." They find mixed effects from exercise, and consider psychological support essential, although the benefits of cognitive-behavioral therapy were controversial. Combining cognitive-behavioral therapy with physical exercise appears more effective, while natural and complementary therapies have short-term benefits and high costs. CONCLUSIONS Pain management is a source for frustration and an unmet need for patients with fibromyalgia. The current findings provide crucial insight for providers and researchers; and support the need for fibromyalgia phenotyping and precision medicine approaches to pain management.Implications for RehabilitationChronic widespread pain is the defining feature of fibromyalgia, yet pain reduction is often an unmet need for these individuals.The lack of effective treatments resulting in long-term relief proves frustrating for patients and healthcare providers.Rehabilitation professional should consider the unique insight into this complex, heterogeneous condition that this qualitative synthesis provides to better understand their patient's perspective on pain management.Given the differing perspectives on pain treatment approaches individuals with fibromyalgia report, providers should discuss with each patient their current strategies and take a patient-centered, individualized approach to form an effective treatment plan.
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Affiliation(s)
- Carolina Climent-Sanz
- Department of Nursing and Physiotherapy, University of Lleida, Lleida, Spain
- Health Care Research Group (GRECS), Lleida Institute for Biomedical Research Dr. Pifarré Foundation, IRBLleida, Lleida, 25198, Spain
- Grup d’Estudis Societat, Salut, Educació i Cultura (GESEC), Institute for Social and Territorial Development (INDEST), University of Lleida, Spain
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Katrina R. Hamilton
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Oriol Martínez-Navarro
- Department of Nursing and Physiotherapy, University of Lleida, Lleida, Spain
- Health Care Research Group (GRECS), Lleida Institute for Biomedical Research Dr. Pifarré Foundation, IRBLleida, Lleida, 25198, Spain
| | - Erica Briones-Vozmediano
- Department of Nursing and Physiotherapy, University of Lleida, Lleida, Spain
- Health Care Research Group (GRECS), Lleida Institute for Biomedical Research Dr. Pifarré Foundation, IRBLleida, Lleida, 25198, Spain
- Grup d’Estudis Societat, Salut, Educació i Cultura (GESEC), Institute for Social and Territorial Development (INDEST), University of Lleida, Spain
| | | | - Helena Fernández-Lago
- Department of Nursing and Physiotherapy, University of Lleida, Lleida, Spain
- Health Care Research Group (GRECS), Lleida Institute for Biomedical Research Dr. Pifarré Foundation, IRBLleida, Lleida, 25198, Spain
- Grup d’Estudis Societat, Salut, Educació i Cultura (GESEC), Institute for Social and Territorial Development (INDEST), University of Lleida, Spain
| | - Fran Valenzuela-Pascual
- Department of Nursing and Physiotherapy, University of Lleida, Lleida, Spain
- Health Care Research Group (GRECS), Lleida Institute for Biomedical Research Dr. Pifarré Foundation, IRBLleida, Lleida, 25198, Spain
- Grup d’Estudis Societat, Salut, Educació i Cultura (GESEC), Institute for Social and Territorial Development (INDEST), University of Lleida, Spain
| | - Patrick H. Finan
- Department of Anesthesiology, University of Virginia School of Medicine, Charlottesville, VA, USA
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16
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Lanario JW, Hudson E, Locher C, Dee A, Elliot K, Davies AF. Body reprogramming for fibromyalgia and central sensitivity syndrome: A preliminary evaluation. SAGE Open Med 2023; 11:20503121231207207. [PMID: 37920842 PMCID: PMC10619357 DOI: 10.1177/20503121231207207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 09/26/2023] [Indexed: 11/04/2023] Open
Abstract
Objectives Central sensitivity syndrome disorders such as fibromyalgia, provoke continued debate, highlighting diagnostic and therapeutic uncertainty. The Hyland model provides a way of understanding and treating the medically unexplained symptoms of central sensitivity syndromes using complexity theory and principles of adaption in network systems. The body reprogramming is a multi-modal intervention based on the Hyland model designed for patients living with medically unexplained symptoms. This preliminary, naturalistic and single-arm service evaluation set out to evaluate outcome after attending a body reprogramming course in patients living with fibromyalgia or central sensitivity syndrome. Methods Patients diagnosed with fibromyalgia or central sensitivity syndrome were recruited. The body reprogramming courses consisting of eight sessions, each 2.5 h in length, were run at two study sites in England. Data were collected at baseline, post course and 3-months post course using questionnaires assessing symptomatology (FIQR/SIQR), Depression (PHQ9), Anxiety (GAD7) and quality of life (GQoL). Repeated measures t-tests were used, and all comparisons were conducted on an intention to treat basis. Results In total, 198 patients with a mean age of 47.73 years were enrolled on the body reprogramming courses. Statistically and clinically significant improvement were observed in the FIQR from baseline to post course (mean change: 11.28) and baseline to follow-up (mean change: 15.09). PHQ9 scores also improved significantly from baseline to post course (mean reduction 3.72) and baseline to follow-up (mean reduction 5.59). Conclusions Our study provides first evidence that the body reprogramming intervention is an effective approach for patients living with fibromyalgia or central sensitivity syndromes on a variety of clinical measures. Besides these promising results, important limitations of the study are discussed, and larger randomized controlled trials are clearly warranted.
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Affiliation(s)
| | - Esther Hudson
- Cornwall Partnership NHS Foundation Trust, Redruth, Cornwall, UK
| | - Cosima Locher
- Faculty of Health, University of Plymouth, Plymouth, UK
- University Hospital Zurich, Zurich, Switzerland
| | - Annily Dee
- University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - Kerry Elliot
- Royal Cornwall Hospital NHS Trust, Truro, Cornwall, UK
| | - Anthony F Davies
- Faculty of Health, University of Plymouth, Plymouth, UK
- University Hospitals Plymouth NHS Trust, Plymouth, UK
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17
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Varrassi G, Rekatsina M, Perrot S, Bouajina E, Paladini A, Coaccioli S, Narvaez Tamayo MA, Sarzi Puttini P. Is Fibromyalgia a Fashionable Diagnosis or a Medical Mystery? Cureus 2023; 15:e44852. [PMID: 37809234 PMCID: PMC10560069 DOI: 10.7759/cureus.44852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 09/07/2023] [Indexed: 10/10/2023] Open
Abstract
Despite its prevalence, there is no clear-cut diagnostic path or treatment paradigm for fibromyalgia; this can lead to a multiplicity of symptoms and comorbid conditions that complicate care. "Overlapping symptoms" describe conditions that can occur concomitantly with fibromyalgia and include migraine, irritable bowel syndrome, obesity, and pelvic pain syndromes. A variety of pharmacologic and nonpharmacologic treatments are available for fibromyalgia, but treatment is best personalized for an individual and recognizes potential comorbidities. Opioids are not the recommended front-line treatment, cannabinoids hold promise but with limitations and nonpharmacologic options, such as aerobic or resistance exercise and cognitive behavior therapy, can play a very important but often underestimated role. Amitriptyline appears to be safe and effective in treating six of the main fibromyalgia domains: pain, disturbed sleep, fatigue, affective symptoms, functional limitations, and impaired cognition ("fibro fog"). Very low-dose naltrexone (2.5-4.5 mg) may offer analgesic and anti-inflammatory benefits to fibromyalgia patients, but further studies are needed. Fibromyalgia can be a devastating and debilitating condition for patients, and clinicians are challenged with its diagnosis and treatment as well. Further research as well as compassionate approaches to offering personalized care to those with fibromyalgia are required.
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Affiliation(s)
| | | | | | - Elyse Bouajina
- Rheumatology, Farhat Hached University Hospital Center, Sousse, TUN
| | - Antonella Paladini
- Life, Health and Environmental Sciences (MESVA), University of L'Aquila, L'Aquila, ITA
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18
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Zabihiyeganeh M, Afshar SV, Kadijani AA, Janbozorgi M, Akbari A, Yahyazadeh H, Mirzaei A. How durable are the effects of cognitive-behavioural therapy in controlling fibromyalgia symptoms? A prospective cohort study. Musculoskeletal Care 2023; 21:890-894. [PMID: 36987397 DOI: 10.1002/msc.1766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 03/18/2023] [Accepted: 03/23/2023] [Indexed: 03/30/2023]
Abstract
PURPOSE Cognitive-behavioural therapy (CBT) is widely used for the treatment of fibromyalgia. However, there is no consensus on the durability of its effects on these patients. In this study, we evaluated how durable are the effects of CBT in controlling fibromyalgia symptoms. METHODS Forty-eight fibromyalgia patients treated with traditional face-to-face CBT were included. CBT was performed in 20 consecutive group sessions. To evaluate the durability of treatment, the effects of CBT on fibromyalgia symptoms were checked at five time-points: before the CBT, immediately after the CBT, 3 months after the CBT, 6 months after the CBT, and 12 months after the CBT. Outcome measures were the Fibromyalgia impact questionnaire (FIQ) and widespread pain index (WPI). RESULTS The mean FIQ score of the patients was 68.3 ± 18.8 before the CBT and 50.5 ± 14.1 1 week after the CBT (p < 0.001). The mean post-CBT FIQ score did not significantly change three and 6 months after the CBT (p = 0.11 and p = 0.09, respectively) while the positive effects of CBT significantly diminished after 12 months (p < 0.001). The mean WPI was 10.4 ± 3.6 before the CBT and 8.6 ± 3.1 1 week after the end of CBT (p < 0.001). The mean WPI of three and 6 months was not statistically different from that immediately after the CBT (p = 0.18 and p = 0.15, respectively), while after 12 months, it significantly worsened (p < 0.001). CONCLUSION CBT's beneficial effects for fibromyalgia patients are durable for 6 months. Complementary CBT sessions could be implemented to boost the CBT effect after this period.
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Affiliation(s)
- Mozhdeh Zabihiyeganeh
- Bone and Joint Reconstruction Research Center, Department of Orthopedics, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Sedigheh Vafaee Afshar
- Bone and Joint Reconstruction Research Center, Department of Orthopedics, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Azade Amini Kadijani
- Basic and Molecular Epidemiology of Gastrointestinal Disorders Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Masoud Janbozorgi
- Department of Psychology, Research Institute of Hawzah and University, Ghom, Iran
| | - Abolfazl Akbari
- Colorectal Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Hooman Yahyazadeh
- Bone and Joint Reconstruction Research Center, Department of Orthopedics, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
- Department of Orthopedic Surgery, Farhikhtegan Hospital, Faculty of Medicine, Tehran Medical Sciences Islamic Azad University, Tehran, Iran
| | - Alireza Mirzaei
- Bone and Joint Reconstruction Research Center, Department of Orthopedics, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
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19
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Seaton N, Moss-Morris R, Hulme K, Macaulay H, Hudson J. A cognitive-behavioural therapy programme for managing depression and anxiety in long-term physical health conditions: mixed-methods real-world evaluation of the COMPASS programme. BJPsych Open 2023; 9:e153. [PMID: 37563762 PMCID: PMC10594095 DOI: 10.1192/bjo.2023.519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 06/11/2023] [Indexed: 08/12/2023] Open
Abstract
BACKGROUND Mental health comorbidities are common in physical long-term health conditions. AIMS We evaluate the effectiveness of COMPASS, a therapist-supported, digital cognitive-behavioural therapy programme specifically designed to treat anxiety/depression in the context of long-term conditions. We also investigate patient experiences of the programme. METHOD We utilised a mixed-methods, non-randomised design. We analysed pre-post data from 76 patients with long-term conditions who were receiving psychological treatment (COMPASS) via local NHS services, using paired sample t-tests and Cohen's d, with depression, anxiety, distress and functional impairment self-report scales. Qualitative interviews explored patients' experiences of using COMPASS. Twenty-one semi-structured interviews were completed and underwent inductive thematic analysis. RESULTS Patients who received COMPASS had significantly reduced depression (-2.47, 95% CI -3.7 to -1.3, P < 0.001; Cohen's d = -0.376), anxiety (-2.30, 95% CI -3.6 to -1.2, P < 0.001; Cohen's d = -0.420) and psychological distress (-4.87, 95% CI -7.0 to -2.7, P < 0.001; Cohen's d = -0.422) and significantly improved functional impairment (-3.00, 95% CI -4.8 to -1.2, P ≤ 0.001; Cohen's d = -0.282). Effect sizes were larger when analyses included only patients with clinically significant baseline symptoms: depression (-4.02, 95% CI -5.6 to -2.5, P < 0.001; Cohen's d = -0.701), anxiety (-3.60, 95% CI -5.3 to -1.9, P < 0.001; Cohen's d = -0.739), psychological distress (-5.58, 95% CI -7.9 to -3.2, P < 0.001; Cohen's d = -0.523), functional impairment (-3.28, 95% CI -5.4 to -1.1, P ≤ 0.001; Cohen's d = -0.355). Qualitative analysis yielded two meta-themes: engagement and integration of mental and physical health. CONCLUSIONS Results suggest that COMPASS is effective in NHS settings, and is acceptable to patients. Content tailored to long-term conditions, therapist support and clear delivery strategies should be prioritised to aid intervention implementation.
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Affiliation(s)
- Natasha Seaton
- Institute of Psychology, Psychiatry and Neuroscience, King's College London, UK
| | - Rona Moss-Morris
- Institute of Psychology, Psychiatry and Neuroscience, King's College London, UK
| | - Katrin Hulme
- Institute of Psychology, Psychiatry and Neuroscience, King's College London, UK
| | - Hannah Macaulay
- Institute of Psychology, Psychiatry and Neuroscience, King's College London, UK
| | - Joanna Hudson
- Institute of Psychology, Psychiatry and Neuroscience, King's College London, UK
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20
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Cuenca-Martínez F, Suso-Martí L, Fernández-Carnero J, Muñoz-Alarcos V, Sempere-Rubio N. Exercise-based interventions on sleep quality in patients with fibromyalgia syndrome: An umbrella and mapping review with meta-analysis. Semin Arthritis Rheum 2023; 61:152216. [PMID: 37229847 DOI: 10.1016/j.semarthrit.2023.152216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 04/11/2023] [Accepted: 04/26/2023] [Indexed: 05/27/2023]
Abstract
The main aim of this umbrella review was to assess the impact of exercise-based interventions (EBIs) on sleep quality in patients with fibromyalgia syndrome (FMS). We searched systematically in PubMed, PEDro, EMBASE, CINAHL, SPORTDiscus and Google Scholar. Methodological quality was analyzed using AMSTAR and ROBIS scale, and the strength of evidence was established according to GRADE. Nine systematic reviews were included. Meta-analysis (MA) of primary studies (n = 42) were performed with a random-effects model. The MA revealed a moderate statistically significant effect of EBIs (SMD=-0.46 [-0.69 to -0.23]). Subgroup analyses by type of exercise showed significant effect of body-mind exercises (SMD=-0.55 [-0.86 to -0.23]) and combined exercises (SMD=-1.11 [-2.12 to -0.11]) but not for aerobic (SMD=-0.04 [-0.15 to 0.07]) or strength (SMD=-0.52 [-1.14 to 0.1]) exercises in isolation. The results obtained showed that EBIs were effective in improving sleep quality compared to minimal intervention, no intervention or usual care, with a low certainty of evidence. Subgroup analyses showed that mind-body and combined exercises elicited the strongest effect, while aerobic and strength exercise in isolation did not show significant effects.
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Affiliation(s)
| | - Luis Suso-Martí
- Exercise Intervention for Health Research Group (EXINH-RG), Department of Physiotherapy, University of Valencia, 46010, Valencia, Spain.
| | - Josué Fernández-Carnero
- Motion in Brains Research Group, Institute of Neuroscience and Sciences of the Movement (INCIMOV), Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, Spain; Department of Physical and Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Madrid, Spain; La Paz Hospital Institute for Health Research, IdiPAZ, Madrid, Spain; Grupo de investigación en Neurociencia cognitiva, dolor y rehabilitación en ciencias de la salud de la Universidad Rey Juan Carlos, NECODOR, Madrid, Spain
| | - Vicente Muñoz-Alarcos
- Exercise Intervention for Health Research Group (EXINH-RG), Department of Physiotherapy, University of Valencia, 46010, Valencia, Spain
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21
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Burgess HJ, Bahl S, Wilensky K, Spence E, Jouppi RJ, Rizvydeen M, Goldstein C, Kim HM, Williams DA, Burns JW. A 4-week morning light treatment with stable sleep timing for individuals with fibromyalgia: a randomized controlled trial. PAIN MEDICINE (MALDEN, MASS.) 2023; 24:787-795. [PMID: 36715638 PMCID: PMC10321765 DOI: 10.1093/pm/pnad007] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 01/11/2023] [Accepted: 01/24/2023] [Indexed: 01/31/2023]
Abstract
OBJECTIVES Fibromyalgia is characterized by chronic widespread pain, mood, and sleep disturbance. Pharmacological treatments have modest efficacy and are associated with negative side effects, and alternative approaches are needed. Morning bright light treatment may assist in the management of fibromyalgia as it can reduce depressive symptoms, improve sleep, and advance circadian timing. METHODS Sixty people with fibromyalgia (58 women, mean age 41.8 ± 13.3 years) were enrolled in a study comparing 4 weeks of a 1-hour daily morning bright light treatment (active treatment) to a morning dim light treatment (comparison treatment). Both light treatments included behavioral procedures to stabilize sleep timing. The morning bright light treatment was expected to produce larger improvements in pain and function than the dim light treatment and larger improvements in potential mediators (mood, sleep, and circadian timing). RESULTS Both the bright and dim light treatment groups achieved significant but similar levels of improvement in pain intensity, pain interference, physical function, depressive symptoms, and sleep disturbance. Overall, the sample on average displayed a clinically meaningful improvement in the Fibromyalgia Impact Questionnaire-Revised score (mean reduction of 11.2 points), comparable to that reported following physical exercise treatments. Minimal side effects were observed. CONCLUSIONS Findings indicate that the effects of a morning bright light treatment did not exceed those of a comparison dim light treatment; yet the changes on average in both conditions revealed clinically meaningful improvements. Future research is warranted to identify what elements of this trial may have contributed to the observed effects.
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Affiliation(s)
- Helen J Burgess
- Department of Psychiatry, University of Michigan, Ann Arbor, MI 48109, United States
| | - Sonal Bahl
- Department of Psychiatry, University of Michigan, Ann Arbor, MI 48109, United States
| | - Katelyn Wilensky
- Department of Psychiatry, University of Michigan, Ann Arbor, MI 48109, United States
| | - Emily Spence
- Department of Psychiatry, University of Michigan, Ann Arbor, MI 48109, United States
| | - Riley J Jouppi
- Department of Psychiatry, University of Michigan, Ann Arbor, MI 48109, United States
| | - Muneer Rizvydeen
- Department of Psychiatry, University of Michigan, Ann Arbor, MI 48109, United States
| | - Cathy Goldstein
- Department of Neurology, University of Michigan, Ann Arbor, MI 48109, United States
| | - Hyungjin Myra Kim
- Department of Biostatistics, University of Michigan, Ann Arbor, MI 48109, United States
| | - David A Williams
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI 48109, United States
| | - John W Burns
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL 60612, United States
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22
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Misje M, Ask T, Skouen JS, Anderson B, Magnussen LH. Body awareness and cognitive behavioral therapy for multisite musculoskeletal pain: patients` experiences with group rehabilitation. Physiother Theory Pract 2023:1-11. [PMID: 37395042 DOI: 10.1080/09593985.2023.2227967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 05/04/2023] [Accepted: 06/05/2023] [Indexed: 07/04/2023]
Abstract
BACKGROUND An extended group program called Mind and Body (MB), based on body awareness exercises and cognitive behavioral therapy (CBT), was offered to a subgroup of patients who had completed their traditional outpatient multidisciplinary rehabilitation and were motivated for further treatment. PURPOSE To explore how patients with multisite musculoskeletal pain experienced participation in the MB program with respect to usefulness, meaningfulness, behavioral changes, and transferability to daily life and work. METHOD The study is rooted in the phenomenological tradition. Individual, semi-structured interviews were performed with eight patients aged 29-56 years. The data were analyzed using systematic text condensation. RESULTS Two main themes emerged: 1) New knowledge provided increased body awareness, new ways of thinking, and acceptance of one's own situation. This theme reflected how new knowledge and MB coping strategies were useful in the process of changing problematic thoughts, increasing body awareness, and facilitating acceptance; and 2) Implementing new habits and strategies in daily life revealed how demanding it was to alter behavior, a process that unfolded over time. CONCLUSION A combination of body awareness exercises and cognitive coping strategies was described as helpful in further improving function and coping with pain and stress in daily life and work.
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Affiliation(s)
- Marianne Misje
- Department of Physiotherapy, Haukeland University Hospital, Bergen, Norway
- Department of Physical Medicine and Rehabilitation, Haukeland University Hospital, Rådal, Norway
| | - Tove Ask
- Department of Physiotherapy, Haukeland University Hospital, Bergen, Norway
- Department of Health and Functioning, Western Norway University of Applied Sciences, Bergen, Norway
| | - Jan Sture Skouen
- Department of Physical Medicine and Rehabilitation, Haukeland University Hospital, Rådal, Norway
| | - Bodil Anderson
- Department of Physiotherapy, Haukeland University Hospital, Bergen, Norway
- Department of Physical Medicine and Rehabilitation, Haukeland University Hospital, Rådal, Norway
| | - Liv Heide Magnussen
- Department of Health and Functioning, Western Norway University of Applied Sciences, Bergen, Norway
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23
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Donisi V, De Lucia A, Pasini I, Gandolfi M, Schweiger V, Del Piccolo L, Perlini C. e-Health Interventions Targeting Pain-Related Psychological Variables in Fibromyalgia: A Systematic Review. Healthcare (Basel) 2023; 11:1845. [PMID: 37444679 DOI: 10.3390/healthcare11131845] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 06/05/2023] [Accepted: 06/19/2023] [Indexed: 07/15/2023] Open
Abstract
There is growing evidence to support the potential benefit of e-Health interventions targeting psychosocial outcomes and/or pain-related psychological variables for chronic pain conditions, including fibromyalgia syndrome (FMS). This systematic review aims at providing an in-depth description of the available e-Health psychological and/or multicomponent interventions for patients with FMS. Searches were made in PubMed, Cochrane, Web of Science, and PsycINFO up to 15 May 2023, finally including twenty-six articles. The quality of the included articles was medium-high (average quality assessment score of 77.1%). 50% of studies were randomized controlled trials (RCTs) (n = 13), and the majority of them focused exclusively on adult patients with FMS (n = 23) who were predominantly female. Four categories of e-Health modalities were identified: web-based (n = 19), mobile application (m-Health) (n = 3), virtual reality (VR) (n = 2), and video consulting (n = 2). Interventions were mainly based on the cognitive behavioral therapy (CBT) approach (n = 14) and mostly involved contact with a healthcare professional through different digital tools. Overall, a growing number of psychological and multicomponent interventions have been created and delivered using digital tools in the context of FMS, showing their potentiality for improving psychosocial outcomes and pain-related psychological variables. However, some digital tools resulted as underrepresented, and the literature on this topic appears highly heterogeneous precluding robust conclusions.
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Affiliation(s)
- Valeria Donisi
- Section of Clinical Psychology, Department of Neuroscience, Biomedicine and Movement Science, University of Verona, 37134 Verona, Italy
| | - Annalisa De Lucia
- Section of Clinical Psychology, Department of Neuroscience, Biomedicine and Movement Science, University of Verona, 37134 Verona, Italy
| | - Ilenia Pasini
- Section of Clinical Psychology, Department of Neuroscience, Biomedicine and Movement Science, University of Verona, 37134 Verona, Italy
| | - Marialuisa Gandolfi
- UOC Neurorehabilitation, Department of Neurosciences, Biomedicine and Movement Sciences, Neuromotor and Cognitive Rehabilitation Research Centre (CRRNC), University of Verona, Policlinico GB Rossi, 37134 Verona, Italy
| | - Vittorio Schweiger
- Pain Therapy Centre, Department of Surgery, Dentistry, Maternal and Infant Sciences, Verona University Hospital, Policlinico GB Rossi, 37134 Verona, Italy
| | - Lidia Del Piccolo
- Section of Clinical Psychology, Department of Neuroscience, Biomedicine and Movement Science, University of Verona, 37134 Verona, Italy
| | - Cinzia Perlini
- Section of Clinical Psychology, Department of Neuroscience, Biomedicine and Movement Science, University of Verona, 37134 Verona, Italy
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24
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Hedman-Lagerlöf M, Andersson E, Ljótsson B, Engelbrektsson J, Lundbäck K, Björkander D, Hedman-Lagerlöf E, Flink I, Axelsson E. Effect moderators in Internet-based exposure therapy for fibromyalgia: The role of pain intensity. Eur J Pain 2023; 27:507-517. [PMID: 36585933 DOI: 10.1002/ejp.2074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 12/08/2022] [Accepted: 12/26/2022] [Indexed: 01/01/2023]
Abstract
BACKGROUND A recent randomized controlled trial (N = 140) was indicative of large and sustained average improvements of Internet-based exposure for fibromyalgia, as compared to a waitlist. However, little is known about who benefits the most from this treatment. OBJECTIVES To test for potential moderating effects of age, educational attainment, the duration of fibromyalgia, baseline overall fibromyalgia severity, pain intensity, fibromyalgia-related avoidance behaviour and symptom preoccupation on the waitlist-controlled effect of 10 weeks of Internet-based exposure for fibromyalgia. METHODS Secondary analysis of a randomized controlled trial (ClinicalTrials.gov NCT02638636). We used linear mixed effects models to determine whether the waitlist-controlled effect of exposure therapy on overall fibromyalgia severity (Fibromyalgia Impact Questionnaire) differed as a function of the potential moderators. RESULTS Only pain intensity (0-10) was found to be a significant moderator, where a higher baseline pain intensity predicted a more limited waitlist-controlled effect of Internet-based exposure (B = 3.48, 95% CI: 0.84-6.13). Standardized point estimates of effects were small for the sociodemographic variables, and in the moderate range for some clinical variables that did not reach statistical significance such as behavioural avoidance and time with the fibromyalgia diagnosis. CONCLUSIONS Results suggest that Internet-based exposure treatment was more useful for participants with lower baseline levels of pain, and less so for participants with higher baseline levels of pain. The treatment had relatively similar effects across the other tested moderators. SIGNIFICANCE This study evaluated potential effect moderators in exposure-based treatment for fibromyalgia. Results indicated that a higher level of pain intensity at baseline was predictive of a less favourable outcome. It may be extra important to monitor progression for these patients and to provide additional therapeutic support when needed.
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Affiliation(s)
- Maria Hedman-Lagerlöf
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Erik Andersson
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Brjánn Ljótsson
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Johanna Engelbrektsson
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Karolina Lundbäck
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Daniel Björkander
- Department of Psychology, Stockholms Universitet, Stockholm, Sweden
- Liljeholmen Primary Health Care Center, Region Stockholm, Stockholm, Sweden
| | - Erik Hedman-Lagerlöf
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Gustavsberg Primary Health Care Centre, Stockholm, Sweden
| | - Ida Flink
- Center for Health and Medical Psychology (CHAMP), Örebro Universitet, Örebro, Sweden
| | - Erland Axelsson
- Liljeholmen Primary Health Care Center, Region Stockholm, Stockholm, Sweden
- Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Academic Primary Health Care Center, Region Stockholm, Stockholm, Sweden
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25
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Crosky S, McFarlin M, Sullivan N, Winograd D, Litke D, Masheb RM, Lu SE, Costanzo M, Anastasides N, Gonzalez C, Doshi J, Graff F, Khatib L, Thien S, McAndrew LM. Randomized controlled trial protocol of health coaching for veterans with complex chronic pain. Trials 2023; 24:239. [PMID: 36997946 PMCID: PMC10061706 DOI: 10.1186/s13063-023-07113-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 01/23/2023] [Indexed: 04/01/2023] Open
Abstract
BACKGROUND Pain predominant multisymptom illness (pain-CMI) refers to symptom-based conditions where pain is a primary symptom. There is initial evidence that health coaching may be efficacious in treating pain-CMI because it can be tailored to the veteran's goals and emphasizes long-term behavior change, which may indirectly impact the maintaining factors of pain-CMI (e.g., catastrophizing, poor pain control, and limited activity). This paper describes the study protocol and rationale of a randomized controlled trial that will compare the efficacy of remote-delivered health coaching in reducing disability and pain impairment for veterans with pain-CMI to remote-delivered supportive psychotherapy. METHODS This randomized controlled trial will consist of two treatment arms: remote-delivered health coaching and remote-delivered supportive psychotherapy, the active control. Each treatment condition will consist of twelve, weekly one-on-one meetings with a study provider. In addition to the baseline assessment, participants will also complete 6-week (mid-treatment), 12-week (post-treatment), and 24-week (follow-up) assessments that consist of questionnaires that can be completed remotely. The primary aims for this study are to determine whether health coaching reduces disability and pain impairment as compared to supportive psychotherapy. We will also examine whether health coaching reduces physical symptoms, catastrophizing, limiting activity, and increasing pain control as compared to supportive psychotherapy. DISCUSSION This study will contribute to the existing literature on pain-CMI and report the effectiveness of a novel, remote-delivered behavioral intervention.
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Affiliation(s)
- Sarah Crosky
- Department of Educational and Counseling Psychology, University at Albany-State University of New York, Albany, USA
| | - Mikhaela McFarlin
- Department of Educational and Counseling Psychology, University at Albany-State University of New York, Albany, USA
| | - Nicole Sullivan
- War Related Illness and Injury Study Center, Veterans Affairs New Jersey Healthcare System, 385 Tremont Ave., East Orange, NJ, 07018, USA
| | - Darren Winograd
- Department of Educational and Counseling Psychology, University at Albany-State University of New York, Albany, USA
| | - David Litke
- War Related Illness and Injury Study Center, Veterans Affairs New Jersey Healthcare System, 385 Tremont Ave., East Orange, NJ, 07018, USA
- Department of Rehabilitation Medicine, NYU Grossman School of Medicine, New York, NY, 10016, USA
| | - Robin M Masheb
- VA Connecticut Healthcare System, 950 Campbell Ave., West Haven, CT, 06516, USA
- Yale University School of Medicine, 333 Cedar St., New Haven, CT, 06610, USA
| | - Shou-En Lu
- Epidemiology and Statistics, School of Public Health, Rutgers University, Piscataway, NJ, 08854, USA
| | - Michelle Costanzo
- War Related Illness and Injury Study Center, Washington DC VA Medical Center, 50 Irving St. NW, Washington, DC, 20422, USA
- Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Nicole Anastasides
- War Related Illness and Injury Study Center, Veterans Affairs New Jersey Healthcare System, 385 Tremont Ave., East Orange, NJ, 07018, USA
| | - Christina Gonzalez
- War Related Illness and Injury Study Center, Veterans Affairs New Jersey Healthcare System, 385 Tremont Ave., East Orange, NJ, 07018, USA
| | - Jaineel Doshi
- War Related Illness and Injury Study Center, Veterans Affairs New Jersey Healthcare System, 385 Tremont Ave., East Orange, NJ, 07018, USA
| | - Fiona Graff
- War Related Illness and Injury Study Center, Veterans Affairs New Jersey Healthcare System, 385 Tremont Ave., East Orange, NJ, 07018, USA
| | - Linda Khatib
- War Related Illness and Injury Study Center, Veterans Affairs New Jersey Healthcare System, 385 Tremont Ave., East Orange, NJ, 07018, USA
| | - Scott Thien
- War Related Illness and Injury Study Center, Veterans Affairs New Jersey Healthcare System, 385 Tremont Ave., East Orange, NJ, 07018, USA
| | - Lisa M McAndrew
- War Related Illness and Injury Study Center, Veterans Affairs New Jersey Healthcare System, 385 Tremont Ave., East Orange, NJ, 07018, USA.
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26
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Valladales-Restrepo LF, Oyuela-Gutiérrez MC, Alzate-García M, Osorio-Rodas I, Quintero-Flórez V, Restrepo-Muñoz JF, Suárez-Cardona JA, Barroso-Fernandes ST, Machado-Alba JE. Treatment patterns in fibromyalgia including the use of opioids. Musculoskeletal Care 2023; 21:66-77. [PMID: 35765712 DOI: 10.1002/msc.1670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 06/15/2022] [Accepted: 06/17/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Opioids (except for tramadol) have not been shown to be effective in patients with fibromyalgia, but they can increase the risk of adverse drug reactions. The aim was to determine the treatment patterns of a group of patients with fibromyalgia and to identify the factors associated with the use of opioids in Colombia. METHODS This was a cross-sectional study of a group of patients with fibromyalgia from a pain clinic in Colombia. Sociodemographic, clinical and pharmacological variables were identified. Descriptive, bivariate, and multivariate analyses were performed. RESULTS A total of 559 patients were analysed, 88.6% of whom were women, and the mean age was 53.4 ± 12.6 years. A total of 40.6% received nonpharmacological management, and the majority were treated with acetaminophen (96.1%) and pregabalin (62.8%). A total of 69.6% received opioids, the most common of which was hydrocodone (36.3%). The average morphine equivalent milligrammes was 36.9 ± 91.2 (range: 2.3-750 mg), and 43.8% had intermediate/high doses. Being male (OR: 3.12; 95% CI: 1.40-6.91), having arterial hypertension (OR: 1.67; 95% CI: 1.04-2.69), obesity (OR: 2.23; 95% CI: 1.18-4.24), degenerative disease of vertebral discs (OR: 2.32; 95% CI: 1.10-4.88) and comedication with gabapentinoids (OR: 1.75; 95% CI: 1,15-2.65) were associated with a higher probability of receiving opioids, while patients treated with muscle relaxants had a lower risk of opioid treatment (OR: 0.64; 95% CI: 0.41-0.98). CONCLUSIONS A significant proportion of patients were treated with opioids, the most common of which was hydrocodone, which goes against the recommendations of clinical practice guidelines.
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Affiliation(s)
- Luis F Valladales-Restrepo
- Grupo de Investigación Biomedicina, Facultad de Medicina, Fundación Universitaria Autónoma de las Américas, Pereira, Colombia.,Semillero de Investigación en Farmacología Geriátrica, Grupo de Investigación Biomedicina, Facultad de Medicina, Fundación Universitaria Autónoma de las Américas, Pereira, Colombia.,Grupo de Investigación en Farmacoepidemiología y Farmacovigilancia, Universidad Tecnológica de Pereira-Audifarma S.A, Pereira, Colombia
| | - María C Oyuela-Gutiérrez
- Semillero de Investigación en Farmacología Geriátrica, Grupo de Investigación Biomedicina, Facultad de Medicina, Fundación Universitaria Autónoma de las Américas, Pereira, Colombia
| | - Mariana Alzate-García
- Semillero de Investigación en Farmacología Geriátrica, Grupo de Investigación Biomedicina, Facultad de Medicina, Fundación Universitaria Autónoma de las Américas, Pereira, Colombia
| | - Isabella Osorio-Rodas
- Semillero de Investigación en Farmacología Geriátrica, Grupo de Investigación Biomedicina, Facultad de Medicina, Fundación Universitaria Autónoma de las Américas, Pereira, Colombia
| | - Valentina Quintero-Flórez
- Semillero de Investigación en Farmacología Geriátrica, Grupo de Investigación Biomedicina, Facultad de Medicina, Fundación Universitaria Autónoma de las Américas, Pereira, Colombia
| | - Juan F Restrepo-Muñoz
- Semillero de Investigación en Farmacología Geriátrica, Grupo de Investigación Biomedicina, Facultad de Medicina, Fundación Universitaria Autónoma de las Américas, Pereira, Colombia
| | - Julián A Suárez-Cardona
- Semillero de Investigación en Farmacología Geriátrica, Grupo de Investigación Biomedicina, Facultad de Medicina, Fundación Universitaria Autónoma de las Américas, Pereira, Colombia
| | - Sergio T Barroso-Fernandes
- Semillero de Investigación en Farmacología Geriátrica, Grupo de Investigación Biomedicina, Facultad de Medicina, Fundación Universitaria Autónoma de las Américas, Pereira, Colombia
| | - Jorge E Machado-Alba
- Grupo de Investigación Biomedicina, Facultad de Medicina, Fundación Universitaria Autónoma de las Américas, Pereira, Colombia
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27
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Pasini I, Perlini C, Donisi V, Mason A, Schweiger V, Secchettin E, Lugoboni F, Valenza G, Del Piccolo L. "INTEGRO INTEGRated Psychotherapeutic InterventiOn" on the Management of Chronic Pain in Patients with Fibromyalgia: The Role of the Therapeutic Relationship. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3973. [PMID: 36900982 PMCID: PMC10002139 DOI: 10.3390/ijerph20053973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 02/18/2023] [Accepted: 02/20/2023] [Indexed: 06/18/2023]
Abstract
Fibromyalgia (FM) is a chronic disease characterized by a heterogeneous set of physical and psychological conditions. The chronic experience of disability felt by patients and the impact on quality of life (QoL) of the disease may worsen the cognitive reappraisal ability and contribute to maintaining an altered pain modulation mechanism. This paper presents the study protocol of an INTEGRated psychotherapeutic interventiOn on the management of chronic pain in patients with fibromyalgia (INTEGRO). The aim of the study is to investigate the efficacy of an integrated psychotherapeutic intervention focused on pain management on QoL and pain perception, in a pilot sample of 45 FM patients with idiopathic chronic pain. The contribution of perceived therapeutic relationship (alliance) and physiological attunement, in both the patient and therapist, will be considered as possible mediators of intervention efficacy. Attachment dimensions, traumatic experiences, difficulties in emotion regulation, mindfulness attitude and psychophysiological profile will also be considered as covariates. The objectives are to evaluate longitudinally if patients will experience an increase in QoL perception (primary endpoint), pain-managing self-efficacy and emotion-regulation abilities as well as a reduction in pain intensity (secondary endpoints), considering the mediating role of perceived therapeutic alliance and physiological attunement in both the patient and therapist.
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Affiliation(s)
- Ilenia Pasini
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, 37134 Verona, Italy
| | - Cinzia Perlini
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, 37134 Verona, Italy
| | - Valeria Donisi
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, 37134 Verona, Italy
| | - Anna Mason
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, 37134 Verona, Italy
| | - Vittorio Schweiger
- Pain Therapy Centre, Department of Surgery, Dentistry, Maternal and Infant Sciences, Verona University Hospital, Policlinico GB Rossi, 37134 Verona, Italy
| | - Erica Secchettin
- Pain Therapy Centre, Department of Surgery, Dentistry, Maternal and Infant Sciences, Verona University Hospital, Policlinico GB Rossi, 37134 Verona, Italy
| | - Fabio Lugoboni
- Unit of Addiction Medicine, Department of Internal Medicine, Integrated University Hospital of Verona, Policlinico GB Rossi, 37134 Verona, Italy
| | - Gaetano Valenza
- Bioengineering and Robotics Research Center “E. Piaggio”, Department of Information Engineering, School of Engineering, University of Pisa, 56122 Pisa, Italy
| | - Lidia Del Piccolo
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, 37134 Verona, Italy
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Buis L, Moral-Munoz JA, Salazar A, Failde I. mHealth Intervention for Improving Pain, Quality of Life, and Functional Disability in Patients With Chronic Pain: Systematic Review. JMIR Mhealth Uhealth 2023; 11:e40844. [PMID: 36729570 PMCID: PMC9936365 DOI: 10.2196/40844] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 11/24/2022] [Accepted: 12/14/2022] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Chronic pain (CP) is 1 of the leading causes of disability worldwide and represents a significant burden on individual, social, and economic aspects. Potential tools, such as mobile health (mHealth) systems, are emerging for the self-management of patients with CP. OBJECTIVE A systematic review was conducted to analyze the effects of mHealth interventions on CP management, based on pain intensity, quality of life (QoL), and functional disability assessment, compared to conventional treatment or nonintervention. METHODS PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines were followed to conduct a systematic review of randomized controlled trials (RCTs) published in PubMed, Web of Science, Scopus, and Physiotherapy Evidence Database (PEDro) databases from February to March 2022. No filters were used. The eligibility criteria were RCTs of adults (≥18 years old) with CP, intervened with mHealth systems based on mobile apps for monitoring pain and health-related outcomes, for pain and behavioral self-management, and for performing therapeutic approaches, compared to conventional treatments (physical, occupational, and psychological therapies; usual medical care; and education) or nonintervention, reporting pain intensity, QoL, and functional disability. The methodological quality and risk of bias (RoB) were assessed using the Checklist for Measuring Quality, the Oxford Centre for Evidence-Based Medicine Levels of Evidence, and the Cochrane RoB 2.0 tool. RESULTS In total, 22 RCTs, involving 2641 patients with different CP conditions listed in the International Classification of Diseases 11th Revision (ICD-11), including chronic low back pain (CLBP), chronic musculoskeletal pain (CMSP), chronic neck pain (CNP), unspecified CP, chronic pelvic pain (CPP), fibromyalgia (FM), interstitial cystitis/bladder pain syndrome (IC/BPS), irritable bowel syndrome (IBS), and osteoarthritis (OA). A total of 23 mHealth systems were used to conduct a variety of CP self-management strategies, among which monitoring pain and symptoms and home-based exercise programs were the most used. Beneficial effects of the use of mHealth systems in reducing pain intensity (CNP, FM, IC/BPS, and OA), QoL (CLBP, CNP, IBS, and OA), and functional disability (CLBP, CMSP, CNP, and OA) were found. Most of the included studies (18/22, 82%) reported medium methodological quality and were considered as highly recommendable; in addition, 7/22 (32%) studies had a low RoB, 10/22 (45%) had some concerns, and 5/22 (23%) had a high RoB. CONCLUSIONS The use of mHealth systems indicated positive effects for pain intensity in CNP, FM, IC/BPS, and OA; for QoL in CLBP, CNP, IBS, and OA; and for functional disability in CLBP, CMSP, CNP, and OA. Thus, mHealth seems to be an alternative to improving pain-related outcomes and QoL and could be part of multimodal strategies for CP self-management. High-quality studies are needed to merge the evidence and recommendations of the use of mHealth systems for CP management. TRIAL REGISTRATION PROSPERO International Prospective Register of Systematic Reviews CRD42022315808; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=315808.
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Affiliation(s)
| | - Jose A Moral-Munoz
- Observatory of Pain, University of Cádiz, Cádiz, Spain.,Department of Nursing and Physiotherapy, University of Cádiz, Cádiz, Spain.,Institute of Research and Innovation in Biomedical Sciences of the Province of Cadiz (INiBICA), Cádiz, Spain
| | - Alejandro Salazar
- Observatory of Pain, University of Cádiz, Cádiz, Spain.,Institute of Research and Innovation in Biomedical Sciences of the Province of Cadiz (INiBICA), Cádiz, Spain.,Department of Statistics and Operational Research, University of Cádiz, Cádiz, Spain
| | - Inmaculada Failde
- Preventive Medicine and Public Health Area, Department of Biomedicine, Biotechnology and Public Health, University of Cádiz, Cádiz, Spain.,Observatory of Pain, University of Cádiz, Cádiz, Spain.,Institute of Research and Innovation in Biomedical Sciences of the Province of Cadiz (INiBICA), Cádiz, Spain
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Frisch S, Gündel H. Emerging evidence for emotion-focused psychotherapy in patients with somatic symptom disorders and chronic pain. J Psychosom Res 2023; 165:111132. [PMID: 36608511 DOI: 10.1016/j.jpsychores.2022.111132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 12/19/2022] [Accepted: 12/22/2022] [Indexed: 12/26/2022]
Affiliation(s)
- Stephan Frisch
- Department of Psychosomatic Medicine and Psychotherapy, University of Ulm, Ulm, Germany; Division Medical Psychology, Department of Psychosomatic Medicine and Psychotherapy, University of Ulm, Ulm, Germany.
| | - Harald Gündel
- Department of Psychosomatic Medicine and Psychotherapy, University of Ulm, Ulm, Germany
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Lin HM, Hsieh PS, Chen NC, Tsai CH, Kuo WF, Lee YL, Hung KC. Impact of cognitive behavior therapy on osteoarthritis-associated pain, insomnia, depression, fatigue, and physical function in patients with knee/hip osteoarthritis: A systematic review and meta-analysis of randomized controlled trials. Front Med (Lausanne) 2023; 9:1083095. [PMID: 36687459 PMCID: PMC9853196 DOI: 10.3389/fmed.2022.1083095] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 12/15/2022] [Indexed: 01/09/2023] Open
Abstract
Background This meta-analysis aimed at evaluating the efficacy of cognitive behavior therapy (CBT) against osteoarthritis-associated symptoms in patients with knee/hip osteoarthritis. Methods Medline, PubMed, Cochrane Library, and EMBASE databases were searched from inception to July 2022 to identify randomized controlled trials (RCTs) comparing the efficacy of CBT with other treatment approaches in adults with confirmed knee/hip osteoarthritis. The pain intensity (primary outcome) and the secondary outcomes including insomnia severity, sleep efficiency, physical function as well as the severity of depression and fatigue were assessed at two time points (i.e., immediately after treatment and during the follow-up period). The effect size is expressed as standardized mean difference (SMD) with SMDs of < 0.2, 0.2-0.5, and 0.5-0.8, and > 0.8 representing negligible, small, medium, and large effect sizes, respectively. Results Fifteen RCTs were included for analysis. Immediately after CBT intervention, meta-analysis showed similar treatment effect in pain severity [SMD = -0.46, 95% confidence interval (CI): -0.95 to 0.04, 11 studies, 1557 participants] and other symptoms including depression (SMD = -0.26, 95% CI: -0.58 to 0.06, five studies, 735 participants), fatigue (SMD = -2.44, 95% CI:-6.53 to 1.65, two RCTs, 511 participants), and physical function (SMD = -0.11, 95% CI:-0.25 to 0.02, five RCTs, 720 participants) between CBT and control groups, while there was an improvement in insomnia severity (SMD = -0.65, 95% CI: -1.06 to -0.24, four RCTs, 639 participants, medium treatment effect) and sleep efficiency (SMD = 0.32, 95% CI: 0.04 to 0.59, three RCTs, 352 patients, small treatment effect). During follow-up, CBT improved pain severity (SMD = -0.52, 95% CI: -1.03 to -0.01, eight studies, 1447 participants, medium treatment effect), insomnia (SMD = -0.43, 95% CI: -0.85 to -0.01, three RCTs, 571 participants, small treatment effect), and depression (SMD = -0.39, 95% CI: -0.59 to -0.18, four RCTs, 791 participants, small treatment effect). Nevertheless, sleep efficiency, fatigue, and physical function were not improved in the follow-up period. Conclusion Our results may suggest the durability of CBT-associated treatment benefits, supporting its role as a potential promising alternative or complementary intervention for patients with knee/hip osteoarthritis, especially against pain and insomnia. Future large-scale investigations are warranted to verify our findings. Systematic review registration [https://www.crd.york.ac.uk/prospero/], identifier [CRD42022331165].
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Affiliation(s)
- Hong-Min Lin
- Department of Family Medicine, Chi Mei Medical Center, Tainan, Taiwan
| | - Pei-Shan Hsieh
- Department of Family Medicine, Chi Mei Medical Center, Tainan, Taiwan
| | - Nai-Ching Chen
- Department of Nursing, Chi Mei Medical Center, Tainan, Taiwan
| | | | - Wen-Fu Kuo
- Department of Nursing, Chi Mei Medical Center, Tainan, Taiwan
| | - Ying-Li Lee
- Department of Nursing, Chi Mei Medical Center, Tainan, Taiwan,Department of Nursing, Chang Jung Christian University, Tainan, Taiwan,*Correspondence: Ying-Li Lee,
| | - Kuo-Chuan Hung
- School of Medicine, College of Medicine, National Sun Yat-sen University, Kaohsiung City, Taiwan,Department of Anesthesiology, Chi Mei Medical Center, Tainan, Taiwan,Kuo-Chuan Hung,
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The Role of Self-Efficacy and Activity Patterns in the Physical Activity Levels of Women with Fibromyalgia. BIOLOGY 2023; 12:biology12010085. [PMID: 36671777 PMCID: PMC9855924 DOI: 10.3390/biology12010085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 12/28/2022] [Accepted: 12/30/2022] [Indexed: 01/07/2023]
Abstract
Keeping high levels of physical activity is a challenge among chronic patients. In this regard, self-efficacy has been identified as a crucial variable to reduce sedentarism and physical inactivity in women with fibromyalgia. The current study aimed to evaluate the associations among objective physical activity levels, self-efficacy, activity patterns, and the impact of the disease, as well as to compare those variables between women with fibromyalgia with different self-efficacy levels. For this purpose, in this cross-sectional study, the physical activity levels of 123 women with fibromyalgia were assessed by accelerometers, together with self-efficacy, the impact of the disease, and activity patterns. Results revealed that self-efficacy for light or moderate physical activity was directly related to light (p < 0.01), moderate (p < 0.01), and vigorous physical activity (p < 0.05), as well as inversely related to sedentary time (p < 0.01). Moreover, the main differences were observed between those with low self-efficacy levels and the rest of the sample, while there were no differences between the high and the medium self-efficacy groups (p > 0.05). Thus, self-efficacy for walking and light physical activity seems to be more relevant than self-efficacy for moderate and vigorous physical activity to achieve higher levels of physical activity.
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Maroti D, Lumley MA, Schubiner H, Lilliengren P, Bileviciute-Ljungar I, Ljótsson B, Johansson R. Internet-based emotional awareness and expression therapy for somatic symptom disorder: A randomized controlled trial. J Psychosom Res 2022; 163:111068. [PMID: 36327532 DOI: 10.1016/j.jpsychores.2022.111068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 09/11/2022] [Accepted: 10/18/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Somatic symptom disorder (SSD) is commonly encountered in health care settings. Cognitive-behavioural treatments have been most extensively studied, but they tend to have small effects of temporary duration. Emotional awareness and expression therapy (EAET) is a newly developed treatment for SSD, targeting emotional processing of trauma and conflict as a mechanism of symptom change. In an earlier uncontrolled study of self-guided, internet-administrated EAET (I-EAET), we found substantial reductions in somatic symptoms, prompting the need for a randomized controlled trial of I-EAET. METHODS We conducted a 2-arm RCT, comparing 10-week I-EAET (n = 37) to a waitlist control (WL; n = 37). Primary outcomes were reductions of somatic symptoms (PHQ-15) and pain intensity (BPI-4) at post-treatment, with a 4-month evaluation of effect duration. We also analysed emotional processing (EPS-25) and depression (PHQ-9) as possible mediators of I-EAET's effects. RESULTS Compared to controls, I-EAET significantly reduced somatic symptoms at both post-treatment and follow-up. I-EAET also reduced pain, depression, insomnia, and anxiety at post-treatment, but these effects were not retained at follow-up. As hypothesized, a facet of emotional processing partially mediated the treatment effect on somatic symptoms, even when controlling for depression. CONCLUSIONS Although treatment effects were smaller than in the previous uncontrolled trial, I-EAET is a promising treatment for SSD, with a minority of patients (around 20%) experiencing substantial clinical improvement. The benefits of I-EAET are partially mediated by improved emotional processing. Future research should identify and target patients who respond best to I-EAET and develop tailored treatment to enhance treatment effects. (Preregistered at clinicaltrials.gov: NCT04751825.).
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Affiliation(s)
- Daniel Maroti
- Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden.
| | - Mark A Lumley
- Department of Psychology, Wayne State University, Detroit, MI, USA..
| | - Howard Schubiner
- Department of Internal Medicine, Ascension Providence-Providence Hospital, Michigan State University College of Human Medicine, Southfield, MI, USA
| | - Peter Lilliengren
- Department of Health Care Sciences, Ersta Sköndal Bräcke University College, Stockholm, Sweden..
| | - Indre Bileviciute-Ljungar
- Department of Clinical Sciences, Karolinska Institute and Department of Rehabilitation Medicine, Danderyd Hospital, Stockholm, Sweden..
| | - Brjánn Ljótsson
- Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden.
| | - Robert Johansson
- Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden; Department of Psychology, Stockholm University, Stockholm, Sweden..
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Ismail ZNE, Hefny MA, Hendi AE. Impact of resilience on disease severity and psychiatric comorbidities in patients with fibromyalgia. EGYPTIAN RHEUMATOLOGY AND REHABILITATION 2022. [DOI: 10.1186/s43166-022-00136-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Resilience is the process of adjusting successfully in the face of adversity, trauma, threats, or severe stress, such as serious health problems. It is one of the factors that affect recovery from psychiatric disorders. It was suggested that fibromyalgia patients have low resilience. This study aimed to assess the impact of resilience on disease severity and psychiatric comorbidities in patients with fibromyalgia.
Results
We found that patients with fibromyalgia had a significantly lower resilience and higher prevalence of psychiatric comorbidities than the control group (P < 0.05). Also, fibromyalgia patients with high disease severity had a significantly lower resilience and a higher percentage of psychiatric problems than those with a better disease state (P = 0.0001). Also, there was a significant negative correlation of resilience with disease severity (as assessed by the FIQ score), visual analog scale (VAS) of anxiety, and VAS of depression (P = 0.0001).
Conclusion
Resilience significantly impacts the severity and psychiatric comorbidities in patients with fibromyalgia. So, enhancing and improving resilience must be considered in the management protocols of fibromyalgia patients.
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AlOmair M, AlMalki H, Sarhan L, Shweel M, Asiri A, Almhjani E, Asiri A, AlQahtani H, Rahman A, Hasan E. Fibromyalgia Concomitant with Seropositive Rheumatoid Arthritis in a Tertiary Hospital in South-Western Saudi Arabia: Prevalence and Treatment Patterns. Open Rheumatol J 2022. [DOI: 10.2174/18743129-v16-e2209290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Introduction:
Rheumatoid arthritis (RA) patients with fibromyalgia syndrome (FMS) report worse functional status and quality of life hence the association has important clinical implications. FMS can be challenging to treat, and the current evidence recommends a multidisciplinary treatment approach focused on symptom management.
Aim:
Information regarding the current prevalence of FMS in RA patients is lacking. Thus, this study aims to address the prevalence and predictors of FMS in seropositive RA patients and demonstrate our clinical practice in the management of FMS.
Methods:
Participants’ data was gathered from Aseer central hospital (ACH) rheumatology clinics and daycare units over a period of 2 years. Subjects were assessed using the 2010 American College of Rheumatology (ACR) criteria for FMS. Data were collected from medical records, including patient demographics, comorbidities and concomitant FMS-related data.
Results:
Out of 310 seropositive RA patients, 15% (n = 47) fulfilled the diagnostic criteria for FMS. Of them, 29, 11 and 7 were on pregabalin, amitriptyline and duloxetine, respectively. Half of FMS patients showed one or more therapy changes. A significant difference between RA patients with and without concomitant FMS was observed, including age, gender and comorbidities.
Conclusion:
In this retrospective study, a high prevalence of FMS in individuals with seropositive RA was identified. This study explores real-world practice in the treatment of FMS with remarkable findings regarding underdosing and lower discontinuation rate of pregabalin.
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Serrat M, Ferrés S, Auer W, Almirall M, Lluch E, D’Amico F, Maes M, Lorente S, Navarrete J, Montero-Marín J, Neblett R, Nijs J, Borràs X, Luciano JV, Feliu-Soler A. Effectiveness, cost-utility and physiological underpinnings of the FIBROWALK multicomponent therapy in online and outdoor format in individuals with fibromyalgia: Study protocol of a randomized, controlled trial (On&Out study). Front Physiol 2022; 13:1046613. [DOI: 10.3389/fphys.2022.1046613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 10/20/2022] [Indexed: 11/11/2022] Open
Abstract
Introduction: The On&Out study is aimed at assessing the effectiveness, cost-utility and physiological underpinnings of the FIBROWALK multicomponent intervention conducted in two different settings: online (FIBRO-On) or outdoors (FIBRO-Out). Both interventions have proved to be efficacious in the short-term but there is no study assessing their comparative effectiveness nor their long-term effects. For the first time, this study will also evaluate the cost-utility (6-month time-horizon) and the effects on immune-inflammatory biomarkers and Brain-Derived Neurotrophic Factor (BDNF) levels of both interventions. The objectives of this 6-month, randomized, controlled trial (RCT) are 1) to examine the effectiveness and cost-utility of adding FIBRO-On or FIBRO-Out to Treatment-As-Usual (TAU) for individuals with fibromyalgia (FM); 2) to identify pre–post differences in blood biomarker levels in the three study arms and 3) to analyze the role of process variables as mediators of 6-month follow-up clinical outcomes.Methods and analysis: Participants will be 225 individuals with FM recruited at Vall d’Hebron University Hospital (Barcelona, Spain), randomly allocated to one of the three study arms: TAU vs. TAU + FIBRO-On vs. TAU + FIBRO-Out. A comprehensive assessment to collect functional impairment, pain, fatigue, depressive and anxiety symptoms, perceived stress, central sensitization, physical function, sleep quality, perceived cognitive dysfunction, kinesiophobia, pain catastrophizing, psychological inflexibility in pain and pain knowledge will be conducted pre-intervention, at 6 weeks, post-intervention (12 weeks), and at 6-month follow-up. Changes in immune-inflammatory biomarkers [i.e., IL-6, CXCL8, IL-17A, IL-4, IL-10, and high-sensitivity C-reactive protein (hs-CRP)] and Brain-Derived Neurotrophic Factor will be evaluated in 40 participants in each treatment arm (total n = 120) at pre- and post-treatment. Quality of life and direct and indirect costs will be evaluated at baseline and at 6-month follow-up. Linear mixed-effects regression models using restricted maximum likelihood, mediational models and a full economic evaluation applying bootstrapping techniques, acceptability curves and sensitivity analyses will be computed.Ethics and dissemination: This study has been approved by the Ethics Committee of the Vall d’Hebron Institute of Research. The results will be actively disseminated through peer-reviewed journals, conference presentations, social media and various community engagement activities. Trial registration number NCT05377567 (clinicaltrials.gov).
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Hennemann S, Böhme K, Kleinstäuber M, Ruckes C, Baumeister H, Daniel Ebert D, Küchler AM, Witthöft M. Is Therapist Support Needed? Comparing Therapist- and Self-Guided Internet-Based CBT for Somatic Symptom Distress (iSOMA) in Emerging Adults. Behav Ther 2022; 53:1205-1218. [PMID: 36229117 DOI: 10.1016/j.beth.2022.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 06/01/2022] [Accepted: 06/18/2022] [Indexed: 11/19/2022]
Abstract
Persistent somatic symptoms of varying etiology are very common in emerging adults and can lead to distress and impairment. Internet-delivered interventions could help to prevent the burden and chronicity of persistent somatic symptoms. This study investigated the impact of therapist guidance on the effectiveness of a cognitive-behavioral Internet intervention for somatic symptom distress (iSOMA) in emerging adults, as a secondary analysis of a two-armed randomized controlled trial. We included 149 university students (83.2% female, 24.60 yrs) with varying degrees of somatic symptom distress who were either allocated to the 8-week intervention with regular, written therapeutic guidance (iSOMA guided) or to the control group (waitlist), which was afterwards crossed over to receive iSOMA with guidance-on-demand (iSOMA-GoD). Primary outcomes were somatic symptom distress (assessed by the PHQ-15) and psychobehavioral symptoms of the somatic symptom disorder (assessed by the SSD-12) at pre- and post-treatment. Secondary outcomes included depression, anxiety, and disability. Both treatments showed statistically significant pre-post improvements in primary (iSOMA-guided: d = 0.86-0.92, iSOMA-GoD: d = 0.55-0.63) and secondary outcomes. However, intention-to-treat analysis revealed non-significant between-group effects for all outcomes (ps ≥ .335), after controlling for confounding variables, and effect sizes were marginal (d = -0.06 to 0.12). Overall, our findings indicate that Internet-delivered cognitive behavioral therapy with regular guidance is not unequivocally superior to guidance-on-demand in alleviating somatic symptom distress and associated psychopathology in emerging adults. As a next step, non-inferiority studies are needed to test the robustness of these findings and their impact on clinical populations.
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Affiliation(s)
| | | | - Maria Kleinstäuber
- Utah State University, Emma Eccles Jones College of Education and Human Services
| | - Christian Ruckes
- Interdisciplinary Center for Clinical Trials, University Medical Center of the Johannes Gutenberg University Mainz
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Online Questionnaire with Fibromyalgia Patients Reveals Correlations among Type of Pain, Psychological Alterations, and Effectiveness of Non-Pharmacological Therapies. Healthcare (Basel) 2022; 10:healthcare10101975. [PMID: 36292422 PMCID: PMC9602604 DOI: 10.3390/healthcare10101975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 10/04/2022] [Accepted: 10/06/2022] [Indexed: 11/04/2022] Open
Abstract
Fibromyalgia (FM) is a chronic pain syndrome with an unclear etiology. In addition to pain, FM patients suffer from a diverse array of symptoms and comorbidities, encompassing fatigue, cognitive dysfunction, mood disorders, sleep deprivation, and dizziness. Due to the complexity of FM, the diagnosis and treatment of it are highly challenging. The aim of the present work was to investigate some clinical and psychological characteristics of FM patients, and to uncover possible correlations with pharmacological and non-pharmacological therapies. We conducted a cross-sectional, questionnaire-based study aimed at evaluating pain, psychological traits, and the self-perceived effectiveness of pharmacological and non-pharmacological treatments in an Italian population of FM patients. Descriptive statistics, correlation, and inference analyses were performed. We found a prevalence of a neuropathic/nociplastic type of pain, which correlated with psychological traits such as anxiety, low mood, psychophysical discomfort, and the inability to relax. The pain type and psychological traits proved to play a role in determining the self-perceived effectiveness of therapeutic interventions. Patients revealed a better response to non-pharmacological therapies, particularly dietary interventions, relaxation techniques, and psychotherapy rather than pharmacological interventions. The sum of our data indicates that for better outcomes, the type of pain and psychological traits should be considered for tailor-made treatments considering non-pharmacological protocols as a complement to the use of drugs.
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Fonia D, Aisenberg D. The Effects of Mindfulness Interventions on Fibromyalgia in Adults aged 65 and Older: A Window to Effective Therapy. J Clin Psychol Med Settings 2022:10.1007/s10880-022-09911-7. [PMID: 36163446 DOI: 10.1007/s10880-022-09911-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/07/2022] [Indexed: 11/25/2022]
Abstract
Pain usually receives insufficient attention by individuals due to the misconception that pain is a natural consequence of aging. For persons aged 65 and older, a disease requiring further research is fibromyalgia, characterized by chronic pain without clear pathology. Mind-body therapies like mindfulness are beneficial for this population as they affect psychological and biological aspects of pain. These therapies emphasize a nonjudgmental acceptance of thoughts and attention to the experience without attempting to resist or change them. Despite the potential benefits of mindfulness interventions for persons with fibromyalgia aged 65 and older, only few studies have examined the effects of these therapies, yielding conflicting findings. Importantly, no study has yet to be conducted exclusively on this population. This comprehensive review examined existing literature focusing on the effects of mindfulness-based interventions on the physical and mental well-being of persons with fibromyalgia aged 65 and older. It highlights the need for further research on the relationship between mindfulness, fibromyalgia, and gerontology, calling for a standard protocol of intervention.
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Affiliation(s)
- Dvir Fonia
- Clinical Psychology of Adulthood and Aging, Ruppin Academic Center, Emek Hefer, Israel.
| | - Daniela Aisenberg
- Clinical Psychology of Adulthood and Aging, Ruppin Academic Center, Emek Hefer, Israel
- The Dror (Imri) Aloni Center for Health Informatics, Ruppin Academic Center, Emek Hefer, Israel
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Miró J, Lleixà-Daga M, de la Vega R, Llorens-Vernet P, Jensen MP. A Mobile Application to Help Self-Manage Pain Severity, Anxiety, and Depressive Symptoms in Patients with Fibromyalgia Syndrome: A Pilot Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12026. [PMID: 36231327 PMCID: PMC9566351 DOI: 10.3390/ijerph191912026] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 09/16/2022] [Accepted: 09/21/2022] [Indexed: 06/16/2023]
Abstract
Treatment for individuals with fibromyalgia syndrome (FMS) is complex and is not always accessible to those who could benefit. The aim of this study was to conduct a preliminary evaluation of a mobile-app-delivered, cognitive behavioral treatment (CBT)-based intervention in helping adults self-manage fibromyalgia symptoms. A total of 100 adults with FMS (M [SD] age = 49.81, [9.99] years; 94% women) were given access to the digital treatment program and downloaded the app. Pain severity, anxiety symptoms, depression symptoms, fatigue, and sleep quality were assessed at pre-treatment, post-treatment, and 3-month follow-up. Fifty-three of the potential participants completed the 47-day treatment. Data showed significant improvements in pain severity (p = 0.007, d = 0.43), anxiety (p = 0.011, d = 0.40) and depressive symptoms (p = 0.001, d = 0.50) from pre-treatment to post-treatment. The effect sizes associated with app use are consistent with improvements seen in previously published clinical trials of CBT for FMS. Improvements were generally maintained, although there was some decrease in the outcomes from post-treatment to the 3-month follow-up. Most participants reported that they were very satisfied with the app. The use of the app was associated with similar levels of improvements found with in-person CBT treatment for FMS. Research to evaluate the effectiveness of the app in a controlled trial is warranted.
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Affiliation(s)
- Jordi Miró
- Universitat Rovira i Virgili, Carretera de Valls, 43007 Tarragona, Spain
- Unit for the Study and Treatment of Pain—ALGOS, Research Center for Behavior Assessment (CRAMC), Department of Psychology, Institut d’Investigació Sanitària Pere Virgili, 43007 Tarragona, Spain
| | - Meritxell Lleixà-Daga
- Universitat Rovira i Virgili, Carretera de Valls, 43007 Tarragona, Spain
- Unit for the Study and Treatment of Pain—ALGOS, Research Center for Behavior Assessment (CRAMC), Department of Psychology, Institut d’Investigació Sanitària Pere Virgili, 43007 Tarragona, Spain
| | - Rocío de la Vega
- Faculty of Psychology, Andalucía Tech. Campus de Teatinos, Universidad de Málaga, 29071 Málaga, Spain
- Biomedical Research Institute of Málaga (IBIMA), Avda. Jorge Luis Borges n°15, Bl.3 Pl.3, 29010 Málaga, Spain
| | - Pere Llorens-Vernet
- Universitat Rovira i Virgili, Carretera de Valls, 43007 Tarragona, Spain
- Unit for the Study and Treatment of Pain—ALGOS, Research Center for Behavior Assessment (CRAMC), Department of Psychology, Institut d’Investigació Sanitària Pere Virgili, 43007 Tarragona, Spain
| | - Mark P. Jensen
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA 98195, USA
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Serrat M, Albajes K, Navarrete J, Almirall M, Lluch Girbés E, Neblett R, Luciano JV, Moix J, Feliu-Soler A. Effectiveness of two video-based multicomponent treatments for fibromyalgia: The added value of cognitive restructuring and mindfulness in a three-arm randomised controlled trial. Behav Res Ther 2022; 158:104188. [PMID: 36116229 DOI: 10.1016/j.brat.2022.104188] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 06/28/2022] [Accepted: 09/01/2022] [Indexed: 12/19/2022]
Abstract
BACKGROUND/OBJECTIVES The aim of this study was to examine the effectiveness of two video-based multicomponent programs (FIBROWALK) and the Multicomponent Physiotherapy Program (MPP) for patients with fibromyalgia (FM) compared to treatment-as-usual (TAU) only. We posit that FIBROWALK, due to inclusion of specific psychological ingredients (cognitive restructuring and mindfulness), can produce additional clinical benefits when compared to TAU or MPP alone. METHODS A total of 330 patients with FM were recruited and randomly allocated (1:1:1) to TAU only, TAU + FIBROWALK, or TAU + MPP. FIBROWALK and MPP consisted of weekly videos on pain neuroscience education, therapeutic exercise and self-management patient education, but only the FIBROWALK intervention provided cognitive restructuring and mindfulness. Both programs were structurally equivalent. Between-group differences in functional impairment, pain, kinesiophobia, anxious-depressive symptoms and physical functioning were evaluated at post-treatment following Intention-To-Treat and complete-case approaches. RESULTS Compared to TAU only, individuals in the FIBROWALK arm showed larger improvements in all clinical outcomes; similarly, participants in the MPP program also showed greater improvements in functional impairment, perceived pain, kinesiophobia, depressive symptoms compared to TAU only. The FIBROWALK intervention showed superior effects in improving pain, anxiety and depressive symptoms and physical functioning compared to MPP. CONCLUSIONS This RCT supports the short-term effectiveness of the video-based multicomponent programs FIBROWALK and MPP for FM and provides evidence that cognitive-behavioural and mindfulness-based techniques can be clinically useful in the context of physiotherapeutic multicomponent treatment programs. TRIAL REGISTRATION NUMBER NCT04571528.
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Affiliation(s)
- Mayte Serrat
- Unitat d'Expertesa en Síndromes de Sensibilització Central, Servei de Reumatologia, Vall d'Hebron Hospital, 08035, Barcelona, Spain; Escoles Universitàries Gimbernat, Autonomous University of Barcelona, Bellaterra (Cerdanyola del Vallès), 08193, Barcelona, Spain.
| | - Klara Albajes
- Department of Basics, Developmental and Educational Psychology, Faculty of Psychology, Autonomous University of Barcelona, Bellaterra (Cerdanyola del Vallès), 08193, Barcelona, Spain.
| | - Jaime Navarrete
- Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, 08950, Barcelona, Spain; Psychological Research in Fibromyalgia and Chronic Pain (AGORA Research Group), Teaching, Research & Innovation Unit, Parc Sanitari Sant Joan de Déu, St. Boi de Llobregat, Spain.
| | - Miriam Almirall
- Unitat d'Expertesa en Síndromes de Sensibilització Central, Servei de Reumatologia, Vall d'Hebron Hospital, 08035, Barcelona, Spain.
| | | | | | - Juan V Luciano
- Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, 08950, Barcelona, Spain; Psychological Research in Fibromyalgia and Chronic Pain (AGORA Research Group), Teaching, Research & Innovation Unit, Parc Sanitari Sant Joan de Déu, St. Boi de Llobregat, Spain; Department of Clinical and Health Psychology, Faculty of Psychology, Autonomous University of Barcelona, Bellaterra (Cerdanyola del Vallès), 08193, Barcelona, Spain.
| | - Jenny Moix
- Department of Basics, Developmental and Educational Psychology, Faculty of Psychology, Autonomous University of Barcelona, Bellaterra (Cerdanyola del Vallès), 08193, Barcelona, Spain.
| | - Albert Feliu-Soler
- Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, 08950, Barcelona, Spain; Psychological Research in Fibromyalgia and Chronic Pain (AGORA Research Group), Teaching, Research & Innovation Unit, Parc Sanitari Sant Joan de Déu, St. Boi de Llobregat, Spain; Department of Clinical and Health Psychology, Faculty of Psychology, Autonomous University of Barcelona, Bellaterra (Cerdanyola del Vallès), 08193, Barcelona, Spain.
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Fenton C, Kang C. Consider fibromyalgia in older patients with chronic widespread pain. DRUGS & THERAPY PERSPECTIVES 2022. [DOI: 10.1007/s40267-022-00940-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Prados G, Miró E, Martínez MP, Sánchez AI, Pichot V, Medina-Casado M, Chouchou F. Effect of Cognitive-Behavioral Therapy on Nocturnal Autonomic Activity in Patients with Fibromyalgia: A Preliminary Study. Brain Sci 2022; 12:brainsci12070947. [PMID: 35884753 PMCID: PMC9320055 DOI: 10.3390/brainsci12070947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 07/11/2022] [Accepted: 07/18/2022] [Indexed: 02/04/2023] Open
Abstract
Objective: fibromyalgia is a complex chronic pain syndrome characterized by widespread musculoskeletal pain, insomnia and autonomic alterations. Cognitive-behavioral therapy (CBT) is regarded as a promising treatment in fibromyalgia, but its impact on autonomic function remains uncertain. In this research, we studied the effect of CBT on autonomic functions in fibromyalgia. Methods: Twenty-five participants underwent overnight polysomnographic recordings before and after CBT programs focused on pain (CBT-P) or a hybrid modality focused on pain and insomnia (CBT-C). Sleep quality, daily pain, depression and anxiety were assessed by self-reported questionnaires. We analyzed heart rate variability (HRV) using high-frequency power (HF) as a marker for parasympathetic activity, and low-frequency power (LF) and the LF/HF ratio as relative sympathetic markers during wakefulness and at each sleep stage. Results: After treatment, 14 patients (/25, 58.0%) reported improvement in their sleep: 6 in the CBT-P condition (/12, 50%), and 8 in the CBT-C condition (/13, 61.5%). We found that, regardless of the type of CBT, patients who reported improvement in sleep quality (n = 14, 58%) had an increase in HF during stages N2 (p < 0.05) and N3 (p < 0.05). These changes were related to improvement in sleep quality (N2, r = −0.43, p = 0.033) but not to pain, depression or anxiety. Conclusions: This study showed an improvement in parasympathetic cardiac control during non-rapid-eye-movement sleep following CBT in fibromyalgia participants who reported better sleep after this therapy. CBT may have a cardio-protective effect and HRV could be used as a sleep monitoring tool in fibromyalgia.
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Affiliation(s)
- Germán Prados
- Department of Nursing, Faculty of Health Sciences, University of Granada, 18016 Granada, Spain;
- Instituto de Investigación Biosanitaria ibs.GRANADA, 18012 Granada, Spain
| | - Elena Miró
- Department of Personality, Assessment and Psychological Treatment, Faculty of Psychology, University of Granada, 18071 Granada, Spain; (M.P.M.); (A.I.S.)
- Mind, Brain and Behavior Research Center (CIMCYC), University of Granada, 18071 Granada, Spain
- Correspondence: ; Tel.: +34-958249537
| | - M. Pilar Martínez
- Department of Personality, Assessment and Psychological Treatment, Faculty of Psychology, University of Granada, 18071 Granada, Spain; (M.P.M.); (A.I.S.)
- Mind, Brain and Behavior Research Center (CIMCYC), University of Granada, 18071 Granada, Spain
| | - Ana I. Sánchez
- Department of Personality, Assessment and Psychological Treatment, Faculty of Psychology, University of Granada, 18071 Granada, Spain; (M.P.M.); (A.I.S.)
- Mind, Brain and Behavior Research Center (CIMCYC), University of Granada, 18071 Granada, Spain
| | - Vincent Pichot
- INSERM, U1059, Sainbiose, Dysfonction Vasculaire et Hémostase, Université de Lyon, Université Jean Monnet, 42023 Saint-Etienne, France;
| | - Marta Medina-Casado
- Blood Transfusion Centre and Tissue Bank of Granada-Almería, 18014 Granada, Spain;
| | - Florian Chouchou
- IRISSE Laboratory (EA4075), UFR SHE, University of La Réunion, 97430 Le Tampon, France;
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McIlroy S, Vaughan B, Crowe H, Bearne L. The experiences and acceptability of a novel multimodal programme for the management of fibromyalgia: A qualitative service evaluation. Musculoskeletal Care 2022; 20:686-696. [PMID: 35837789 PMCID: PMC9545101 DOI: 10.1002/msc.1672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 07/02/2022] [Indexed: 11/23/2022]
Abstract
Introduction Fibromyalgia guidelines recommend multi‐modal, non‐pharmacological interventions but there is limited evidence on the optimal programme. The Fibromyalgia Active Management and Exercise programme (FAME) aimed to improve function and quality of life. It consisted of 12 sessions delivered by a multidisciplinary team and incorporated education, exercise, Cognitive Behavioural Therapy and mindfulness approaches. This qualitative service evaluation explored the experience and acceptability of FAME from the perspective of the patients' and healthcare practitioners' (HCP). Methods All patients and HCP involved in the first FAME programme were invited to attend either one audio‐recorded focus group or an individual semi‐structured interview. Topic guides were developed a priori. Data were transcribed verbatim and analysed thematically. Results Thirteen participants (six HCP (three physiotherapists, two nurses, one psychologist)) and seven patients (mean age 46 (7.5) years, all female,) were enroled. FAME was acceptable to HCP participants but not to all patient participants. Where patient participants understood and anticipated the aims of FAME, the programme was found to be acceptable. Whereas, patient participants who did not fully understand the aims of the programme reported lower acceptability. Three themes were generated: expectations and preparation for FAME, the value of socialsupport, and FAME as a learning opportunity. The themes could be explained by five constructs of the Theoretical Framework of Acceptability. Conclusion FAME was acceptable to HCPs but not to all patient participants. Patient and HCP participants valued social support and regarded this as central to their learning. Further adaptation of FAME is required to optimise acceptability.
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Affiliation(s)
- Suzanne McIlroy
- Physiotherapy Department, King's College Hospital NHS Foundation Trust, London, UK.,Health Psychology Section, Psychology Department, King's College London, London, UK
| | - Bethany Vaughan
- School of Population Health and Environmental Sciences, King's College London, London, UK
| | - Heather Crowe
- School of Population Health and Environmental Sciences, King's College London, London, UK
| | - Lindsay Bearne
- School of Population Health and Environmental Sciences, King's College London, London, UK.,Population Health Research Institute, St George's University of London, London, UK
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Crump L, LaChapelle D. "My Fibro Family!" A qualitative analysis of facebook fibromyalgia support groups' discussion content. Can J Pain 2022; 6:95-111. [PMID: 36505010 PMCID: PMC9733682 DOI: 10.1080/24740527.2022.2078183] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background Fibromyalgia (FM) is a diagnostically controversial syndrome characterized by chronic widespread pain, fatigue, sleep difficulties, cognitive dysfunction, and mental health symptoms. Though online peer support groups (OPSGs) may help persons with FM access support and information, there are concerns that such groups can be harmful. Aims and Methods Using a nonparticipatory observational stance, the authors analyzed discussions in three Facebook FM OPSGs (approximately 15,000 members, mostly women) to determine what themes best characterize their discussion content and whether being in a particular group was related to the type of thematic content to which they were exposed. Results Two themes were identified that represented explicit reasons group members participated in the OPSG (trying to understand FM and seeking/offering emotional support). Six themes represented underlying reasons members sought informational and emotional support in FM OPSGs (fighting FM, learning to live with FM, struggling with identity, distressing thoughts and feelings, judgment, empowerment-seeking). No salient differences were identified between the thematic content of each group. Conclusions The findings suggest that FM OPSGs may provide much needed psychosocial and emotional support regarding important aspects of psychological adjustment to living with FM while also inadvertently encouraging approaches to living with FM that do not align with evidence-based FM management recommendations (e.g., investment in fighting rather than accepting FM). These findings may be useful to patients considering joining an FM OPSG and to health providers helping patients navigate to resources that can address their emotional or psychological support needs.
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Affiliation(s)
- Lyndsay Crump
- Department of Psychology, University of New Brunswick, Fredericton, New Brunswick, Canada,CONTACT Lyndsay Crump Department of Psychology, University of New Brunswick, P.O. Box 4400, Fredericton, NBE3B 5A3, Canada
| | - Diane LaChapelle
- Department of Psychology, University of New Brunswick, Fredericton, New Brunswick, Canada
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Kneebone II, Munday I, Van Zanden BE, Thomas S, Newton-John T. Psychological interventions for post stroke pain: A systematic review. Neuropsychol Rehabil 2022:1-21. [PMID: 35543171 DOI: 10.1080/09602011.2022.2070506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Chronic pain is prevalent after stroke and has a significant impact on quality of life. Research demonstrates the efficacy of psychological interventions for mixed chronic pain conditions. This review aimed to assess evidence on the effectiveness of psychological interventions for chronic pain in people with stroke. PubMed, PsychINFO, Embase, and CINAHL were searched from inception to 31 January 2021 at all levels of evidence. Psychological interventions assessing chronic pain in adults following stroke as a primary outcome were included. All outcomes related to pain quality were included (e.g., intensity, frequency, duration). Study quality was assessed using the Joanna Briggs Institute (JBI) Critical Appraisal Checklist for Case Reports and Risk of Bias in N-of-1 Trials (RoBiNT) Scale. Three single n case reports were included. A narrative synthesis was performed, indicating that psychological interventions may reduce chronic post-stroke pain; however, overall quality appraisal of the included studies was poor, owing to the low internal validity found in the single-n case report designs. The limited evidence suggests that psychological interventions may have clinical utility in reducing chronic post-stroke pain. However, owing to the paucity and quality of studies found, the results must be treated with caution. More rigorous research is needed.
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Affiliation(s)
- Ian I Kneebone
- Graduate School of Health, University of Technology, Sydney, Australia.,Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Melbourne , Australia
| | - Imogene Munday
- Graduate School of Health, University of Technology, Sydney, Australia
| | | | - Shirley Thomas
- School of Medicine, University of Nottingham, Nottingham, UK.,Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Melbourne , Australia
| | - Toby Newton-John
- Graduate School of Health, University of Technology, Sydney, Australia
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Aguilera M, Paz C, Salla M, Compañ V, Medina JC, Medeiros-Ferreira L, Feixas G. Cognitive-Behavioral and Personal Construct Therapies for Depression in Women with Fibromyalgia: A Randomized Controlled Trial. Int J Clin Health Psychol 2022; 22:100296. [PMID: 35281770 PMCID: PMC8873601 DOI: 10.1016/j.ijchp.2022.100296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 12/21/2021] [Indexed: 11/25/2022] Open
Abstract
Background/Objective Method Results Conclusions
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Yepez D, Grandes XA, Talanki Manjunatha R, Habib S, Sangaraju SL. Fibromyalgia and Depression: A Literature Review of Their Shared Aspects. Cureus 2022; 14:e24909. [PMID: 35698706 PMCID: PMC9187156 DOI: 10.7759/cureus.24909] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2022] [Indexed: 12/12/2022] Open
Abstract
Fibromyalgia (FM) is a chronic pain syndrome characterized by widespread, persistent pain that lasts more than three months without an evident organic lesion. FM has been considered controversial throughout history due to its validity as a diagnosis being constantly in question. Most patients diagnosed with FM are females. FM has been associated with multiple conditions, including irritable bowel and psychiatric disorders. Among all associated conditions, depression has been frequently found in patients with FM. Studies suggest that depression negatively affects the outcome of patients with FM. Moreover, a bidirectional relation between FM and depression has been depicted: depression increases the risk of FM being diagnosed later in life, as well as FM increases the risk of developing depression. In this article, we discussed aspects that FM and depression share and that might link both diseases, such as certain elements they seem to share in their pathophysiology: predisposing and triggering factors, central sensitization and kindling, areas of the brain implicated in both pain modulation and mood regulation, and hypothalamic-pituitary-adrenal axis (HPA axis) alterations. In addition, we highlighted the prevalence of depression in patients with FM, overlapping symptoms between FM and depression and how to assess them, and treatment strategies that have shown effective management of both conditions when concomitant. Due to the improvement of many aspects of FM when depression is appropriately targeted, screening for depression in patients with FM, despite its difficulty, has been encouraged.
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Affiliation(s)
- Daniela Yepez
- Faculty of Medicine, Universidad Catolica de Santiago de Guayaquil, Guayaquil, ECU
| | - Xavier A Grandes
- Research, Universidad Catolica de Santiago de Guayaquil, Guayaquil, ECU
| | | | - Salma Habib
- Medicine and Surgery, Institute of Applied Health Sciences (IAHS), Chittagong, BGD
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Robbins R, Helmer D, Monahan P, Hunt S, McAndrew L, Nazario M, Brown WJ, Chao W, Navarro A, Sall J. Management of Chronic Multisymptom Illness: Synopsis of the 2021 US Department of Veterans Affairs and US Department of Defense Clinical Practice Guideline. Mayo Clin Proc 2022; 97:991-1002. [PMID: 35410746 DOI: 10.1016/j.mayocp.2022.01.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 01/21/2022] [Accepted: 01/25/2022] [Indexed: 10/18/2022]
Abstract
In 2019, senior leaders within the US Department of Veterans Affairs and the US Department of Defense commissioned the update of a clinical practice guideline for managing chronic multisymptom illness. Clinical experts were assembled across both agencies to systematically review evidence and to develop treatment recommendations based on that evidence. This effort resulted in the development of 29 evidence-based recommendations for providing care for individuals with chronic multisymptom illness.
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Affiliation(s)
- Rachel Robbins
- Associate Program Director, Rheumatology Fellowship, Walter Reed National Military Medical Center, Bethesda, MD
| | - Drew Helmer
- Deputy Director, Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX
| | - Patrick Monahan
- Director, Integrated Clinical Skills, Uniformed Services University of the Health Sciences, Bethesda, MD
| | - Stephen Hunt
- VA National Director Post-Deployment Integrated Care Initiative, VA Puget Sound Health Care System, Seattle, WA
| | - Lisa McAndrew
- Acting Director of Research, War Related Illness and Injury Study Center, VA New Jersey Health Care System, East Orange, NJ
| | - Mitchell Nazario
- National PBM Clinical Program Manager for Pain and Substance Abuse, Veterans Health Administration, Hines, IL
| | - William J Brown
- Chief, Center for Nursing Science and Clinical Inquiry, Landstuhl Regional Medical Center, Germany
| | - Wendy Chao
- Chief, Neurology Services, San Antonio Military Medical Center, Fort Sam Houston, TX
| | - Aniceto Navarro
- Consultation Liaison Psychiatry/Geriatric Psychiatry, Fort Belvoir Community Hospital, Fort Belvoir, VA
| | - James Sall
- Clinical Quality Specialist, Office of Evidence-Based Practice, VA Central Office, Washington, DC.
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Areso-Bóveda PB, Mambrillas-Varela J, García-Gómez B, Moscosio-Cuevas JI, González-Lama J, Arnaiz-Rodríguez E, Del Barco MBA, Teodoro-Blanco PS. Effectiveness of a group intervention using pain neuroscience education and exercise in women with fibromyalgia: a pragmatic controlled study in primary care. BMC Musculoskelet Disord 2022; 23:323. [PMID: 35379222 PMCID: PMC8978762 DOI: 10.1186/s12891-022-05284-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Accepted: 03/29/2022] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Very positive effects have been described in the application of pain neuroscience education (PNE) to chronic pain and migraine. However, there are few data on the applicability of this therapeutic approach in actual clinical practice in a primary care (PC) setting. The aim of this study was to explore the efficacy in fibromyalgia (FM) of an intervention based on PNE and exercise compared to treatment as usual (TAU). METHODS Pragmatic nonrandomised controlled trial set in 5 healthcare centres and one physiotherapy centre in PC. Fifty-three women with FM (2010 American College of Rheumatology Diagnostic Criteria for Fibromyalgia) were studied, 35 in the intervention group (IG) and 18 in the control group (CG). The women in the IG were interviewed individually and then received 6 weekly sessions plus one review session (1 month later): those in the CG received their TAU. The subject assignation to the CG or the IG was determined according to their availability to attend the sessions. They all filled in several questionnaires (prior to and 1 year after the intervention) to evaluate the impact of FM in their daily lives, catastrophism, anxiety and depression, severity and impact of pain in daily personal performance and functional capacity. RESULTS The reductions (improvements) in the scores of all tests (baseline-final) were greater in the IG (p < 0.05) when adjusted for age and baseline values, with moderate or high effect size. After 1 year, 20% (CI - 1 to 42%) more women in the IG, compared to the CG, had a FIQ score < 39 (mild functional impairment). 17/38 (49%) women in the IG no longer met FM criteria at the end of follow-up. CONCLUSIONS An intervention based on PNE and exercise in patients with FM is feasible and seems effective in PC. TRIAL REGISTRATION The study was retrospectively registered at ClinicalTrials.gov (Trial Registration NCT04539171 ), on 04/09/2020.
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Affiliation(s)
- Paula B Areso-Bóveda
- Burgos Centre Physiotherapy Unit in Burgos Centre, GAP (Primary Care Management) Burgos (SACYL: Castille and Leon Health Service), C/ José María de la Puente 1, 09006, Burgos, Spain
| | - Julia Mambrillas-Varela
- Burgos Centre Physiotherapy Unit in Burgos Centre, GAP (Primary Care Management) Burgos (SACYL: Castille and Leon Health Service), C/ José María de la Puente 1, 09006, Burgos, Spain
| | - Bárbara García-Gómez
- López Sáiz Health Centre, GAP (Primary Care Management) Burgos (SACYL: Castille and Leon Health Service), C/ José María de la Puente 1, 09006, Burgos, Spain
| | - José Ignacio Moscosio-Cuevas
- Fuensanta Health Centre, Córdoba-Guadalquivir Primary Care District (SAS: Andalusian Health Service), C/ Núñez de Balboa 2, 14010, Córdoba, Spain.,Group-Program Communication and Health -GPCyS- (semFYC), c/ Diputació, 320 Bajo, 08009, Barcelona, Spain
| | - Jesús González-Lama
- Group-Program Communication and Health -GPCyS- (semFYC), c/ Diputació, 320 Bajo, 08009, Barcelona, Spain. .,Clinical Management Unit in Cabra, Matrona Antonia Mesa Fernández Health Centre, South Córdoba Health Management Area (SAS: Andalusian Health Service), Avda. Góngora s/n, 14940-Cabra, Córdoba, Spain. .,Prevention and Health Promotion Program -PAPPS- (semFYC), c/ Diputació, 320 Bajo, 08009, Barcelona, Spain. .,Clinical Epidemiology Research Group in Primary Care (GICEAP), Maimónides Biomedical Research Institute of Córdoba (IMIBIC), Reina Sofía University Hospital / University of Córdoba, Avda. Menéndez Pidal s/n, 14004, Córdoba, Spain.
| | - Eva Arnaiz-Rodríguez
- San Agustín Physiotherapy Unit, C/ Bonifacio Zamora de Usabel, 09001, Burgos, Spain
| | | | - Pilar San Teodoro-Blanco
- López Sáiz Health Centre, GAP (Primary Care Management) Burgos (SACYL: Castille and Leon Health Service), C/ José María de la Puente 1, 09006, Burgos, Spain.,Group-Program Communication and Health -GPCyS- (socalemFYC), C/ Veinte de Febrero 6, 47001, Valladolid, Spain.,Healthcare Ethics Committee in the Burgos University Hospital, Avda. de las Islas Baleares 3, 09006, Burgos, Spain
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Hennemann S, Witthöft M, Kleinstäuber M, Böhme K, Baumeister H, Ebert DD, Probst T. Somatosensory amplification moderates the efficacy of internet-delivered CBT for somatic symptom distress in emerging adults: Exploratory analysis of a randomized controlled trial. J Psychosom Res 2022; 155:110761. [PMID: 35182889 DOI: 10.1016/j.jpsychores.2022.110761] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 02/07/2022] [Accepted: 02/07/2022] [Indexed: 10/19/2022]
Abstract
OBJECTIVE While studies mainly provide positive evidence for the efficacy of internet-delivered cognitive-behavioral therapy (ICBT) for various persistent somatic symptoms, it remains largely unclear for whom these interventions work or not. This exploratory analysis aimed to identify moderators for the outcome between ICBT for somatic symptom distres and a waitlist control group (WL) in a vulnerable target group of emerging adults. METHODS Based on data from a randomized controlled trial on 156 university students with varying degrees of somatic symptom distress who were allocated to either an eight-week, therapist guided ICBT (iSOMA) or to the WL, we examined pretreatment demographic characteristics, health-related variables (e.g., somatic symptom duration), mental distress (e.g., depression, anxiety) and cognitive-emotional factors (emotional reactivity, somatosensory amplification) as candidate moderators of the outcome, somatic symptom distress (assessed by the Patient Health Questionnaire, PHQ-15) from pre- to posttreatment. RESULTS Somatosensory amplification (assessed by the Somatosensory Amplification Scale, SSAS) moderated the outcome in favor of iSOMA (B = -0.17, SE = 0.08, p = 0.031), i.e., higher pretreatment somatosensory amplification was associated with better outcome in the active compared to the control intervention. No significant moderation effects were found among demographic characteristics, health-related variables, or mental distress. CONCLUSION Our findings suggest that an internet-delivered CBT for somatic symptom distress should be preferred over no active treatment particularly in individuals with moderate to high levels of somatosensory amplification, which as a next step should be tested against further treatments and in clinical populations. TRIAL REGISTRATION German Clinical Trials Register (DRKS00014375).
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Affiliation(s)
- Severin Hennemann
- Johannes Gutenberg University Mainz, Department of Clinical Psychology, Psychotherapy and Experimental Psychopathology, Mainz, Germany.
| | - Michael Witthöft
- Johannes Gutenberg University Mainz, Department of Clinical Psychology, Psychotherapy and Experimental Psychopathology, Mainz, Germany
| | - Maria Kleinstäuber
- Utah State University, Emma Eccles Jones College of Education and Human Services, Department of Psychology, Logan (Utah), USA
| | - Katja Böhme
- Johannes Gutenberg University Mainz, Department of Clinical Psychology, Psychotherapy and Experimental Psychopathology, Mainz, Germany
| | - Harald Baumeister
- Ulm University, Department of Clinical Psychology and Psychotherapy, Ulm, Germany
| | - David Daniel Ebert
- Technical University of Munich, Department of Sport and Health Sciences, München, Germany
| | - Thomas Probst
- Danube University Krems, Department for Psychotherapy and Biopsychosocial Health, Krems, Austria
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