Test of a nursing intervention to promote adjustment to fibromyalgia

Fibromyalgia--management of a misunderstood disorder

PURPOSE

The purpose of this article is to review (a) what is currently known about the pathophysiology of fibromyalgia (FM), (b) how to identify patients who are susceptible to this disorder, and (c) the recommended pharmacological and nonpharmacological treatment options.

DATA SOURCES

Data sources include reviews and original research from scholarly journals and Internet sites.

CONCLUSIONS

There are approximately 6 million individuals in the United States diagnosed with FM, making it the third most prevalent rheumatologic disorder in this country. Failure to identify a specific causal mechanism for FM has resulted in a shift in the focus of research from etiology to treatment (Baumstark & Buckelew, 2002). Based on the literature, the most successful interventions for reduction of chronic symptoms in the FM patient is a combination of education, psychological assistance, and exercise, along with medications. It is essential that nurse practitioners (NPs) understand the issues and concerns of patients afflicted with this complex disorder. Although the organic etiology of FM syndrome remains unclear, the goals of treatment are to control pain and improve adjustment, well-being, and daily functioning of these patients to the maximum extent possible.

IMPLICATIONS FOR PRACTICE

NPs are in a unique position to help identify patients who may be suffering from FM or those diagnosed with FM reporting inadequate relief of symptoms. The incomplete understanding of the biological underpinnings, as well as the multiple symptoms that characterize FM syndrome, make it a challenging disorder to diagnose and treat. It takes time and patience to care for FM patients, and there are no "quick fixes." Diagnosis is made by a combination of patient history, physical examination, laboratory evaluations, and exclusion of other causes of symptoms confused with FM. Understanding the symptomology and recommended treatments will allow NPs to give appropriate care that may include making referrals for multidisciplinary treatment of these complex patients.

Developing an intervention to alter catastrophizing in persons with fibromyalgia

PURPOSE

The purpose of this pilot study was to develop and evaluate a brief psychoeducational intervention to decrease pain catastrophizing, a focus on pain and its negative consequences in patients with fibromyalgia.

DESIGN

A case-study design was used to design the targeted intervention. The intervention was piloted with 2 small groups of patients and family members.

SAMPLE

Thirty-nine patients with fibromyalgia completed the surveys; patients/family members (N = 9) and ten interdisciplinary staff members participated in separate focus groups or e-mail surveys to provide data to develop the intervention. Two additional groups of patients and family members (N = 7) participated in the pilot intervention sessions.

FINDINGS

Catastrophic thinking and associated declines in function were confirmed by survey results and focus group themes. A 2-hour session using self-efficacy theory was developed from these findings and other data sources. The patients/family members in pilot groups reported an increased knowledge of pain catastrophizing and satisfaction with the intervention.

IMPLICATIONS FOR NURSING PRACTICE

A brief, psychoeducational offering that targets the reduction of catastrophizing is a feasible addition to the usual treatment protocol in a fibromyalgia treatment program and warrants further study.

Effects of T'ai Chi exercise on fibromyalgia symptoms and health-related quality of life

BACKGROUND

Fibromyalgia (FM), one of the most common musculoskeletal disorders, is associated with high levels of impaired health and inadequate or limited symptom relief. The cause of this complex syndrome is unknown, and there is no known cure. Numerous research results indicate that a combination of physical exercise and mind-body therapy is effective in symptom management. T'ai Chi, an ancient Chinese exercise, combines physical exercise with mindbody therapy.

PURPOSE

To investigate the effects of T'ai Chi exercise on FM symptoms and health-related quality of life.

DESIGN

Pilot study, one group pre-to-post posttest design.

METHODS

Participants with FM (n = 39) formed a single group for 6 weeks of 1-hour, twice weekly T'ai Chi exercise classes. FM symptoms and health-related quality of life were measured before and after exercise.

FINDINGS

Twenty-one participants completed at least 10 of the 12 exercise sessions. Although the dropout rate was higher than expected, measurements on both the Fibromyalgia Impact Questionnaire (FIQ) (Buckhardt, Clark, & Bennett, 1991) and the Short Form-36 (SE-36) (Ware & Sherbourne, 1992) revealed statistically significant improvement in symptom management and health-related quality of life.

IMPLICATIONS FOR NURSING RESEARCH

Knowledge of interventions to enhance health for the patient with musculoskeletal problems is a National Association of Orthopaedic Nurses priority. Tai Chi is potentially beneficial to patients with FM. Further research is needed to support evidence-based practice.