e-Health Interventions Targeting Pain-Related Psychological Variables in Fibromyalgia: A Systematic Review

Digital approaches to chronic pain: A brief meta-review of eHealth interventions - Current evidence and future directions

Digital approaches to chronic pain are emerging worldwide and rapidly gaining increased empirical support. This brief meta-review aims at providing a comprehensive overview of evidence and recommendations reported in recent reviews (2023-2024) on eHealth interventions for chronic pain promoting self-management. A systematic search provided 2041 records, of which 225 reviews were screened and 20 were synthesized. Existing reviews show that eHealth interventions for chronic pain are beneficial for patients, healthcare professionals, and society at large. However, long-term effects, change mechanisms, cost-effectiveness, and real-world utility are understudied. Moreover, quality, safety, relevance, and sustainable use are key targets for future research. Future researchers should utilize existing implementation frameworks and make explicit efforts to include diverse patient populations to advance digital approaches to chronic pain.

Evolution of the Quality of Life of Long-Term Fibromyalgia Users of Millimeter Wave-Based Neuromodulation: A Real-World Retrospective Study

Purpose

Fibromyalgia (FM) is a widespread pain condition, associated with other symptoms such as fatigue, sleep disorders, stiffness, and mood disturbances. It significantly impacts patients' quality of life (QoL) and poses a substantial challenge due to the lack of a definitive cure. This study aimed to report real-world data on the long-term use (18 months) of a millimeter (MMW)-based neuromodulation device and tracking application, and its effects on various health dimensions in a self-declared FM population.

Methods

This retrospective study was based on data including daily MMW wristband use and health parameters assessed at baseline (D0) and tracked weekly (pain, stiffness and fatigue) or quarterly (QoL, quality of sleep and impression of change). The primary inclusion criteria were a self-reported diagnosis of FM and consistent device usage for a minimum of 18 months.

Results

The inclusion criteria were met by 185 users. There was a reduction in the Fibromyalgia Impact Questionnaire (FIQ) scores, with an average reduction of 27% after the first three months (M3), indicating improved QoL, and stabilization thereafter. Similar improvements were observed in sleep quality, stiffness and fatigue. In contrast, pain intensity showed a continuous decline throughout the 18-month period.

Conclusion

The significant improvements in QoL, pain intensity, and sleep quality, maintained over time, underline the MMW device's ability to provide sustained relief and enhance daily lives of people with FM.

Targeting Daily Positive Events to Improve Emotional and Functional Well-Being in Adults With Fibromyalgia: Insights From the LARKSPUR Randomized Controlled Trial

BACKGROUND

Fibromyalgia is a chronic pain condition characterized by widespread musculoskeletal pain, fatigue, and cognitive difficulties, affecting individuals across all age groups. Positive affect (PA) interventions have shown promise in enhancing emotional well-being and pain management in patients with diverse chronic pain conditions. However, the efficacy of internet-delivered PA interventions for individuals with fibromyalgia remains understudied.

OBJECTIVE

This randomized controlled trial investigated the efficacy of a web-based PA regulation intervention-Lessons in Affect Regulation to Keep Stress and Pain Under Control (LARKSPUR)-in enhancing emotional and functional well-being among adults with fibromyalgia syndrome.

METHODS

A total of 95 participants with fibromyalgia syndrome aged 50 years and older (89/95, 94% female) were randomized to one of two fully automated conditions: (1) LARKSPUR (n=49) or (2) emotion reporting/attention control (n=46). At the postintervention and 1-month follow-up time points, participants completed 7 consecutive, end-of-day, web-based reports capturing positive events (PE), pain, fatigue, PA, and negative affect.

RESULTS

Compared to control, LARKSPUR resulted in greater improvements in daily affective responsivity to PE at the postintervention time point, including greater reductions in negative affect (bL-bC=-0.06, 95% highest posterior density interval [HPD] -0.10 to -0.02) and increases in PA (bL-bC=0.10, 95% HPD 0.02-0.19). Furthermore, across the postintervention and 1-month follow-up time points, LARKSPUR led to greater reductions in pain (bL-bC=-0.20, 95% HPD -0.36 to -0.04) and fatigue (bL-bC=-0.24, 95% HPD -0.41 to -0.06) following PE.

CONCLUSIONS

This randomized controlled trial provides initial evidence that a web-based PA skills intervention can enhance emotional well-being and reduce pain and fatigue in aging adults with fibromyalgia.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04869345; https://clinicaltrials.gov/study/NCT04869345.

Chronic pain management in fibromyalgia: the INTEGRO (INTEGRated Psychotherapeutic InterventiOn) protocol and its application on two case studies

Objectives

To present an innovative integrated manualized psychotherapeutic intervention for fibromyalgia (FM) based on cognitive and behavioral therapy, acceptance and commitment therapy, and somatic experiential techniques (namely the INTEGRated Psychotherapeutic InterventiOn, INTEGRO) and illustrate its application on two case studies.

Methods

INTEGRO is composed of 12 individual sessions. The main objectives of the intervention were psychoeducation of chronic pain mechanisms, understanding the role of cognitive and emotional variables in one's pain perception, teaching patient-tailored skills to increase pain awareness and its management, and learning how to live with pain experience. A 57-year-old woman (patient A) and a 26-year-old woman (patient B) with FM have been selected to describe their care pathways connected to the INTEGRO protocol. Data related to assessment variables and clinical processes have been reported, focusing on the mechanisms that contribute to the maintenance (i.e., avoidance or overcompensation) of chronic pain in FM, on the role of patients' naïf theories, and on the implications that all these aspects may have on the burden related to pain management.

Results

Both patients showed a reduction in FM burden and an increase in self-efficacy in pain management: patient A reported an improvement in emotional regulation ability; patient B showed a decrease in pain interference in work activities and on emotional dimension.

Conclusion

Examining each phase of the clinical protocol through the lens of its clinical application, the paper provides insights into the relationship among crucial psychosocial mechanisms, pain perception, management in FM treatment, and how all these aspects have been dealt with during psychotherapeutic treatment.

Effectiveness of Digital Health Interventions (DHI) in Chronic Pain Management: A Scoping Review of Current Evidence and Emerging Trends

This review aims to address the impact of digital health interventions (DHIs) on chronic pain management, specifically, mHealth, eHealth, wearable devices, virtual reality (VR), and artificial intelligence. The following study identifies and assesses DHIs' efficacy in specific chronic pain conditions and then extrapolates improved outcomes and patient groups that benefit from their use. Using a systematic methodology, this review synthesizes findings that could improve knowledge for patients and practitioners in chronic pain management while also addressing gaps in understanding the impact of DHIs. Sub-questions guide the identification of gaps and recommendations assessing DHIs' effectiveness for pain reduction and improved quality of life. A systematic search across databases (EMBASE, Ovid MEDLINE, CINAHL, Web of Sciences, Cochrane Central) targets original, English-language, peer-reviewed studies (2013-2023). The inclusion criteria cover DHIs in chronic pain management for adults age 18+, excluding non-full texts, reviews, opinion pieces, or unrelated articles. Search terms include "chronic pain management" OR "long-term pain relief strategies" OR "sustained pain alleviation" OR "pain control for chronic conditions" OR "chronic pain" AND "ehealth interventions" OR "mobile health interventions" OR "digital therapy" OR "health informatic solutions" OR "digital health intervention." After applying inclusion criteria, 34 articles from 11 countries are included, with studies conducted primarily in the United States (n = 17), United Kingdom (n = 4), and Australia (n = 3). DHIs are emerging as effective tools in pain management, as they can emphasize patient autonomy and communication with clinicians while enabling medical self-management in diverse populations. These various digital interventions show promise in reducing pharmaceutical usage and deferring surgical procedures, with most studies reporting positive outcomes in pain reduction. DHIs were also associated with positive mental health outcomes; however, some studies found no significant improvement. Additionally, interventions targeting pain catastrophizing showed varied results, with some app-based approaches demonstrating promise. Overall, the review underscores the potential of DHIs in improving chronic pain management outcomes.

Virtual Reality Rehabilitation and Artificial Intelligence in Healthcare Technology

The benefit of virtual rehabilitation is that it helps the patient increase their engagement and motivation. Another advantage is that it allows patient specific. A third utility is that the therapist can make the sessions more efficient and productive. A feature of virtual reality (VR) rehabilitation is that it is possible to create virtual environments which are more realistic than those in a video game and in which the patients can perform exercises. As a result, the patients are more immersed and motivated to avoid the boredom from which patients in standard therapy usually suffer. The features of artificial intelligence (AI) in biomedicine are the optimisation of diagnostics, treatment, and patient monitoring. AI allows for the analysis to have the potential to detect subtle deviations. In this chapter, the application of virtual reality and artificial intelligence in healthcare was discussed.

eHealth-Integrated Psychosocial and Physical Interventions for Chronic Pain in Older Adults: Scoping Review

BACKGROUND

Chronic noncancer pain (CNCP) is highly present among older adults, affecting their physical, psychological, and social functioning. A biopsychosocial multimodal approach to CNCP management is currently extensively suggested by international clinical practice guidelines. Recently, the growing development and application of eHealth within pain management has yielded encouraging results in terms of effectiveness and feasibility; however, its use among the older population remains underexamined.

OBJECTIVE

The overall aim of this scoping review was to systematically map existing literature about eHealth multimodal interventions (including both physical and psychosocial components) targeting older adults with CNCP.

METHODS

This review adhered to the JBI methodology, a protocol was a priori registered as a preprint on the medRxiv platform, and the results were reported according to the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. Four electronic databases (PubMed, Cochrane Central Register of Controlled Trials, Web of Science, and PsycINFO) were systematically searched for relevant articles. Studies were included if they reported on multimodal interventions (including both physical and psychosocial components) delivered through any eHealth modality to an older population with any type of CNCP. Two reviewers selected the studies: first by screening titles and abstracts and second by screening full-text articles. The quality of the included studies was evaluated using the Quality Assessment Tool for Studies with Diverse Designs. The results of the studies were summarized narratively.

RESULTS

A total of 9 studies (n=6, 67% published between 2021 and 2023) with quality rated as medium to high were included, of which 7 (78%) were randomized controlled trials (n=5, 71% were pilot and feasibility studies). All the included studies evaluated self-management interventions, most of them (n=7, 78%) specifically designed for older adults. The participants were aged between 65 and 75 years on average (mean 68.5, SD 3.5 y) and had been diagnosed with different types of CNCP (eg, osteoarthritis and chronic low back pain). Most of the included studies (5/9, 56%) involved the use of multiple eHealth modalities, with a higher use of web-based programs and video consulting. Only 1 (11%) of the 9 studies involved a virtual reality-based intervention. The evaluated interventions showed signs of effectiveness in the targeted biopsychosocial outcomes, and the participants' engagement and ratings of satisfaction were generally positive. However, several research gaps were identified and discussed.

CONCLUSIONS

Overall, of late, there has been a growing interest in the potential that eHealth multimodal interventions offer in terms of improving pain, physical, and psychosocial outcomes in older adults with CNCP. However, existing literature on this topic still seems scarce and highly heterogeneous, with few proper randomized controlled trials, precluding robust conclusions. Several gaps emerged in terms of the older population considered and the lack of evaluation of comorbidities.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.1101/2023.07.27.23293235.

Fibromyalgia interventions, obstacles and prospects: narrative review

This review aims to increase awareness and improve understanding, diagnosis, and management of fibromyalgia - a complex, distressing health challenge that significantly impacts people's lives due to its variable nature and lack of clear diagnostic markers. Healthcare professionals must assist those with this condition and improve their general quality of life. Further, they can do a lot to improve the lives of people with Fibromyalgia by resolving diagnostic hurdles, promoting collaboration, supporting patient advocacy, advancing medical technology, and adopting novel approaches.