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Di-Bonaventura S, Ferrer-Peña R, Pardo-Montero J, Férnandez-Carnero J, La Touche R. Perceived benefits and limitations of a psychoeducation program for patients with fibromyalgia: an interpretative phenomenological analysis. Front Psychol 2024; 15:1422894. [PMID: 39205971 PMCID: PMC11350163 DOI: 10.3389/fpsyg.2024.1422894] [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: 04/24/2024] [Accepted: 07/17/2024] [Indexed: 09/04/2024] Open
Abstract
Objective To analyze the perceived benefits and limitations of a pain psychoeducation program as a non-pharmacological treatment for patients with fibromyalgia. Methods An interpretative phenomenological analysis was applied to analyze the subjective experiences of 11 patients with fibromyalgia who participated in a pain psychoeducation program. This program includes educational sessions that address pain understanding, coping strategies, and relaxation techniques. Semi-structured interviews were conducted, transcribed, and analyzed using ATLAS.ti software. Results Patients reported significant improvements in cognitive-functional capacity and socio-emotional ability, including better disease understanding and management, emotional stability, and interpersonal relationships. Despite these benefits, they identified limitations in program individualization and insufficient coverage of certain topics, such as sexual health and legal aspects of disability. Enhanced self-management skills were evident, with observed shifts in disease perception and coping strategies. Conclusion The psychoeducation program was viewed positively, influencing functional, cognitive, and emotional enhancements. Nonetheless, the need for increased program personalization and expanded socio-economic support was noted. Future research should focus on the long-term impacts of psychoeducation and the feasibility of tailored interventions.
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Affiliation(s)
- Silvia Di-Bonaventura
- Escuela Internacional de Doctorado, Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Rey Juan Carlos University, Alcorcón, Spain
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Rey Juan Carlos University, Alcorcón, Spain
- Cognitive Neuroscience, Pain and Rehabilitation Research Group (NECODOR), Faculty of Health Sciences, Rey Juan Carlos University, Madrid, Spain
- Clinico-Educational Research Group on Rehabilitation Sciences (INDOCLIN), CSEU La Salle, Universidad Autonóma de Madrid, Madrid, Spain
| | - Raúl Ferrer-Peña
- Cognitive Neuroscience, Pain and Rehabilitation Research Group (NECODOR), Faculty of Health Sciences, Rey Juan Carlos University, Madrid, Spain
- Clinico-Educational Research Group on Rehabilitation Sciences (INDOCLIN), CSEU La Salle, Universidad Autonóma de Madrid, Madrid, Spain
- Department of Physiotherapy, Faculty of Health Sciences, CSEU La Salle, Universidad Autonóma de Madrid, Madrid, Spain
- Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain
| | - Joaquín Pardo-Montero
- Department of Physiotherapy, Faculty of Health Sciences, CSEU La Salle, Universidad Autonóma de Madrid, Madrid, Spain
- Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain
- Motion in Brains Research Group, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, Spain
| | - Josué Férnandez-Carnero
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Rey Juan Carlos University, Alcorcón, Spain
- Cognitive Neuroscience, Pain and Rehabilitation Research Group (NECODOR), Faculty of Health Sciences, Rey Juan Carlos University, Madrid, Spain
- Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain
- Motion in Brains Research Group, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, Spain
- Musculoskeletal Pain and Motor Control Research Group, Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, Spain
| | - Roy La Touche
- Department of Physiotherapy, Faculty of Health Sciences, CSEU La Salle, Universidad Autonóma de Madrid, Madrid, Spain
- Motion in Brains Research Group, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, Spain
- Instituto de Dolor Craneofacial y Neuromusculoesquelético (INDCRAN), Madrid, Spain
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Salazar-Méndez J, Cuyul-Vásquez I, Ponce-Fuentes F, Guzmán-Muñoz E, Núñez-Cortés R, Huysmans E, Lluch-Girbés E, Viscay-Sanhueza N, Fuentes J. Pain neuroscience education for patients with chronic pain: A scoping review from teaching-learning strategies, educational level, and cultural perspective. PATIENT EDUCATION AND COUNSELING 2024; 123:108201. [PMID: 38387389 DOI: 10.1016/j.pec.2024.108201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 02/05/2024] [Accepted: 02/07/2024] [Indexed: 02/24/2024]
Abstract
OBJECTIVE (1) To identify the characteristics of PNE programs in terms of teaching-learning strategies, session modality, content delivery format, number of sessions, total minutes and instructional support material used in patients with chronic musculoskeletal pain, (2) to describe PNE adaptations for patients with different educational levels or cultural backgrounds, and (3) to describe the influence of the patient's educational level or cultural background on the effects of PNE. METHODS The PRISMA guideline for scoping reviews was followed. Nine databases were systematically searched up to July 8, 2023. Articles that examined clinical or psychosocial variables in adults with chronic musculoskeletal pain who received PNE were included. RESULTS Seventy-one articles were included. Studies found benefits of PNE through passive/active teaching-learning strategies with group/individual sessions. However, PNE programs presented great heterogeneity and adaptations to PNE were poorly reported. Most studies did not consider educational level and culture in the effects of PNE. CONCLUSIONS Despite the large number of studies on PNE and increased interest in this intervention, the educational level and culture are poorly reported in the studies. PRACTICAL IMPLICATIONS It is recommended to use passive and/or active teaching-learning strategies provided in individual and/or group formats considering the patient's educational level and culture.
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Affiliation(s)
| | - Iván Cuyul-Vásquez
- Departamento de Procesos Terapéuticos, Facultad de Ciencias de la Salud, Universidad Católica de Temuco, Chile; Facultad de las Ciencias de la Salud, Universidad Autónoma de Chile, Temuco, Chile
| | - Felipe Ponce-Fuentes
- Escuela de Kinesiología, Facultad de Medicina y Ciencias de la Salud, Universidad Mayor, Temuco, Chile
| | - Eduardo Guzmán-Muñoz
- Escuela de Kinesiología, Facultad de Salud, Universidad Santo Tomás, Chile; Escuela de Kinesiología, Facultad de Ciencias de la Salud, Universidad Autónoma de Chile, Talca, Chile
| | - Rodrigo Núñez-Cortés
- Physiotherapy in Motion Multispeciality Research Group (PTinMOTION), Department of Physiotherapy, University of Valencia, Valencia, Spain; Departament of Physical Therapy, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Eva Huysmans
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy,Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels 1090, Belgium; Department of Physical Medicine and Physiotherapy, University Hospital Brussels, Brussels 1090, Belgium; Research Foundation - Flanders (FWO), Brussels, Belgium
| | - Enrique Lluch-Girbés
- Physiotherapy in Motion Multispeciality Research Group (PTinMOTION), Department of Physiotherapy, University of Valencia, Valencia, Spain; Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy,Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels 1090, Belgium
| | | | - Jorge Fuentes
- Clinical Research Lab, Department of Physical Therapy, Catholic University of Maule, Chile; Faculty of Rehab Medicine, University of Alberta, Edmonton, Canada.
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Valenzuela B. Landau model for illustrating the learning and unlearning process of nociplastic pain. FRONTIERS IN PAIN RESEARCH 2024; 5:1307532. [PMID: 38444432 PMCID: PMC10913031 DOI: 10.3389/fpain.2024.1307532] [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: 10/25/2023] [Accepted: 01/30/2024] [Indexed: 03/07/2024] Open
Abstract
Recent advancements in understanding the consolidation of nociplastic pain point to a complex, non-conscious learned process of threat perception. Neurobiological pain education is emerging as a promising approach to unlearn nociplastic pain, supported by biopsychosocial tools such as exposure to movement, mindfulness, and group sharing formats. However, this approach is still not well-known among clinicians and the society at large, creating a communication problem that unfortunately perpetuates the suffering of patients. Herein, we propose a Landau model to describe the learning and unlearning process of nociplastic pain, aiming to clarify this complex situation and facilitate communication across different sectors of the society. Nociplastic pain corresponds to a first-order transition, with attention more likely in the alert-protection state than in the trust-explore state. Two appealing results of the model are that the perception of the critical context depends on personal history regarding the symptom and that biopsychosocial loops are formed when there is alarming learned historical information about the symptom, along with confused and contradictory expert information, as seen in nocebo messages. Learning and unlearning in the model correspond to a chang in control parametrs that can weigh more on the alert-protection state, trust-explore state, uncertain state or neutral state. This description clarifies why neurobiological education is the foundational therapy from which others must be built to embody the accessible, clear, and trustworthy information.
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Affiliation(s)
- Belén Valenzuela
- Department of Theory and Simulation of Materials, Instituto de Ciencia de Materiales de Madrid, ICMM-CSIC, Madrid, Spain
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Carmen SG, José LM, Adriana RS, Eugenia GG. A Pilot Randomized Controlled Trial of Effectiveness of a Psychoeducational Intervention on the Management of Musculoskeletal Chronic Noncancer Pain. Pain Manag Nurs 2023; 24:427-435. [PMID: 36944558 DOI: 10.1016/j.pmn.2023.01.007] [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: 04/24/2022] [Revised: 01/15/2023] [Accepted: 01/29/2023] [Indexed: 03/23/2023]
Abstract
AIMS To investigate the effectiveness of a psychoeducational intervention on pain intensity management in musculoskeletal chronic noncancer pain and to identify relevant variables and preliminary data to allow the design of a randomized controlled trial. DESIGN Two arms parallel randomized pilot study. SUBJECTS AND SETTING ADULT PATIENTS WITH MUSCULOSKELETAL CHRONIC NONCANCER PAIN WITH MODERATE-SEVERE INTENSITY TREATED AT PRIMARY HEALTH CENTERS. METHODS Participants were randomly assigned to a psychoeducational intervention or a control group without intervention. Pain intensity, quality of life, and opioid use were assessed at baseline and at a 1-month follow-up. RESULTS The sample consisted of 37 adult patients (intervention group: 19; control group: 18). A significant reduction in pain intensity measured by the Verbal Numerical Rating Scale (p = .02, Cohen's d = 0.57) and improvement in quality of life measured by EuroQol-5D questionnaire (p = .04) were observed in the intervention group compared to the control. This improvement on pain intensity was greater in patients without strong opioid treatment (p = .01, Cohen's d = 1.36). Eighty percent of the strong opioids users in the intervention group reduced their consumption, without changes in the control group. CONCLUSIONS These findings provide promising support for the beneficial effects of psychoeducation on the intensity of noncancer chronic musculoskeletal pain. Based on the results, future randomized controlled trials are needed.
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Affiliation(s)
- Sánchez-Gutiérrez Carmen
- Department of Anesthesiology and Pain Medicine, Virgen del Rocío Universitary Hospital, Seville, Spain; Department of Anesthesiology and Pain Medicine, San Juan de Dios del Aljarafe Hospital, Avda, San Juan de Dios S/N. Seville, Spain.
| | - López-Millán José
- Department of Anesthesiology and Pain Medicine, Virgen Macarena Universitary Hospital, Seville, Spain.
| | | | - Gil-García Eugenia
- Department of Nursing, School of Nursing, Physiotherapy and Podiatry, University of Seville, Seville, Spain.
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Cooper C, Green S, Hartstein A, Fergus A. The impact of pain neuroscience education in a Hispanic-American population: A mixed-methods exploratory study. Physiother Theory Pract 2022:1-14. [PMID: 35383528 DOI: 10.1080/09593985.2022.2060884] [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
BACKGROUND Chronic pain and pain catastrophization are growing problems across the United States, within the Hispanic-American population. Pain neuroscience education (PNE) changes pain knowledge and beliefs in many populations, but its impact on reconceptualization in people of Hispanic-American origin is unknown. PURPOSE Explore the changes in pain knowledge in Hispanic-American individuals and the process involved in reconceptualization following a PNE lecture. METHODS Eight Hispanic-American adults participated in a mixed-methods exploratory study. The Revised Neurophysiology of Pain Questionnaire (R-NPQ) was completed before, immediately after, and eight months after an adapted PNE lecture. A focus group involving four participants discussed the impact of PNE. Transcripts were translated and theme coded, and a concept map was developed by consensus. RESULTS R-NPQ scores improved from 25.3% to 43.5% post-lecture, and the number of unsure responses decreased from 41.5% to 18.4%. At eight months, R-NPQ scores remained stable (44.2%) but unsure responses increased (28.9%). Themes that contributed to the process of change included cognitive dissonance, relevance of instruction, idea exchange through peer interaction, reflection, confidence, changed behaviors, and educational utility. CONCLUSION While small improvements in knowledge and perception of pain appeared to occur with the PNE, knowledge remained low. Consideration of adult learning principles such as applicability, peer-interaction, the confrontation of beliefs, and reflection throughout PNE may enhance its impact. Future investigation should explore the efficacy of this intervention, when compared or combined with other techniques in the treatment of Hispanic-Americans experiencing persistent pain.
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Affiliation(s)
- Christine Cooper
- Division of Physical Therapy, Shenandoah University, Winchester, VA USA
| | - Savannah Green
- Division of Physical Therapy, Shenandoah University, Winchester, VA USA
| | - Aaron Hartstein
- Division of Physical Therapy, Shenandoah University, Winchester, VA USA
| | - Andrea Fergus
- Division of Physical Therapy, Shenandoah University, Winchester, VA USA
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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: 5] [Impact Index Per Article: 2.5] [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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7
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[Fibromyalgia: Adversity from the healthcare system]. Aten Primaria 2021; 54:102273. [PMID: 34929553 PMCID: PMC8693402 DOI: 10.1016/j.aprim.2021.102273] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 11/25/2021] [Indexed: 11/21/2022] Open
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Barrenengoa-Cuadra MJ, Muñoa-Capron-Manieux M, Fernández-Luco M, Angón-Puras LÁ, Romón-Gómez AJ, Azkuenaga M, Etxebarria A, Orrantia G, Pikaza A, Uribe-Etxebarria L, Zorrilla A, Larrinaga G, Arana-Arri E, Gracia-Ballarín R. Effectiveness of a structured group intervention based on pain neuroscience education for patients with fibromyalgia in primary care: A multicentre randomized open-label controlled trial. Eur J Pain 2021; 25:1137-1149. [PMID: 33512028 PMCID: PMC8247853 DOI: 10.1002/ejp.1738] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Accepted: 01/20/2021] [Indexed: 12/22/2022]
Abstract
Background There has been increased interest in pain neuroscience education (PNE) as a therapeutic approach for the management of fibromyalgia (FM). Methods A multicentre randomized, open‐label, controlled trial was conducted to assess the effectiveness of a structured group intervention based on PNE in patients with FM. A total of 139 patients were included in the study and randomized to the intervention group (7 group sessions of education in neurobiology of pain) or to the control group (treatment as usual only). The primary outcome was the improvement of functional status and pain measured with the Fibromyalgia Impact Questionnaire (FIQ), and secondary outcomes were the reduction in the impact of pain and other symptoms (catastrophizing, anxiety and depression) and number of patients reaching no worse than moderate functional impairment (FIQ score <39). Differences between groups were calculated by linear mixed‐effects (intention‐to‐treat approach) and mediational models through path analyses. Results At 1 year, improvements in FIQ scores were higher in the intervention group with moderate or high effect size, and decreases of ≥20% in 69.1% of patients (20.9% in the control group) and of ≥50% in 39.7% (4.5% in the control group). Also, 52.9% of patients had a FIQ <39 points (13.4% in the control group). Conclusions In this sample of patients with FM, the improvement in quality of life and control of symptoms obtained by adding a PNE intervention showed promising results, equalling or surpassing previously reported outcomes. Significance A structured group intervention based on pain neuroscience education for 1 year in patients with fibromyalgia was associated with significant amelioration of the impact of the disease on scores of the Fibromyalgia Impact Questionnaire, the Health Assessment Questionnaire, the Hospital Anxiety and Depression Scale, the Pain Catastrophizing Scale and the Polysymptomatic Distress Scale as compared with only treatment as usual. These findings are clinically relevant considering the challenges posed by fibromyalgia to clinicians and patients alike.
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Affiliation(s)
- María Jesús Barrenengoa-Cuadra
- Primary Health Care Center Sáenz de Buruaga, Osakidetza Basque Health Service, OSI Bilbao-Basurto, Bilbao, Spain.,Working Group on Fibromyalgia, Migraine and Chronic Pain, Osatzen Sociedad Vasca de Medicina Familiar y Comunitaria, Bilbao, Spain
| | - María Muñoa-Capron-Manieux
- Working Group on Fibromyalgia, Migraine and Chronic Pain, Osatzen Sociedad Vasca de Medicina Familiar y Comunitaria, Bilbao, Spain.,Working Group on Central Hypersensitivity and Generalized Pain, Biocruces Bizkaia Health Research Institute, Cruces University Hospital, Barakaldo, Spain.,Primary Health Care Center Alango, Osakidetza Basque Health Service, OSI Uribe, Getxo, Spain.,Department of Medicine, Faculty of Medicine and Nursing, University of the Basque Country (UPV/EHU), Leioa, Spain
| | - Marian Fernández-Luco
- Working Group on Fibromyalgia, Migraine and Chronic Pain, Osatzen Sociedad Vasca de Medicina Familiar y Comunitaria, Bilbao, Spain.,Working Group on Central Hypersensitivity and Generalized Pain, Biocruces Bizkaia Health Research Institute, Cruces University Hospital, Barakaldo, Spain.,Primary Health Care Center Begoña, Osakidetza Basque Health Service, OSI Bilbao-Basurto, Bilbao, Spain
| | - Luis Ángel Angón-Puras
- Working Group on Fibromyalgia, Migraine and Chronic Pain, Osatzen Sociedad Vasca de Medicina Familiar y Comunitaria, Bilbao, Spain.,Primary Health Care Center Areeta, Osakidetza Basque Health Service, Getxo, Spain
| | - Ana J Romón-Gómez
- Working Group on Fibromyalgia, Migraine and Chronic Pain, Osatzen Sociedad Vasca de Medicina Familiar y Comunitaria, Bilbao, Spain.,Pedagogía Terapéutica, Bilbao, Spain
| | - Maider Azkuenaga
- Working Group on Fibromyalgia, Migraine and Chronic Pain, Osatzen Sociedad Vasca de Medicina Familiar y Comunitaria, Bilbao, Spain.,Department of Physical Therapy, Osakidetza Basque Health Service, OSI, Bilbao-Basurto, Spain
| | - Amaia Etxebarria
- Working Group on Fibromyalgia, Migraine and Chronic Pain, Osatzen Sociedad Vasca de Medicina Familiar y Comunitaria, Bilbao, Spain.,Department of Physical Therapy, Osakidetza Basque Health Service, OSI, Bilbao-Basurto, Spain
| | - Gixane Orrantia
- Working Group on Fibromyalgia, Migraine and Chronic Pain, Osatzen Sociedad Vasca de Medicina Familiar y Comunitaria, Bilbao, Spain.,Department of Physical Therapy, Osakidetza Basque Health Service, OSI Barrualde, Amurrio, Spain
| | - Ainhoa Pikaza
- Working Group on Fibromyalgia, Migraine and Chronic Pain, Osatzen Sociedad Vasca de Medicina Familiar y Comunitaria, Bilbao, Spain.,Primary Health Care Center Begoña, Osakidetza Basque Health Service, OSI Bilbao-Basurto, Bilbao, Spain
| | - Lourdes Uribe-Etxebarria
- Working Group on Fibromyalgia, Migraine and Chronic Pain, Osatzen Sociedad Vasca de Medicina Familiar y Comunitaria, Bilbao, Spain.,Primary Health Care Center Bidezabal, Osakidetza Basque Health Service, Getxo, Spain
| | - Ana Zorrilla
- Working Group on Fibromyalgia, Migraine and Chronic Pain, Osatzen Sociedad Vasca de Medicina Familiar y Comunitaria, Bilbao, Spain.,Primary Health Care Center Alango, Osakidetza Basque Health Service, OSI Uribe, Getxo, Spain.,Department of Medicine, Faculty of Medicine and Nursing, University of the Basque Country (UPV/EHU), Leioa, Spain
| | - Gorka Larrinaga
- Department of Nursing, Faculty of Medicine and Nursing, University of the Basque Country (UPV/EHU), Leioa, Spain
| | - Eunate Arana-Arri
- Biocruces Bizkaia Health Research Institute, Cruces University Hospital, Barakaldo, Spain
| | - Rafael Gracia-Ballarín
- Working Group on Fibromyalgia, Migraine and Chronic Pain, Osatzen Sociedad Vasca de Medicina Familiar y Comunitaria, Bilbao, Spain.,Primary Health Care Center Amurrio, Osakidetza Basque Health Service, OSI Barrualde, Amurrio, Spain
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