Struggling With Adversities of Life: The Role of Forgiveness in Patients Suffering from Fibromyalgia

Sexuality in Women with Fibromyalgia Syndrome: A Metasynthesis of Qualitative Studies

Fibromyalgia syndrome (FMS) is a nonarticular rheumatic syndrome which presents as chronic musculoskeletal pain, stiffness and body aches. FMS affects approximately 2.5% of the population, mostly women. FMS causes physical and psychological problems and reduces quality of life. The objective of this study is to identify qualitative evidence about experiences of women diagnosed with FMS about their sexuality.

METHODS

Metasynthesis of qualitative studies. The search included articles published between 2000 and June 2023 on the PubMed, WOS, CINAHL, SCOPUS, and SCIELO databases.

RESULTS

450 articles were found through the initial search, of which, only nine fulfilled the criteria and were included in the thematic synthesis. From this analysis, three main themes emerged: (1) "I want to, but I can't": FMS causes a shift in feminine sexuality. (2) Resetting sex life and intimacy. (3) Taking charge of a "new sexuality."

CONCLUSIONS

Women with FMS suffer from limitations of their sexuality that affect their partner. Pain, stiffness and a loss of desire make sexual encounters difficult. Becoming aware of this and striving not to lose their sexuality is key to coping with this problem. Women and their sexual partners can change roles and encourage communication, games, foreplay or touching. The use of lubricants, physical exercise and complementary therapies, along with social, professional and partner support, are key to coping with FMS.

Patients' Lived Experience in a Multicomponent Intervention for Fibromyalgia Syndrome in Primary Care: A Qualitative Interview Study

Fibromyalgia syndrome (FMS) disrupts patients' biopsychosocial spheres. A multicomponent intervention (MCI) program, which combined health education, cognitive behavioral therapy, and physical activity, was conducted in South Catalonia's primary care centers with the aim of improving symptom self-management and quality of life. A qualitative interview study was carried out to understand patients' lived experiences during the intervention program. Sampled purposively, 10 patients were interviewed via phone calls and face-to-face. The encounters were audio-recorded, verbatim transcribed, and analyzed through thematic analysis. As a result, four themes emerged: legitimizing fibromyalgia through the MCI, the MCI as a socializing experience, learning how to live with FMS through the MCI, and room for improving the MCI. Participants agreed on the program being an insightful experience that promoted illness knowledge and acceptance and that improved their coping skills and symptom self-management. The inclusion of additional psychological guidance, expressive psychological group therapy, and providing relatives with information were proposed for enhancing the program. Our findings have contributed to gaining insight into the subjective impact of the MCI and identifying new therapeutic targets to tailor the program to patients' needs, which will hopefully increase its effectiveness and improve their quality of life.

Does Religiosity/Spirituality Play a Role in Function, Pain-Related Beliefs, and Coping in Patients with Chronic Pain? A Systematic Review

This systematic review examined the extent to which measures of religiosity/spirituality (R/S): (1) are associated with pain, function, pain-related beliefs (beliefs), coping responses, and catastrophizing in people with chronic pain; and (2) moderate the association between beliefs, coping and catastrophizing, and pain and function. Experimental and observational studies examining at least one of these research questions in adults with chronic pain were eligible. Two reviewers independently performed eligibility screening, data extraction, and quality assessment. Twenty studies were included. Most studies focused on the association between R/S and pain or function. When significant associations emerged, those between R/S and psychological function were weak to strong and positive; those between religious/spiritual well-being and pain and physical dysfunction were negative, but weak. Few studies examined the associations between R/S and beliefs/coping/catastrophizing; none examined the moderation role of R/S. The findings suggest that R/S is associated with pain and psychological function in people with chronic pain, and that viewing oneself as being "spiritual," regardless of religion, may contribute to positive psychological adjustment. More research is needed to determine the reliability of this finding. PROSPERO registry CRD42018088803.

The Link between Fibromyalgia Syndrome and Anger: A Systematic Review Revealing Research Gaps

Anger has been associated with increased pain perception, but its specific connection with Fibromyalgia Syndrome (FMS) has not yet been established in an integrated approach. Therefore, the present systematic review focuses on exploring this connection, and based on this connection, delimiting possible gaps in the research, altogether aimed at improving FMS clinical intervention and guiding future research lines. Anger is considered a basic negative emotion that can be divided into two dimensions: anger-in (the tendency to repress anger when it is experienced) and anger-out (the leaning to express anger through verbal or physical means). The current systematic review was performed based on the guidelines of the PRISMA and Cochrane Collaborations. The Prospective Register of Systematic Reviews (PROSPERO) international database was forehand used to register the review protocol. The quality of chosen articles was assessed and the main limitations and research gaps resulting from each scientific article were discussed. The search included PubMed, Scopus, and Web of Science databases. The literature search identified 13 studies eligible for the systematic review. Levels of anger-in have been shown to be higher in FMS patients compared to healthy participants, as well as patients suffering from other pain conditions (e.g., rheumatoid arthritis). FMS patients had also showed higher levels of state and trait anxiety, worry and angry rumination than other chronic pain patients. Anger seems to amplify pain especially in women regardless FMS condition but with a particularly greater health-related quality of life´s impact in FMS patients. In spite of the relevance of emotions in the treatment of chronic pain, including FMS, only two studies have proposed intervention programs focus on anger treatment. These two studies have observed a positive reduction in anger levels through mindfulness and a strength training program. In conclusion, anger might be a meaningful therapeutic target in the attenuation of pain sensitivity, and the improvement of the general treatment effects and health-related quality of life in FMS patients. More intervention programs directed to reduce anger and contribute to improve well-being in FMS patients are needed.

Cognitive behavioral therapy with and without biofeedback in fibromyalgia: Assessment of functional and clinical change

The study compared the effectiveness of Cognitive Behavioral Therapy (CBT) with biofeedback or with emotional expression in individuals with fibromyalgia, and a waiting list control group. 88 women participated in a naturalistic study with random assignment. The Fibromyalgia Impact Questionnaire, SCL-90R, and a visual analog quality of life scale were used. Both intervention groups improved, but differed in physical and emotional control response. Using the reliable change index procedure, clinical improvement occurred in 18.8% of participants, and 4.8% achieved scores comparable with clinical recovery. Greater specificity on therapeutic objectives is warranted.

Positive Psychological Factors and Impairment in Rheumatic and Musculoskeletal Disease: Do Psychopathology and Sleep Quality Explain the Linkage?

OBJECTIVE

Little is known about potential mechanisms of action linking protective positive psychological variables and functional disability in patients with rheumatic and musculoskeletal disease. The present study was undertaken to examine symptoms of psychopathology, including stress, depression, anxiety, and sleep quality, as serial mediators of the association between gratitude, self-compassion, self-forgiveness, and functional impairment.

METHODS

We assessed risk and protective factors for functional disability in patients with fibromyalgia (FM), osteoarthritis (OA), rheumatoid arthritis (RA), and ankylosing spondylitis (AS) who were recruited from an Austrian health care facility. Respondents completed online surveys, including the Gratitude Questionnaire 6-item form, the Self-Compassion Scale short form, the Self-Forgiveness and Forgiveness of Others Index, the Perceived Stress Scale 4, the Patient Health Questionnaire 2, the 2-item Generalized Anxiety Disorder Scale, the Sleep Condition Indicator, and the Health Assessment Questionnaire. Bivariate and serial mediation analyses were conducted.

RESULTS

For our sample of 1,218 patients (52% female, n = 632; AS [37%], OA [34%], RA [14%], and FM [24%]), stress, depression, and anxiety, in parallel as first-order mediators, and sleep quality as a second-order mediator, explained the association between positive psychological variables and functional disability.

CONCLUSION

Positive psychological factors exert a beneficial downstream effect on mental well-being, sleep health, and health-related functional impairment. Therapeutic promotion of gratitude, self-compassion, and self-forgiveness may improve mental and physical health in patients with rheumatic and musculoskeletal disease.

Forgiveness and chronic pain: a systematic review

BACKGROUND

Forgiveness is becoming increasingly recognized for its role in healthcare, having shown promising effects in patients suffering myriad diseases, from coronary artery disease to HIV to breast cancer.

AIMS

To review the current literature examining forgiveness and its relationship specifically to chronic pain.

METHOD

In July 2019, a search was carried out of electronic databases (Academic Search Complete, AMED, Biomedical Reference Collection, General Science, Medline, PsycArticles, PsycInfo, Social Sciences Full Text and SPORTDiscus). Further results were obtained from reference lists. Inclusion and exclusion criteria were applied using PRISMA guidelines for systematic reviews.

RESULTS

The initial search yielded 354 results, and after duplicates were removed and inclusion and exclusion criteria applied, the final result was seven papers to be reviewed. Of the seven papers reviewed, five showed a relationship between lower levels of forgiveness and either increased experience or decreased tolerance for pain. One paper showed higher levels of empathy improving pain levels and suggests that forgiveness could enhance this experience of empathy. One study resulted in a higher level of pain among patients with higher forgiveness scores, although it was qualified that this particular patient population had a higher attachment anxiety, which may have impeded their ability to utilize forgiveness therapy.

CONCLUSIONS

There is an association between the capacity to forgive and the experience of chronic pain. Further research should examine forgiveness as an intervention in a population of chronic pain patients to explore this relationship further.

Forgiveness and late life functioning: the mediating role of finding ego-integrity

OBJECTIVES

This study seeks (1) to replicate previous findings on the mediating effect of integrity/despair in the relation between forgiveness and depression in an elderly population and (2) to extend these findings to other aspects of functioning, namely life satisfaction and subjective health. Both aims were studied in a sample of residential elderly.

METHODS

Residential elderly (n = 329, M = 87 years) filled out questionnaires on forgivingness, depressive symptoms, life satisfaction, subjective health and the developmental task of integrity/despair. Structural equation modeling was used to test the mediational role of integrity-despair in the relation between forgivingness and the aspects of functioning. Direct and indirect effects are tested.

RESULTS

The results confirmed earlier findings stating that forgivingness and depression are negatively associated in residential elderly and that the developmental task of finding integrity and avoiding despair is significant mediator in this relationship. A similar pattern of mediational associations was found for life satisfaction. However, for subjective health only a direct effect between forgiveness and subjective health was found, whereas the developmental task of integrity and despair did not function as an underlying mechanism.

DISCUSSION

Framed within a life span perspective, we showed that the developmental task of finding a balance between integrity and despair is an important intrapersonal mechanism through which forgivingness is related with depressed feelings and life satisfaction for residential elderly. A different mechanism might explain the direct effect between forgiveness and subjective health.

Moderating Effects of Forgiveness on Relationship Between Empathy and Health-Related Quality of Life in Hemodialysis Patients: A Structural Equation Modeling Approach

CONTEXT

Health-related quality of life (QOL) is a recommended clinical tool to assess hemodialysis patients and a primary end point to observe the effectiveness of overall disease management. Empathy is associated with positive outcomes such as pain relief and reduced anxiety and distress. Numerous studies have tested the relationships among empathy, forgiveness, and QOL; however, a mechanism of forgiveness has not been fully explored in hemodialysis patients.

OBJECTIVES

To test the relationship among empathy and health-related QOL and confirm the moderating effects of forgiveness on relationship between empathy and health-related QOL among hemodialysis patients.

METHODS

In a descriptive cross-sectional study conducted from September to December 2017, 457 hemodialysis patients from five hospitals filled out the Heartland Forgiveness Scale, Interpersonal Reactivity Index-C, Kidney Disease Questionnaire, and general information. The data were analyzed using SPSS, and structural equation modeling was used to address the relationships among empathy, forgiveness, and health-related QOL.

RESULTS

Empathy was significantly positively associated with health-related QOL. The proposed model had a good fit to the data. Forgiveness was found to play a partial mediating role between empathy and health-related QOL.

CONCLUSION

The results imply that empathy significantly directly and indirectly influences health-related QOL. Empathy among hemodialysis patients should be monitored and effectively managed to improve positive effects on their health-related QOL. Nurses should consider implementing empathy interventions with an emphasis on building forgiveness strategies to help hemodialysis patients improve their health-related QOL.