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An J, Fan W, Mittal A, Zhang Y, Chen AT. Mobile App Use among Persons with Fibromyalgia: A Cross-sectional Survey. THE JOURNAL OF PAIN 2024; 25:104515. [PMID: 38522593 DOI: 10.1016/j.jpain.2024.03.011] [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: 11/27/2023] [Revised: 03/12/2024] [Accepted: 03/18/2024] [Indexed: 03/26/2024]
Abstract
Persons with fibromyalgia experience a diverse set of symptoms. Recommendations for management generally focus on multidisciplinary approaches involving multiple modalities. Mobile apps can be an essential component for self-management, yet little is known about how persons with fibromyalgia use mobile apps for health-related purposes. A cross-sectional survey (N = 663) was conducted to understand the real-world use of apps among persons with fibromyalgia. The survey included 2 main foci: 1) eHealth literacy and use of information sources, and 2) mobile app use patterns and preferences for health-related purposes, including the types of apps used and usage characteristics of apps currently in use, as well as those that had been discontinued. Respondents' average eHealth literacy as measured by eHealth Literacy Scale (eHEALS) was 31.4 (SD = 7.1), and they utilized diverse information sources. Approximately two-thirds of the sample used mobile apps; the remaining one-third did not. Diverse health management needs were represented in the apps reported, including scheduling/time management, notetaking, fitness, and wellness. Compared to apps that had been discontinued, participants rated apps that they still used higher in terms of ease of use and used them more frequently. Reasons for discontinuing app use included issues with privacy, the effort required, lack of interest, and lack of perceived quality. Other reasons for app nonuse were lack of awareness and how-to knowledge, indicating that disseminating information about apps and addressing other barriers, such as providing user support, are critical to increasing uptake. These study findings can inform both app design and dissemination. PERSPECTIVE: This article presents how persons with fibromyalgia use mobile apps to manage their health. The findings could inform the development of digital interventions or programs for this population.
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Affiliation(s)
- Jiaxin An
- School of Information, University of Texas at Austin, Austin, Texas
| | - Wei Fan
- Department of Biomedical Informatics and Medical Education, University of Washington, Seattle, Washington
| | - Anant Mittal
- Paul G. Allen School of Computer Science & Engineering, University of Washington, Seattle, Washington
| | - Yan Zhang
- School of Information, University of Texas at Austin, Austin, Texas
| | - Annie T Chen
- Department of Biomedical Informatics and Medical Education, University of Washington, Seattle, Washington
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Millar KA, Crump L, LaChapelle DL. Lived Experiences of Cognitive Dysfunction in Fibromyalgia: How Patients Discuss Their Experiences and Suggestions for Patient Education. J Patient Exp 2024; 11:23743735241229385. [PMID: 38333024 PMCID: PMC10851761 DOI: 10.1177/23743735241229385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2024] Open
Abstract
Cognitive dysfunction (CD) is a common, impairing symptom experienced by persons with fibromyalgia (FM). This study explored how individuals with FM describe their experience of CD in an online peer support environment. Posts referencing cognitive symptoms were extracted from two Facebook FM peer support groups at two timepoints. Using inductive Thematic Analysis, key discussion themes were identified and compared across groups and time. Four themes represented the way members described their cognitive experiences in FM: understanding and describing CD experiences, distrust of cognitive abilities, choosing between pain and medication side effects, and misunderstanding and judgement from others. Two themes represented the impact of CD on members' lives: impaired social interaction and loss of identity. Group members described broad impairments in daily functioning that significantly and negatively impacted their quality of life, indicating CD symptoms may play a more prominent role in the FM experience than previously understood. An infographic is included to aid patient education and help facilitate patient-provider discussions of CD symptoms.
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Affiliation(s)
- Kayla A Millar
- Department of Psychology, University of New Brunswick, Fredericton, NB, Canada
| | - Lyndsay Crump
- Department of Psychology, University of New Brunswick, Fredericton, NB, Canada
| | - Diane L LaChapelle
- Department of Psychology, University of New Brunswick, Fredericton, NB, Canada
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Nijs J, Malfliet A, Roose E, Lahousse A, Van Bogaert W, Johansson E, Runge N, Goossens Z, Labie C, Bilterys T, Van Campenhout J, Polli A, Wyns A, Hendrix J, Xiong HY, Ahmed I, De Baets L, Huysmans E. Personalized Multimodal Lifestyle Intervention as the Best-Evidenced Treatment for Chronic Pain: State-of-the-Art Clinical Perspective. J Clin Med 2024; 13:644. [PMID: 38337338 PMCID: PMC10855981 DOI: 10.3390/jcm13030644] [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: 11/14/2023] [Revised: 01/11/2024] [Accepted: 01/17/2024] [Indexed: 02/12/2024] Open
Abstract
Chronic pain is the most prevalent disease worldwide, leading to substantial disability and socioeconomic burden. Therefore, it can be regarded as a public health disease and major challenge to scientists, clinicians and affected individuals. Behavioral lifestyle factors, such as, physical (in)activity, stress, poor sleep and an unhealthy diet are increasingly recognized as perpetuating factors for chronic pain. Yet, current management options for patients with chronic pain often do not address lifestyle factors in a personalized multimodal fashion. This state-of-the-art clinical perspective aims to address this gap by discussing how clinicians can simultaneously incorporate various lifestyle factors into a personalized multimodal lifestyle intervention for individuals with chronic pain. To do so the available evidence on (multimodal) lifestyle interventions targeting physical (in)activity, stress, sleep and nutritional factors, specifically, was reviewed and synthetized from a clinical point of view. First, advise is provided on how to design a personalized multimodal lifestyle approach for a specific patient. Subsequently, best-evidence recommendations on how to integrate physical (in)activity, stress, sleep and nutritional factors as treatment targets into a personalized multimodal lifestyle approach are outlined. Evidence supporting such a personalized multimodal lifestyle approach is growing, but further studies are needed.
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Affiliation(s)
- Jo Nijs
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, 1090 Brussels, Belgium; (A.M.); (E.R.); (A.L.); (W.V.B.); (E.J.); (N.R.); (Z.G.); (C.L.); (T.B.); (J.V.C.); (A.P.); (A.W.); (J.H.); (H.-Y.X.); (I.A.); (L.D.B.); (E.H.)
- Chronic Pain Rehabilitation, Department of Physical Medicine and Physiotherapy, University Hospital Brussels, 1090 Brussels, Belgium
- Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, 405 30 Goteborg, Sweden
| | - Anneleen Malfliet
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, 1090 Brussels, Belgium; (A.M.); (E.R.); (A.L.); (W.V.B.); (E.J.); (N.R.); (Z.G.); (C.L.); (T.B.); (J.V.C.); (A.P.); (A.W.); (J.H.); (H.-Y.X.); (I.A.); (L.D.B.); (E.H.)
- Chronic Pain Rehabilitation, Department of Physical Medicine and Physiotherapy, University Hospital Brussels, 1090 Brussels, Belgium
- Research Foundation—Flanders (FWO), 1000 Brussels, Belgium
| | - Eva Roose
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, 1090 Brussels, Belgium; (A.M.); (E.R.); (A.L.); (W.V.B.); (E.J.); (N.R.); (Z.G.); (C.L.); (T.B.); (J.V.C.); (A.P.); (A.W.); (J.H.); (H.-Y.X.); (I.A.); (L.D.B.); (E.H.)
- Chronic Pain Rehabilitation, Department of Physical Medicine and Physiotherapy, University Hospital Brussels, 1090 Brussels, Belgium
- Rehabilitation Research Group, Department of Physiotherapy, Vrije Universiteit Brussel, 1090 Brussels, Belgium
- REVAL, Universiteit Hasselt, 3590 Diepenbeek, Belgium
| | - Astrid Lahousse
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, 1090 Brussels, Belgium; (A.M.); (E.R.); (A.L.); (W.V.B.); (E.J.); (N.R.); (Z.G.); (C.L.); (T.B.); (J.V.C.); (A.P.); (A.W.); (J.H.); (H.-Y.X.); (I.A.); (L.D.B.); (E.H.)
- Chronic Pain Rehabilitation, Department of Physical Medicine and Physiotherapy, University Hospital Brussels, 1090 Brussels, Belgium
- Research Foundation—Flanders (FWO), 1000 Brussels, Belgium
| | - Wouter Van Bogaert
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, 1090 Brussels, Belgium; (A.M.); (E.R.); (A.L.); (W.V.B.); (E.J.); (N.R.); (Z.G.); (C.L.); (T.B.); (J.V.C.); (A.P.); (A.W.); (J.H.); (H.-Y.X.); (I.A.); (L.D.B.); (E.H.)
- Chronic Pain Rehabilitation, Department of Physical Medicine and Physiotherapy, University Hospital Brussels, 1090 Brussels, Belgium
- Research Foundation—Flanders (FWO), 1000 Brussels, Belgium
- Interuniversity Centre for Health Economics Research (I-CHER), Department of Public Health (GEWE), Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, 1090 Brussels, Belgium
| | - Elin Johansson
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, 1090 Brussels, Belgium; (A.M.); (E.R.); (A.L.); (W.V.B.); (E.J.); (N.R.); (Z.G.); (C.L.); (T.B.); (J.V.C.); (A.P.); (A.W.); (J.H.); (H.-Y.X.); (I.A.); (L.D.B.); (E.H.)
- Research Foundation—Flanders (FWO), 1000 Brussels, Belgium
- Laboratory for Brain-Gut Axis Studies (LaBGAS), Translational Research in Gastrointestinal Disorders (TARGID), Department of Chronic Diseases and Metabolism (CHROMETA), Katholieke Universiteit Leuven, 3000 Leuven, Belgium
| | - Nils Runge
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, 1090 Brussels, Belgium; (A.M.); (E.R.); (A.L.); (W.V.B.); (E.J.); (N.R.); (Z.G.); (C.L.); (T.B.); (J.V.C.); (A.P.); (A.W.); (J.H.); (H.-Y.X.); (I.A.); (L.D.B.); (E.H.)
- Musculoskeletal Rehabilitation Research Group, Department of Rehabilitation Sciences, Faculty of Movement and Rehabilitation Sciences, Katholieke Universiteit Leuven, 3000 Leuven, Belgium
| | - Zosia Goossens
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, 1090 Brussels, Belgium; (A.M.); (E.R.); (A.L.); (W.V.B.); (E.J.); (N.R.); (Z.G.); (C.L.); (T.B.); (J.V.C.); (A.P.); (A.W.); (J.H.); (H.-Y.X.); (I.A.); (L.D.B.); (E.H.)
- Brain, Body and Cognition (BBCO), Faculty of Psychology and Educational Sciences, Vrije Universiteit Brussel, 1090 Brussels, Belgium
| | - Céline Labie
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, 1090 Brussels, Belgium; (A.M.); (E.R.); (A.L.); (W.V.B.); (E.J.); (N.R.); (Z.G.); (C.L.); (T.B.); (J.V.C.); (A.P.); (A.W.); (J.H.); (H.-Y.X.); (I.A.); (L.D.B.); (E.H.)
- Division of Rheumatology, University Hospitals Leuven, 3000 Leuven, Belgium
| | - Thomas Bilterys
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, 1090 Brussels, Belgium; (A.M.); (E.R.); (A.L.); (W.V.B.); (E.J.); (N.R.); (Z.G.); (C.L.); (T.B.); (J.V.C.); (A.P.); (A.W.); (J.H.); (H.-Y.X.); (I.A.); (L.D.B.); (E.H.)
- Institute of Advanced Study, University of Warwick, Coventry CV4 7AL, UK
- Department of Psychology, University of Warwick, Coventry CV4 7AL, UK
| | - Jente Van Campenhout
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, 1090 Brussels, Belgium; (A.M.); (E.R.); (A.L.); (W.V.B.); (E.J.); (N.R.); (Z.G.); (C.L.); (T.B.); (J.V.C.); (A.P.); (A.W.); (J.H.); (H.-Y.X.); (I.A.); (L.D.B.); (E.H.)
| | - Andrea Polli
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, 1090 Brussels, Belgium; (A.M.); (E.R.); (A.L.); (W.V.B.); (E.J.); (N.R.); (Z.G.); (C.L.); (T.B.); (J.V.C.); (A.P.); (A.W.); (J.H.); (H.-Y.X.); (I.A.); (L.D.B.); (E.H.)
- Research Foundation—Flanders (FWO), 1000 Brussels, Belgium
- Department of Public Health and Primary Care, Centre for Environment and Health, Katholieke Universiteit Leuven, 3000 Leuven, Belgium
| | - Arne Wyns
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, 1090 Brussels, Belgium; (A.M.); (E.R.); (A.L.); (W.V.B.); (E.J.); (N.R.); (Z.G.); (C.L.); (T.B.); (J.V.C.); (A.P.); (A.W.); (J.H.); (H.-Y.X.); (I.A.); (L.D.B.); (E.H.)
| | - Jolien Hendrix
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, 1090 Brussels, Belgium; (A.M.); (E.R.); (A.L.); (W.V.B.); (E.J.); (N.R.); (Z.G.); (C.L.); (T.B.); (J.V.C.); (A.P.); (A.W.); (J.H.); (H.-Y.X.); (I.A.); (L.D.B.); (E.H.)
- Research Foundation—Flanders (FWO), 1000 Brussels, Belgium
- Department of Public Health and Primary Care, Centre for Environment and Health, Katholieke Universiteit Leuven, 3000 Leuven, Belgium
| | - Huan-Yu Xiong
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, 1090 Brussels, Belgium; (A.M.); (E.R.); (A.L.); (W.V.B.); (E.J.); (N.R.); (Z.G.); (C.L.); (T.B.); (J.V.C.); (A.P.); (A.W.); (J.H.); (H.-Y.X.); (I.A.); (L.D.B.); (E.H.)
| | - Ishtiaq Ahmed
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, 1090 Brussels, Belgium; (A.M.); (E.R.); (A.L.); (W.V.B.); (E.J.); (N.R.); (Z.G.); (C.L.); (T.B.); (J.V.C.); (A.P.); (A.W.); (J.H.); (H.-Y.X.); (I.A.); (L.D.B.); (E.H.)
- Department of Movement and Sport Sciences, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, 1090 Brussels, Belgium
| | - Liesbet De Baets
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, 1090 Brussels, Belgium; (A.M.); (E.R.); (A.L.); (W.V.B.); (E.J.); (N.R.); (Z.G.); (C.L.); (T.B.); (J.V.C.); (A.P.); (A.W.); (J.H.); (H.-Y.X.); (I.A.); (L.D.B.); (E.H.)
| | - Eva Huysmans
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, 1090 Brussels, Belgium; (A.M.); (E.R.); (A.L.); (W.V.B.); (E.J.); (N.R.); (Z.G.); (C.L.); (T.B.); (J.V.C.); (A.P.); (A.W.); (J.H.); (H.-Y.X.); (I.A.); (L.D.B.); (E.H.)
- Chronic Pain Rehabilitation, Department of Physical Medicine and Physiotherapy, University Hospital Brussels, 1090 Brussels, Belgium
- Research Foundation—Flanders (FWO), 1000 Brussels, Belgium
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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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von Bülow C, Wæhrens EE, Andersen U, Amris K, la Cour K. How a group-based occupational therapy program works in woman with fibromyalgia: A process evaluation of the ADAPT program. Scand J Occup Ther 2023; 30:1523-1540. [PMID: 37557901 DOI: 10.1080/11038128.2023.2242380] [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: 11/10/2022] [Revised: 06/30/2023] [Accepted: 07/25/2023] [Indexed: 08/11/2023]
Abstract
BACKGROUND The ADAPT Program have improved activities of daily living (ADL) in women with fibromyalgia. To understand the functioning of the program, it is relevant to evaluate how program theory components are linked to outcomes (mechanisms) and how the randomised controlled trial (RCT) context, influenced delivery and outcomes. OBJECTIVE To evaluate ADAPT in terms of dose, mechanisms of change and contextual factors. MATERIAL/METHODS Dose was recorded on the n = 21 participants receiving ADAPT in the IMPROvE trial (NCT01352052). A subsample of n = 16 attended one of three 2-hour focusgroups, evaluating mechanisms of change and contextual factors. Interview questions explored participants' interaction with four program components, i.e. how the 'client-centred approach', 'group-based peer-exchange format', 'teaching-learning strategies' and 'long-term program format' triggered mechanisms facilitating/hindering outcomes. Moreover, how randomisation procedures influenced delivery and outcomes. RESULTS Attending a long-term educational peer-exchange program, in which participants experienced met by a health professional that legitimised difficulties, facilitated participants knowledge, insights and motivation for changing habits. With time and support, participants experienced increased acceptance of their situation and began to implement more effective ways to perform ADL tasks. CONCLUSIONS/SIGNIFICANCE Results support previous findings of improved ADL ability post-ADAPT and provide initial evidence to support the ADAPT Program theory.
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Affiliation(s)
- Cecilie von Bülow
- The Parker Institute, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
- Occupational Science, User Perspectives and Community-based Interventions, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Eva Ejlersen Wæhrens
- The Parker Institute, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
- Occupational Science, User Perspectives and Community-based Interventions, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Ulla Andersen
- The Parker Institute, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
- Occupational Science, User Perspectives and Community-based Interventions, Department of Public Health, University of Southern Denmark, Odense, Denmark
- The Department of Occupational Therapy, Copenhagen University College, Copenhagen, Denmark
| | - Kirstine Amris
- The Parker Institute, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Karen la Cour
- Occupational Science, User Perspectives and Community-based Interventions, Department of Public Health, University of Southern Denmark, Odense, Denmark
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Hintz EA. "It's All in Your Head": A Meta-Synthesis of Qualitative Research About Disenfranchising Talk Experienced by Female Patients with Chronic Overlapping Pain Conditions. HEALTH COMMUNICATION 2023; 38:2501-2515. [PMID: 35694781 DOI: 10.1080/10410236.2022.2081046] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Interactions between female patients with chronic pain and their medical providers in which providers question or contest the "realness" or nature of their illness experience (e.g. "It's all in your head") have been reported extensively in the extant qualitative literature, particularly for poorly understood ("contested") chronic pain syndromes. Many terms have been offered to describe this talk (e.g. invalidating, dismissive), resulting in conceptual fragmentation and isolated silos of research which together report about one communicative phenomenon. To rectify this fragmentation, the present study offers a meta-synthesis which explores, analyzes, and integrates the findings of 82 qualitative interview studies representing the patient-provider communication experiences of 2,434 female patients living with one or more of 10 chronic overlapping pain conditions (COPCs). COPCs are costly, gendered, and poorly understood. From the meta-synthesis, three key concepts are identified: (1) Functions of disenfranchising talk: Discrediting, silencing, and stereotyping; (2) Effects of disenfranchising talk: Harmed agency, credibility; access to care, support, and resources; and perception of patient-provider relationship; and (3) Responses to disenfranchising talk: Submission, critique, and resistance. Findings confirm the centrality of gender in the experience of disenfranchising talk, underscore the need to adopt an intersectional approach to the study of this talk along additional axes of race and class, and offer heuristic value toward conceptually unifying research about female COPC patients' experiences of disenfranchising talk from providers.
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Nishigami T, Manfuku M, Lahousse A. Central Sensitization in Cancer Survivors and Its Clinical Implications: State of the Art. J Clin Med 2023; 12:4606. [PMID: 37510721 PMCID: PMC10380903 DOI: 10.3390/jcm12144606] [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: 06/12/2023] [Revised: 07/04/2023] [Accepted: 07/06/2023] [Indexed: 07/30/2023] Open
Abstract
Although the prevalence of cancer pain is 47% after treatment, cancer pain is often underestimated, and many patients are undertreated. The complexity of cancer pain contributes to the lack of its management. Recently, as the mechanism of cancer pain, it has become clear that central sensitization (CS) influences chronic pain conditions and the transition from acute to chronic pain. In this state-of-the-art review, we summarized the association of CS or central sensitivity syndrome with pain and the treatment for pain targeting CS in cancer survivors. The management of patients with CS should not only focus on tissue damage in either the affected body regions or within the central nervous system; rather, it should aim to target the underlying factors that sustain the CS process. Pain neuroscience education (PNE) is gaining popularity for managing chronic musculoskeletal pain and could be effective for pain and CS in breast cancer survivors. However, there is a study that did not demonstrate significant improvements after PNE, so further research is needed. Precision medicine involves the classification of patients into subgroups based on a multifaceted evaluation of disease and the implementation of treatment tailored to the characteristics of each patient, which may play a central role in the treatment of CS.
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Affiliation(s)
- Tomohiko Nishigami
- Department of Physical Therapy, Faculty of Health and Welfare, Prefectural University of Hiroshima, Hiroshima 723-0053, Japan
| | - Masahiro Manfuku
- Graduate School of Comprehensive Scientific Research, Prefectural University of Hiroshima, Hiroshima 723-0053, Japan
- Department of Rehabilitation, Breast Care Sensyu Clinic, Osaka 596-0076, Japan
| | - Astrid Lahousse
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy (KIMA), Vrije Universiteit Brussel, 1090 Brussels, Belgium
- Chronic Pain Rehabilitation, Department of Physical Medicine and Physiotherapy, University Hospital Brussels, 1090 Brussels, Belgium
- Research Foundation Flanders (FWO), 1000 Brussels, Belgium
- Rehabilitation Research (RERE) Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy (KIMA), Vrije Universiteit Brussel, 1090 Brussels, Belgium
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8
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Zimney K, Van Bogaert W, Louw A. The Biology of Chronic Pain and Its Implications for Pain Neuroscience Education: State of the Art. J Clin Med 2023; 12:4199. [PMID: 37445234 DOI: 10.3390/jcm12134199] [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: 05/16/2023] [Revised: 06/06/2023] [Accepted: 06/14/2023] [Indexed: 07/15/2023] Open
Abstract
Pain is an individualized experience for the person suffering from chronic pain. Significant strides have been made in the last few decades in understanding various biological changes that coincide with chronic pain. This state-of-the-art overview looks at the current evidence related to the biology of chronic pain and the implications these findings have on the delivery of pain neuroscience education (PNE). The paper summarizes the various (epi)genetic, neural, endocrine, and immune factors discovered and explored in the scientific literature concerning chronic pain. Each of these biological factors has various implications for the content and delivery of PNE. We discuss the future directions these biological factors have for the clinical implementation of PNE by linking the importance of behavior change, optimizing the learning environment, and using an individualized multimodal treatment approach with PNE. In addition, future directions for research of PNE based on these biological factors are provided with importance placed on individualized patient-centered care and how PNE can be used with traditional modes of care and growing trends with other care methods. PNE was originally and continues to be rooted in understanding chronic pain biology and how that understanding can improve patient care and outcomes.
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Affiliation(s)
- Kory Zimney
- Department of Physical Therapy, University of South Dakota, 414 East Clark St., Vermillion, SD 57069, USA
| | - Wouter Van Bogaert
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Laarbeeklaan 121, 1000 Brussels, Belgium
- Research Foundation-Flanders (FWO), Leuvenseweg 38, 1000 Brussels, Belgium
- Interuniversity Centre for Health Economics Research (I-CHER), Department of Public Health (GEWE), Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Laarbeeklaan 103, 1000 Brussels, Belgium
- Department of Physical Medicine and Physiotherapy, University Hospital Brussels, Laarbeeklaan 101, 1000 Brussels, Belgium
| | - Adriaan Louw
- Evidence in Motion, 618 Broad Street, Suite B, Story City, IA 50248, USA
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9
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Montesó-Curto P, Panisello-Chavarria ML, Sarrió-Colás L, Toussaint L. Nurses' Perceptions of Patient Fibromyalgia Illness Experiences after Performing Group-Based Problem-Solving Therapy: A Qualitative Research Study. Healthcare (Basel) 2023; 11:healthcare11111531. [PMID: 37297671 DOI: 10.3390/healthcare11111531] [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: 02/26/2023] [Revised: 04/28/2023] [Accepted: 05/18/2023] [Indexed: 06/12/2023] Open
Abstract
Fibromyalgia patients experience difficulties in their daily lives that are difficult to identify and recognize due to the stigma associated with the disease. Nurses can help identify them to establish biopsychosocial coping and treatment. The main aim of this study was to explore Spanish nurses' perceptions of the illness experiences of their fibromyalgia patients. Qualitative content analysis from the etic perspective was used. Eight nurses met in focus groups to report their perceptions of the illness experiences of FM patients after led group-based problem-solving therapy in fibromyalgia patients. Four themes emerged: (1) the presence of a "specific trigger" (stressful event) for FM symptoms; (2) fulfilling expected gender roles; (3) a lack of support from the family; (4) abuse. Nurses recognize the mind-body connection after the impact of stress on patients' bodies. The expected gender roles interfere with patients' recovery because they feel frustration and guilt about not being able to fulfil them. Managing emotions and improving communication in fibromyalgia is recommended. Clinicians might also consider issues such as abuse and the absence of social-family support for the comprehensive evaluation and effective management of fibromyalgia.
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Affiliation(s)
- Pilar Montesó-Curto
- Primary Care in Institut Català de la Salut (ICS), 43500 Tortosa, Spain
- Faculty of Medicine, Rovira i Virgili University, 43201 Reus, Spain
| | | | | | - Loren Toussaint
- Department of Psychology, Luther College, Decorah, IA 52101, USA
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10
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Wyns A, Hendrix J, Lahousse A, De Bruyne E, Nijs J, Godderis L, Polli A. The Biology of Stress Intolerance in Patients with Chronic Pain—State of the Art and Future Directions. J Clin Med 2023; 12:jcm12062245. [PMID: 36983246 PMCID: PMC10057496 DOI: 10.3390/jcm12062245] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 03/07/2023] [Accepted: 03/10/2023] [Indexed: 03/16/2023] Open
Abstract
Stress has been consistently linked to negative impacts on physical and mental health. More specifically, patients with chronic pain experience stress intolerance, which is an exacerbation or occurrence of symptoms in response to any type of stress. The pathophysiological mechanisms underlying this phenomenon remain unsolved. In this state-of-the-art paper, we summarised the role of the autonomic nervous system (ANS) and hypothalamus-pituitary-adrenal (HPA) axis, the two major stress response systems in stress intolerance. We provided insights into such mechanisms based on evidence from clinical studies in both patients with chronic pain, showing dysregulated stress systems, and healthy controls supported by preclinical studies, highlighting the link between these systems and symptoms of stress intolerance. Furthermore, we explored the possible regulating role for (epi)genetic mechanisms influencing the ANS and HPA axis. The link between stress and chronic pain has become an important area of research as it has the potential to inform the development of interventions to improve the quality of life for individuals living with chronic pain. As stress has become a prevalent concern in modern society, understanding the connection between stress, HPA axis, ANS, and chronic health conditions such as chronic pain is crucial to improve public health and well-being.
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Affiliation(s)
- Arne Wyns
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, 1090 Brussels, Belgium; (A.W.); (A.L.); (J.N.); (A.P.)
| | - Jolien Hendrix
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, 1090 Brussels, Belgium; (A.W.); (A.L.); (J.N.); (A.P.)
- Department of Public Health and Primary Care, Centre for Environment & Health, KU Leuven, Kapucijnenvoer 35, 3000 Leuven, Belgium;
- Flanders Research Foundation-FWO, 1090 Brussels, Belgium
- Correspondence:
| | - Astrid Lahousse
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, 1090 Brussels, Belgium; (A.W.); (A.L.); (J.N.); (A.P.)
- Flanders Research Foundation-FWO, 1090 Brussels, Belgium
- Chronic Pain Rehabilitation, Department of Physical Medicine and Physiotherapy, University Hospital, 1090 Brussels, Belgium
- Rehabilitation Research (RERE) Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy (KIMA), Vrije Universiteit Brussel, 1090 Brussels, Belgium
| | - Elke De Bruyne
- Department of Hematology and Immunology-Myeloma Center Brussels, Vrije Universiteit Brussel, 1090 Brussels, Belgium;
| | - Jo Nijs
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, 1090 Brussels, Belgium; (A.W.); (A.L.); (J.N.); (A.P.)
- Chronic Pain Rehabilitation, Department of Physical Medicine and Physiotherapy, University Hospital, 1090 Brussels, Belgium
- Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, 405 30 Gothenburg, Sweden
| | - Lode Godderis
- Department of Public Health and Primary Care, Centre for Environment & Health, KU Leuven, Kapucijnenvoer 35, 3000 Leuven, Belgium;
- External Service for Prevention and Protection at Work, IDEWE, 3001 Heverlee, Belgium
| | - Andrea Polli
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, 1090 Brussels, Belgium; (A.W.); (A.L.); (J.N.); (A.P.)
- Department of Public Health and Primary Care, Centre for Environment & Health, KU Leuven, Kapucijnenvoer 35, 3000 Leuven, Belgium;
- Flanders Research Foundation-FWO, 1090 Brussels, Belgium
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11
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Varinen A, Vuorio T, Kosunen E, Koskela TH. Experiences of patients with fibromyalgia at a Finnish Health Centre: A qualitative study. Eur J Gen Pract 2022; 28:157-164. [PMID: 35726620 PMCID: PMC9225685 DOI: 10.1080/13814788.2022.2085683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background Fibromyalgia is a functional syndrome. Despite recent findings, there is still considerable uncertainty about its diagnostic process. Objectives This study aimed to explore patients’ experiences with fibromyalgia during the diagnostic process in primary health care. Moreover, we tried to determine how diagnostic consultation could be improved. Methods This study is based on data from patients with fibromyalgia in a primary health care study conducted in Nokia, Finland. Patients with fibromyalgia were identified from electronic medical records. Focus-group participants with fibromyalgia diagnoses were selected using a purposive sampling method to gather a maximum variation sample. Qualitative thematic analysis was used for the coded data from four focus-group discussions in 2018. A description of the coding tree was provided and researchers organised the codes. Finally, all researchers identified themes from the data. Results The main unifying entities were the uncertainty and contradictions fibromyalgia patients faced on several occasions. Physicians sometimes offered other diagnoses – like depression – as an explanation for the symptoms, or used repetitive tests to eliminate other possible diagnoses. Furthermore, patients expressed their wishes for a holistic, empathetic, and up-to-date approach to their symptoms. Conclusion In our interviews, a good doctor-patient relationship and continuity of care were necessary, as were the physician’s attitude and knowledge of fibromyalgia. Our findings also suggest avoiding repeated or unnecessary rule-out tests and the overdiagnosis of psychiatric disorders is necessary.
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Affiliation(s)
- Aleksi Varinen
- Department of General Practice, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | | | - Elise Kosunen
- Department of General Practice, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Tuomas H Koskela
- Department of General Practice, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Centre for General Practice, Tampere University Hospital, Tampere, Finland
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12
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Ecija C, Catala P, Gutierrez L, Javier Arrayás-Grajera M, Peñacoba C. The Influence of the Fear of Negative Evaluation on Activity Avoidance in Fibromyalgia: Exploring Pain Acceptance and Positive Affect as Resilience Variables. Clin Nurs Res 2022; 32:902-913. [PMID: 36217962 DOI: 10.1177/10547738221122670] [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: 11/15/2022]
Abstract
To examine the mediating role of pain acceptance (PAcc) between fear of negative evaluation (FNE) and activity avoidance (AV) at different levels of positive affect (PA) (moderator) among women diagnosed with fibromyalgia (FM) (moderate mediation model). This study was cross-sectional in design. A convenience sample of women with FM (n = 231) completed measures of pain severity, FNE, PAcc, AV, and PA. A simple mediation model and a moderate mediation model was constructed and analyzed using the SPSS macro-PROCESS. First, PAcc mediated the effect of FNE on AV (β = .02, SE = 0.008; [95% CI [0.0075, 0.0394]). Second, a mediated effect of PAcc between FNE and AV moderated by PA at medium and high levels of PA were found (m: 0.23; β = -.22, p = .0006; h: 9.59; β = -.34, p = .0002. Future work should seek to validate study findings in diverse samples of FM patients. Additionally, future work should explore how FM self-management interventions that include PAcc can promote increased activity among women suffering from FM with medium to high levels of PA.
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13
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Characterizing fibromyalgia flares: a prospective observational study. Reumatologia 2022; 60:242-246. [PMID: 36186831 PMCID: PMC9494786 DOI: 10.5114/reum.2022.118677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Accepted: 06/06/2022] [Indexed: 11/25/2022] Open
Abstract
Introduction Although most patients with fibromyalgia describe periods of exacerbation of their symptomatology, there are very few studies describing its characteristics. Material and methods We recruited a total of 124 patients from our outpatient clinics who agreed to a follow-up of at least 6 months. All of them were asked to note and describe whether they had had any worsening of their symptoms during that time. Results Sixty-nine patients (75%) reported at least one flare, with a mean of 2 flares per patient. The mean duration of flares was 11 weeks. The most frequent triggers were: continuous stress (56%), intense stress (39%), physical overexertion (37%) and climatic changes (36%). The most common actions taken by patients were rest and medication. Conclusions Two-thirds of fibromyalgia patients experienced flares within 6 months. The symptoms and measures taken are similar to those patients usually take when they notice a worsening of symptoms.
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14
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Assessment and management of fibromyalgia flares in clinical practice. Reumatologia 2022; 60:229-230. [PMID: 36186834 PMCID: PMC9494787 DOI: 10.5114/reum.2022.119038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Accepted: 08/23/2022] [Indexed: 11/17/2022] Open
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15
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Dinsdale A, Forbes R, Thomas L, Treleaven J. The management experiences, needs and preferences of individuals seeking care for persistent intra-articular temporomandibular disorders: A qualitative study. J Oral Rehabil 2021; 49:10-21. [PMID: 34622974 DOI: 10.1111/joor.13267] [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: 04/28/2021] [Revised: 09/23/2021] [Accepted: 09/30/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Little is known about the management experiences, needs and preferences of individuals seeking care for persistent intra-articular temporomandibular disorders (TMD). Investigating these experiences may improve understanding of the impact management has on individuals, and factors that shape these experiences. This information may advance current practice and guide future management of individuals with intra-articular TMD. OBJECTIVES To investigate the management experiences, needs and preferences of individuals with persistent intra-articular TMD. METHODS A qualitative study was performed. Thirteen eligible participants (mean age 32.7 years, 12 female) were recruited via purposive sampling, and interviewed using a semi-structured framework. Data were analysed using a thematic analysis approach. RESULTS Four themes were established from interview data: (i) searching for help; (ii) wanting answers; (iii) wanting to regain control; and (iv) meeting needs, preferences and expectations, and the implications on care. Numerous factors influenced the experiences of those seeking care, including the ability to navigate care and management expectations. Specific to intra-articular TMD, the absence of pain made seeking care harder, and often, patients perceived neglect of mechanical symptoms by healthcare practitioners, which negatively impacted care. Often, those wanting management expressed the need for answers and to regain control over their jaw symptoms. CONCLUSIONS Strategies to improve healthcare navigation are needed for those wanting help for intra-articular TMD. Within management, a person-centred approach is encouraged. Practitioners should respect individuals' specific needs and preferences, and address underlying management expectations, to facilitate positive care experiences. Consideration of symptoms other than pain in intra-articular TMD populations is paramount.
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Affiliation(s)
- Alana Dinsdale
- School of Health and Rehabilitation Sciences, The University of Queensland, Saint Lucia, QLD, Australia
| | - Roma Forbes
- School of Health and Rehabilitation Sciences, The University of Queensland, Saint Lucia, QLD, Australia
| | - Lucy Thomas
- School of Health and Rehabilitation Sciences, The University of Queensland, Saint Lucia, QLD, Australia
| | - Julia Treleaven
- School of Health and Rehabilitation Sciences, The University of Queensland, Saint Lucia, QLD, Australia
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16
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Mukhida K, Carroll W, Arseneault R. Does work have to be so painful? A review of the literature examining the effects of fibromyalgia on the working experience from the patient perspective. CANADIAN JOURNAL OF PAIN-REVUE CANADIENNE DE LA DOULEUR 2020; 4:268-286. [PMID: 33987505 PMCID: PMC7951172 DOI: 10.1080/24740527.2020.1820858] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Background Chronic pain conditions, such as fibromyalgia, adversely affect individuals’ abilities to work. Aim The aim of this study was to examine, from the perspective of patients, the effects that fibromyalgia symptoms had on their ability to work, the challenges that they encountered in the workplace that did not foster their continued employment, and the types of modifications to their work or workplace that they thought would facilitate their productivity and ability to work. Methods A scoping review method, applying techniques of systematic review, was used to conduct a research synthesis of the literature regarding fibromyalgia and work that looked at this issue from the patient perspective. Results A variety of themes emerged from the analysis and could be broadly categorized into (1) the work experience was a challenging one with which to cope; (2) relationships were strained at work; (3) clinical symptoms had repercussions on subjects’ attitudes toward work and the relation to life outside of work; and (4) a variety of possible solutions were considered to help subjects better cope with fibromyalgia and work. Conclusions Strategies that potentially could foster continued employment of patients with fibromyalgia include those at the micro, meso, and macro levels. Health care providers can support patients’ employment goals by collaborating with patients and their employers, dispelling stigma regarding the illness, and providing practical and specific advice regarding workplace accommodations.
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Affiliation(s)
- K Mukhida
- Pain Management Unit, Department of Anesthesiology, Pain Management and Perioperative Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - W Carroll
- Department of Management, Sobey School of Business, Saint Mary's University, Halifax, Nova Scotia, Canada
| | - R Arseneault
- Department of Management, Sobey School of Business, Saint Mary's University, Halifax, Nova Scotia, Canada
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17
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Eik H, Kirkevold M, Solbrække KN, Mengshoel AM. Rebuilding a tolerable life: narratives of women recovered from fibromyalgia. Physiother Theory Pract 2020; 38:1188-1197. [PMID: 33026930 DOI: 10.1080/09593985.2020.1830454] [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: 10/23/2022]
Abstract
Introduction: Fibromyalgia syndrome (FMS) is a chronic musculoskeletal pain and fatigue condition. Despite extensive research, there is currently no known therapy leading to a cure for FMS. Although studies have reported that some patients can regain their health, little is known about their personal process of becoming well.Objevtive: This study aimed to explore women's narratives about the process of recovering from FMS.Methods: The empirical material consists of qualitative interviews of eight Norwegian women who all have previously had, but do not have FMS any more. Inspired by a narrative approach we analyzed their experiences of becoming better with a focus on recovery as a meaning-making process.Results: The findings revealed a recovery process consisting of two intertwined narratives that are mutually nurturing each other. The first narrative telling moments of prompting changes refers to events during the recovery process where women understood themselves and their suffering in new ways and thereby enabled them to act in new ways or take further action. The second narrative a mundane process of rebuilding a tolerable daily life refers to a lasting, mundane everyday process of exploration how they initially should act to avoid becoming worse and, later, to promote improvement.Conclusion: Our findings show how the women explain their recovery in terms of overcoming fear of movement, making sense of their symptoms and becoming more active in everyday life. The close analysis reveals a recovery narrative portraying a complex and ambiguous process consisting of small dramas about the efforts trying to rebuild a meaningful life.
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Affiliation(s)
- Hedda Eik
- Faculty of Health Sciences, Department of Physiotherapy, Oslo Metropolitan University, Oslo, Norway.,Faculty of Medicine, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Marit Kirkevold
- Faculty of Medicine, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Kari Nyheim Solbrække
- Faculty of Medicine, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Anne Marit Mengshoel
- Faculty of Medicine, Institute of Health and Society, University of Oslo, Oslo, Norway
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18
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Doebl S, Macfarlane GJ, Hollick RJ. "No one wants to look after the fibro patient". Understanding models, and patient perspectives, of care for fibromyalgia: reviews of current evidence. Pain 2020; 161:1716-1725. [PMID: 32701832 DOI: 10.1097/j.pain.0000000000001870] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Fibromyalgia is a common and complex long-term pain condition. Despite advancements in our understanding and treatment of fibromyalgia, patients report patchy health care provision and frustrating journeys through the health care system. To inform how best to deliver care, we undertook 2 narrative reviews examining existing evidence on (1) models of care for fibromyalgia and (2) patients' experiences, preferences, and unmet needs regarding their health care. Seven databases were systematically searched. Quantitative data was narratively synthesised and qualitative data thematically analysed. No evidence-based model of care covering the patient journey through the entire health care system was identified. Limited evidence suggests no clear benefit for ongoing care in secondary care settings. Patients with fibromyalgia report difficult interactions with the health care system that might equally be expressed by those with other long-term conditions, such as inconsistent and poorly coordinated care. However, they also face unique problems; fibromyalgia was often not viewed as a real condition, resulting in difficult encounters with health care staff, in particular not feeling believed or listened to. Significant delays in diagnosis were commonplace. Positive care experiences such as being listened to and shared decision-making made patients feeling better informed, well supported, and more satisfied. There is little evidence to inform how best to organise health care for patients with fibromyalgia and ensure care is delivered in a coordinated and consistent way. These findings provide a strong rationale for developing a new model of care for fibromyalgia.
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Affiliation(s)
- Stefanie Doebl
- Epidemiology Group, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, United Kingdom
- Aberdeen Centre for Arthritis and Musculoskeletal Health, University of Aberdeen, Aberdeen, United Kingdom
| | - Gary J Macfarlane
- Epidemiology Group, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, United Kingdom
- Aberdeen Centre for Arthritis and Musculoskeletal Health, University of Aberdeen, Aberdeen, United Kingdom
| | - Rosemary J Hollick
- Epidemiology Group, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, United Kingdom
- Aberdeen Centre for Arthritis and Musculoskeletal Health, University of Aberdeen, Aberdeen, United Kingdom
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Kratz AL, Whibley D, Kim S, Williams DA, Clauw DJ, Sliwinski M. The Role of Environmental Distractions in the Experience of Fibrofog in Real-World Settings. ACR Open Rheumatol 2020; 2:214-221. [PMID: 32237225 PMCID: PMC7164629 DOI: 10.1002/acr2.11130] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 02/14/2020] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE Perceived cognitive dysfunction in people with fibromyalgia (FM), "fibrofog," is commonly reported and has been demonstrated in neurocognitive testing. Distractibility and inattention have been implicated as potential contributors to fibrofog, but the role of environmental distractions has not been explored. In this study, ambulatory assessment methods were used to examine whether FM is related to more environmental distractions and to examine the impact of distractions on subjective and objective cognitive functioning. METHODS Fifty people with FM and 50 age-, sex-, and education-matched controls without FM completed 8 consecutive days of ambulatory assessments. Five times per day, participants reported perceived cognitive functioning and environmental distractions and completed validated tests of processing speed and working memory. RESULTS The FM group reported distractions in a higher proportion of the ambulatory cognitive testing sessions (40.5%) compared with the group without FM (29.8%; P < 0.001) and more often reported multiple simultaneous distractions. For both groups, sound was the most common distraction. The group with FM reported more distractions caused by light, and the group without FM reported more social distractions. Group differences in subjective and objective cognitive functioning were not augmented during distraction relative to during periods of no distraction. There were no group differences in within-person changes in cognitive functioning as a function of distraction. CONCLUSION The group with FM reported more distractions than the group without FM; both groups reported poorer processing speed when distracted, and the effects of distraction on test performance did not differ significantly by group. Findings suggest that sensitivity to environmental distractions may play a role in the experience of cognitive dysfunction in FM.
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Affiliation(s)
| | - Daniel Whibley
- University of Michigan, Ann Arbor, and School of Medicine, Medical Sciences, and Nutrition, University of AberdeenAberdeenUnited Kingdom
| | - Samsuk Kim
- University of Detroit MercyDetroitMichigan
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Boulton T. Nothing and Everything: Fibromyalgia as a Diagnosis of Exclusion and Inclusion. QUALITATIVE HEALTH RESEARCH 2019; 29:809-819. [PMID: 30296924 DOI: 10.1177/1049732318804509] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The diagnostic process promises a label that validates patients' embodied experiences and a road map for living with and treating illness. Drawing on 31 qualitative interviews with women and men in Canada and the United Kingdom who have been diagnosed with fibromyalgia (FM), in this article, I examine the participants' experiences of the diagnostic process and how they feel about receiving this label. The interviews reflect that the FM label is plagued by uncertainty because the diagnosis is based on the absence of verifiable pathology. The respondents' narratives also reveal that FM is a vague diagnosis that includes a multitude of symptoms, overlaps with several other diagnoses, and results in feelings of doubt regarding whether it is the correct label. Thus, the participants' narratives reflect that the FM diagnosis is largely an empty promise because it fails to provide definitive answers or confer meaning and legitimacy to their illness experiences.
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Fibromyalgia and rheumatoid arthritis: Personality and psychopathology differences from the Minnesota Multiphasic Personality Inventory-2. PERSONALITY AND INDIVIDUAL DIFFERENCES 2019. [DOI: 10.1016/j.paid.2018.11.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Shallcross R, Dickson JM, Nunns D, Taylor K, Kiemle G. Women's Experiences of Vulvodynia: An Interpretative Phenomenological Analysis of the Journey Toward Diagnosis. ARCHIVES OF SEXUAL BEHAVIOR 2019; 48:961-974. [PMID: 30047005 PMCID: PMC6418055 DOI: 10.1007/s10508-018-1246-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Revised: 05/22/2018] [Accepted: 05/26/2018] [Indexed: 06/08/2023]
Abstract
Vulvodynia is the experience of idiopathic pain characterized by burning, soreness, or throbbing in the external female genitalia or vulva and is estimated to be experienced by 4-16% of the female population, yet only half of women seek help regarding their symptoms. Of the women who do seek help, only around 2% obtain a diagnosis. Therefore, the aim of the current study was to explore the experiences of women with vulvodynia on their journey toward diagnosis, by using semi-structured interviews and an interpretative phenomenological analysis (IPA) methodology. Eight women were interviewed, and their experiences were analyzed and interpreted into three master themes, each with constituent sub-themes: (1) The Journey Is a Battle, (2) "What Is Vulvodynia?": Ambivalence Toward Diagnosis, and (3) Patriarchy, Women, and Sex. Overall, women perceived a healthcare system which was dismissive and shaming, with an inadequate knowledge of vulvodynia. This in turn impacted on women's psychological well-being. Psychological understanding, one-to-one therapy, and consultation and training for healthcare professionals may help to improve the psychological well-being of women with vulvodynia.
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Affiliation(s)
- Rebekah Shallcross
- Doctorate in Clinical Psychology, The University of Liverpool, Liverpool, L69 3GB, UK
- Centre for Academic Primary Care, Population Health Sciences, Bristol, The University of Bristol, Bristol, UK
| | - Joanne M Dickson
- Department of Psychological Sciences, University of Liverpool, Liverpool, UK
- Department of Psychology, Edith Cowan University, Joondalup, Australia
| | - David Nunns
- Department of Gynaecological Oncology, Nottingham University Hospitals, Hucknall Road, Nottingham, Nottinghamshire, UK
| | - Kate Taylor
- Vulval Pain Society, PO Box 7804, Nottingham, UK
| | - Gundi Kiemle
- Doctorate in Clinical Psychology, The University of Liverpool, Liverpool, L69 3GB, UK.
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23
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Alameda Cuesta A, Pazos Garciandía Á, Oter Quintana C, Losa Iglesias ME. Fibromyalgia, Chronic Fatigue Syndrome, and Multiple Chemical Sensitivity: Illness Experiences. Clin Nurs Res 2019; 30:32-41. [PMID: 30917692 DOI: 10.1177/1054773819838679] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Fibromyalgia, chronic fatigue syndrome/myalgic encephalomyelitis, and multiple chemical sensitivity can be considered contested illnesses. The questioning of the status of these conditions as real diseases reduces feelings of legitimacy in those affected. The purpose of this study was to analyze subjectivity construction processes in people with these diseases. A qualitative exploratory study was conducted from the perspective of hermeneutic phenomenology and ethnosociology. We used life stories for compiling data (13 informants were interviewed face-to-face), and sociological discourse analysis was developed. Three main categories were identified: (a) self and grieving; (b) images and practices relating to fibromyalgia, chronic fatigue syndrome/myalgic encephalomyelitis, and multiple chemical sensitivity; and (c) relationships with health professionals. This study shows that daily experiences of people living with these diseases are marked by stigmatization processes. The ultimate purpose of nursing care for people with these conditions should be to reduce their vulnerability and exclusion.
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Galvani C, Caramaschi P, Mura P, Paladini A, Piroli A, Arnaudo E, De Franceschi L, Evangelista M, Pari A, Ongaro G, Finco G, Ciannameo A, Carletto A, Varrassi G, Biasi D. Postural counseling represents a novel option in pain management of fibromyalgia patients. J Pain Res 2019; 12:327-337. [PMID: 30666151 PMCID: PMC6333156 DOI: 10.2147/jpr.s164714] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Background Chronic pain is a key symptom in fibromyalgia (FM), and its management is still challenging for rheumatologists in daily practice. FM patients show psychological and psychiatric manifestations, going from mood and emotional disorders to depression and alexithymia that negatively impact their quality of life, limiting their daily activities. Since pharmacological strategies have a limited efficacy in FM pain, alternative or complementary non-pharmacological approaches have been introduced in the clinical management of FM. Patients and methods This is a retrospective study on FM patients (n=52) treated with a novel integrated postural counseling (PC) rehabilitation program carried out by a counselor physiotherapist. The clinical impact of PC was evaluated by 1) a semi-structured interview using an ad hoc modified questionnaire McGill Illness Narrative Interview (MINI) 1 to obtain data on pain management by highlighting everyday experience of living with pain and 2) an FM impact questionnaire (FIQ) total score. Results Two main structures of narrative emplotment of FM illness were recognized: 1) the cumulative life narrative structure (46.15%) and 2) the broken life (53.85%) narrative structure. Baseline FIQ score was 77.38±7.77, and it was significantly reduced after PC to 39.12±13.27 (P<0.0001). Although well-being still requires further definition as outcome in pain management, it is important for FM patients, dealing with pain-related sensations, thoughts and feelings and limiting their daily activities. In our study, 87.5% of interviewed FM patients reported an improvement in their well-being after PC. Conclusion Our data suggest that an integrated PC program positively impacts chronic pain and fatigue based on self-management strategies. PC allows FM patients to resume their own life and regenerate their own image. Finally, we propose the introduction of the evaluation of the ability to resume daily activities as the target of rehabilitation programs in FM.
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Affiliation(s)
- Carla Galvani
- Rheumatology Unit, Department of Medicine, University of Verona, Verona, Italy,
| | - Paola Caramaschi
- Rheumatology Unit, Department of Medicine, University of Verona, Verona, Italy,
| | - Paolo Mura
- Anesthesia, Intensive Care and Pain Therapy Unit, Department of Medical Science "M. Aresu", University of Cagliari, Cagliari, Italy
| | | | - Alba Piroli
- Department of MESVA, University of L'Aquila, L'Aquila, Italy
| | - Elisa Arnaudo
- Department of Internal Medicine, University of Bologna, Bologna, Italy
| | - Lucia De Franceschi
- Internal Medicine Unit, Department of Medicine, University of Verona, Verona, Italy
| | - Maurizio Evangelista
- Emergency Department, Institute of Anesthesia, Resuscitation and Pain Medicine, Catholic University of Sacred Heart, Rome, Italy
| | - Alice Pari
- Department of Internal Medicine, University of Bologna, Bologna, Italy
| | - Giovanna Ongaro
- Rheumatology Unit, Department of Medicine, University of Verona, Verona, Italy,
| | - Gabriele Finco
- Anesthesia, Intensive Care and Pain Therapy Unit, Department of Medical Science "M. Aresu", University of Cagliari, Cagliari, Italy
| | - Anna Ciannameo
- Department of Internal Medicine, University of Bologna, Bologna, Italy
| | - Antonio Carletto
- Rheumatology Unit, Department of Medicine, University of Verona, Verona, Italy,
| | - Giustino Varrassi
- Department of MESVA, University of L'Aquila, L'Aquila, Italy.,Paolo Procacci Foundation, Rome, Italy
| | - Domenico Biasi
- Rheumatology Unit, Department of Medicine, University of Verona, Verona, Italy,
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25
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Mengshoel AM, Sim J, Ahlsen B, Madden S. Diagnostic experience of patients with fibromyalgia - A meta-ethnography. Chronic Illn 2018; 14:194-211. [PMID: 28762775 DOI: 10.1177/1742395317718035] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective To examine how individuals experience the process and consequences of receiving a diagnosis of fibromyalgia syndrome. Methods A systematic literature search of qualitative studies up to May 2016 was performed. Twenty-eight reports including information on patients' diagnostic experiences were subjected to an interpretive analysis in accordance with the principles of meta-ethnography. Results Years were normally spent consulting specialists in an attempt to confirm the reality of symptoms and make sense of the illness. Great relief was felt at finally achieving the fibromyalgia syndrome diagnosis. However, relief waned when therapies proved ineffective. Health professionals and others questioned whether individuals were genuinely ill, that the illness had a psychological nature, and whether they were doing their best to recover. The diagnosis did not provide a meaningful explanation of individuals' suffering and had limited power to legitimate illness. Patients felt blamed for their failure to recover, threatening their personal credibility and moral identity. Conclusion The fibromyalgia syndrome diagnosis has limitations in validating and making sense of patients' illness experiences and in providing social legitimation of their illness. Social relationships are strained during the diagnostic process and in the course of ineffective therapies.
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Affiliation(s)
- Anne Marit Mengshoel
- 1 Institute of Health and Society, Medical Faculty, University of Oslo, Oslo, Norway
| | - Julius Sim
- 2 Institute for Primary Care and Health Sciences, Keele University, Keele, Newcastle, UK
| | - Birgitte Ahlsen
- 1 Institute of Health and Society, Medical Faculty, University of Oslo, Oslo, Norway.,3 Faculty of Health Sciences, Oslo and Akershus University College of Applied Sciences, Oslo, Norway
| | - Sue Madden
- 4 Faculty of Medical Science, Anglia Ruskin University, Cambridge, UK
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Merriel A, Hussein J, Malata A, Coomarasamy A, Larkin M. Learning from the experience of maternity healthcare workers in Malawi: a qualitative study leading to ten low-cost recommendations to improve working lives and quality of care. BMC Pregnancy Childbirth 2018; 18:336. [PMID: 30119654 PMCID: PMC6098626 DOI: 10.1186/s12884-018-1960-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 08/01/2018] [Indexed: 12/02/2022] Open
Abstract
Background In Malawi there are too few maternity healthcare workers to enable delivery of high quality care to women. These staff are often overworked and have low job satisfaction. Skilled maternity healthcare workers are essential to improve outcomes for mothers and babies. This study focuses on understanding the working life experience of maternity staff at district hospitals in Malawi with the aim of developing relevant low-cost solutions to improve working life. Methods A qualitative study using semi-structured interviews was undertaken in three district hospitals around Malawi’s Capital city. Thirty-one staff formed a convenience sample, purposively selected to cover each cadre. Interviews were recorded, transcribed and then analysed using Interpretative Phenomenological Analysis complemented by Template Analysis to elicit the experience of maternity staff. Results Staff describe a system where respect, praise and support is lacking. Many want to develop their skills, however, there are barriers to advancement. Despite this, staff are motivated; they are passionate, committed professionals who endeavor to treat patients well, despite having few resources. Their ‘superdiverse’ background and experience helps them build resilience and strive to provide ‘total care’. Conclusions Improving working lives can improve the care women receive. However, this requires appropriate health policy and investment of resources. There are some inter-relational aspects that can be improved with little cost, which form the ten recommendations of this paper. These improvements in working life center around individual staff (respecting each other, appreciating each other, being available when needed, performing systematic clinical assessments and communicating clearly), leadership (supportive supervision and leading by example) and the system (transparent training selection, training being need driven, clinical skills being considered in rotation of staff). To improve working lives in this way will require commitment to change throughout the health system. Thus, it could help address preventable maternal and newborn deaths. Electronic supplementary material The online version of this article (10.1186/s12884-018-1960-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Abi Merriel
- Population Health Sciences, Bristol Medical School, University of Bristol, Department of Obstetrics and Gynaecology, The Chilterns, Southmead Hospital, Bristol, BS10 5NB, UK. .,Institute of Metabolism and Systems Research, University of Birmingham, Academic Department, Birmingham Women's Hospital Foundation Trust, 3rd Floor, Metchley Park Road, Edgbaston, Birmingham, B15 2TG, UK.
| | - Julia Hussein
- Independent Maternal Health Consultant, Fintray Gardens, Hatton of Fintray, Aberdeen, AB21 0HY, UK
| | - Address Malata
- Malawi University of Science and Technology, PO Box 5196, Limbe, Malawi
| | - Arri Coomarasamy
- Institute of Metabolism and Systems Research, University of Birmingham, Academic Department, Birmingham Women's Hospital Foundation Trust, 3rd Floor, Metchley Park Road, Edgbaston, Birmingham, B15 2TG, UK
| | - Michael Larkin
- School of Psychology, Aston University, Birmingham, B4 7ET, UK
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27
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Sallinen M, Mengshoel AM. "I just want my life back!" - Men's narratives about living with fibromyalgia. Disabil Rehabil 2017; 41:422-429. [PMID: 29069952 DOI: 10.1080/09638288.2017.1395085] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Fibromyalgia is characterized by chronic widespread pain and an array of other symptoms. It is less common among men than among women and the results concerning the severity of men's symptoms are contradictory. The purpose of this study was to elucidate the impacts of fibromyalgia on men's daily life and work ability. METHODS The data were collected through life story interviews of five men with fibromyalgia. RESULTS The results of a narrative analysis are presented in a form of two model narratives: "Adjusting the life to match the illness" and "Being imprisoned by the pain". The first narrative is a description of finding a balance between the illness and wellness, whereas the second is an account of debilitating symptoms, unsuccessful treatment, and rehabilitation interventions. CONCLUSION The results suggest that adjusting one's activities may help to manage the symptoms and to support work ability in many cases but for some patients the experience of feeling healthy or pain free might be nothing but a fading memory. Narrative approach is well applicable to rehabilitation of patients with fibromyalgia: an illness narrative may help the patient and professionals to understand the situation better and to set realistic and relevant goals for rehabilitation. Implications for rehabilitation In addition to chronic pain, men with fibromyalgia suffer from daytime tiredness and cognitive challenges that substantially interfere with their work ability and daily functioning. Vocational rehabilitation interventions, including e.g., adjustments of work tasks and hours, should be started early on to support work ability. The results indicate that psychosocial support is needed to improve health related quality of life of patients with severe and complex symptoms, especially if return-to-work is not an option. Men with fibromyalgia seem to lack peer support both in face-to face groups and in on-line groups. "All-male" support groups could be explored in rehabilitation settings in the future. Using a narrative approach in rehabilitation might result in a shared understanding of the patient's situation. This could help the professionals to set more individual, realistic, and relevant goals for rehabilitation, which in turn might improve rehabilitation outcomes.
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Affiliation(s)
- Merja Sallinen
- a Institute of Health and Society, Medical Faculty , University of Oslo , Oslo , Norway.,b Faculty of Health and Welfare , Satakunta University of Applied Sciences , Pori , Finland
| | - Anne Marit Mengshoel
- a Institute of Health and Society, Medical Faculty , University of Oslo , Oslo , Norway
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28
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Mahjoub F, Salari R, Noras MR, Yousefi M. Are Traditional Remedies Useful in Management of Fibromyalgia and Chronic Fatigue Syndrome? A Review Study. J Evid Based Complementary Altern Med 2017; 22:1011-1016. [PMID: 28597692 PMCID: PMC5871288 DOI: 10.1177/2156587217712763] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Fibromyalgia and chronic fatigue syndrome are disorders that often occur simultaneously and are characterized by widespread pain and persistent fatigue. The patients are associated with disability and impairment social and physical functions. There are many remedies in traditional Persian medicine suggested for management of the disease complaints. The aim of this study was to investigate the clinical presentations and pathophysiology of disorders with the basic and principal textbook of traditional Persian medicine written by Avicenna (Canon of Medicine). According to Persian medicine, the term E’aya can be matched by mentioned disorders. Avicenna believed that strenuous activities play an important role in the beginning of some types of fatigue. He classified fatigue into 4 groups, and in each type the clinical symptoms varied. The multifaceted entity of fibromyalgia and chronic fatigue syndrome in Persian medicine and conventional medicine suggests multidisciplinary therapies in management of these disabling disorders.
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Affiliation(s)
| | | | | | - Mahdi Yousefi
- 1 Mashhad University of Medical Sciences, Mashhad, Iran
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29
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Cooper S, Gilbert L. The role of 'social support' in the experience of fibromyalgia - narratives from South Africa. HEALTH & SOCIAL CARE IN THE COMMUNITY 2017; 25:1021-1030. [PMID: 27782344 DOI: 10.1111/hsc.12403] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/20/2016] [Indexed: 06/06/2023]
Abstract
This paper focuses on the role of 'social support' in the experience of fibromyalgia (a musculoskeletal pain disorder) in South Africa. In-depth semi-structured interviews were used to collect narratives from 15 participants. Sources of social support constitute important mechanisms for coping with the illness experience of fibromyalgia. In providing a space for consultation and validation of the diagnosis of fibromyalgia, and the person living with the condition, people giving support fulfil a critical role in shaping the experience. The findings show how support from family, partners, and peers plays an integral role in the process of accepting fibromyalgia diagnosis, adapting to the demands of the condition, and seeking help from healthcare providers. The findings also show the ways in which people with fibromyalgia provide support for others with the condition, and the importance of this peer network in shaping the paths and outcomes of this illness experience. The findings of this study corroborate existing evidence that show fibromyalgia to be a complex condition to manage, due to the multiplicity, uncertainty and contestation that feature in the experience of the illness. Additionally, this study presents the challenges related to the limitations of access to healthcare in the South African context, and the utility of narrative approaches in garnering insight into the ways in which social support is harnessed in this environment.
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Affiliation(s)
- Silvie Cooper
- Department of Sociology, University of the Witwatersrand, Johannesburg, South Africa
| | - Leah Gilbert
- Department of Sociology, University of the Witwatersrand, Johannesburg, South Africa
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30
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Cooper S, Gilbert L. An exploratory study of the experience of fibromyalgia diagnosis in South Africa. Health (London) 2016; 21:337-353. [PMID: 28521648 DOI: 10.1177/1363459316677623] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Within the conceptual framework of 'medically-ill-defined' conditions, this article focuses on the experiences of 'diagnosis' through a narrative analysis of fibromyalgia (a chronic musculoskeletal pain disorder) in South Africa. In-depth interviews were used to collect narratives from 15 participants. The findings show how the contested and confusing experience of fibromyalgia diagnosis can be understood, by viewing the interactions that patients have with their practitioners, families, peers and colleagues. The currency of fibromyalgia as a diagnosis and the inequalities present in the South African health care system characterise the experiences of symptom recognition, diagnosis and treatment. The analysis reveals how those living with fibromyalgia search for diagnosis, and struggle to maintain legitimacy for their experience in the complex constellation of porous symptoms that appear infrequently. The findings of this study confirm the existing evidence that shows fibromyalgia to be a challenging illness experience, which is attributed to the lack of clarity and legitimacy, and high contestation that surrounds the condition. Additionally, this study presents the ways that limited access to diagnosis and treatment for fibromyalgia in the South African context shapes this specific illness experience, and the value of using narrative approaches to gain insight into how people live with hidden and poorly understood conditions in this environment.
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Affiliation(s)
- Silvie Cooper
- University of the Witwatersrand, Johannesburg, South Africa
| | - Leah Gilbert
- University of the Witwatersrand, Johannesburg, South Africa
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31
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Taylor AG, Adelstein KE, Fischer-White TG, Murugesan M, Anderson JG. Perspectives on Living With Fibromyalgia. Glob Qual Nurs Res 2016; 3:2333393616658141. [PMID: 28620627 PMCID: PMC5459348 DOI: 10.1177/2333393616658141] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Revised: 06/01/2016] [Accepted: 06/06/2016] [Indexed: 12/22/2022] Open
Abstract
Perceptions of people living with chronic illness change over time, contributing to health-related stress that necessitates coping skills. Paterson's shifting perspectives model provides an explanation of chronically ill people's variations in attention to their symptoms. In this qualitative study, 20 people with fibromyalgia living in a rural setting were interviewed in 2013 with the aim of gaining insight into their experiences and the meaning-making associated with their chronic condition. Analysis of the interview data categorized five recurrent, or common, themes: experiences of loss, feelings of fear and uncertainty, influence of stress, stigmatization of the disease, and coping through courage. Difficulties attendant to losses, distress, and stigma associated with this chronic condition led the participants to report poor health-related quality of life. The study findings can be useful across clinical settings to nurses and other health care providers in understanding those diagnosed with fibromyalgia and their care needs.
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32
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Vincent A, Whipple MO, Rhudy LM. Fibromyalgia Flares: A Qualitative Analysis. PAIN MEDICINE 2016; 17:463-468. [PMID: 25586303 DOI: 10.1111/pme.12676] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Patients with fibromyalgia report periods of symptom exacerbation, colloquially referred to as "flares" and despite clinical observation of flares, no research has purposefully evaluated the presence and characteristics of flares in fibromyalgia. The purpose of this qualitative study was to describe fibromyalgia flares in a sample of patients with fibromyalgia. METHODS Using seven open-ended questions, patients were asked to describe how they perceived fibromyalgia flares and triggers and alleviating factors associated with flares. Patients were also asked to describe how a flare differs from their typical fibromyalgia symptoms and how they cope with fibromyalgia flares. Content analysis was used to analyze the text. RESULTS A total of 44 participants completed the survey. Responses to the seven open-ended questions revealed three main content areas: causes of flares, flare symptoms, and dealing with a flare. Participants identified stress, overdoing it, poor sleep, and weather changes as primary causes of flares. Symptoms characteristic of flares included flu-like body aches/exhaustion, pain, fatigue, and variety of other symptoms. Participants reported using medical treatments, rest, activity and stress avoidance, and waiting it out to cope with flares. CONCLUSIONS Our results demonstrate that periods of symptom exacerbation (i.e., flares) are commonly experienced by patients with fibromyalgia and symptoms of flares can be differentiated from every day or typical symptoms of fibromyalgia. Our study is the first of its kind to qualitatively explore characteristics, causes, and management strategies of fibromyalgia flares. Future studies are needed to quantitatively characterize fibromyalgia flares and evaluate mechanisms of flares.
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Affiliation(s)
| | | | - Lori M Rhudy
- Department of Nursing, Mayo Clinic, Rochester, Minnesota.,School of Nursing, University of Minnesota, Rochester, Minnesota, USA
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33
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Fischer S, Doerr JM, Strahler J, Mewes R, Thieme K, Nater UM. Stress exacerbates pain in the everyday lives of women with fibromyalgia syndrome--The role of cortisol and alpha-amylase. Psychoneuroendocrinology 2016; 63:68-77. [PMID: 26431802 DOI: 10.1016/j.psyneuen.2015.09.018] [Citation(s) in RCA: 77] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Revised: 08/28/2015] [Accepted: 09/17/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Although fibromyalgia syndrome (FMS) is a chronic condition, its cardinal symptom pain is known to fluctuate over the day. Stress has often been claimed to exacerbate pain; however, there is barely any evidence on whether or not this is true on a day-to-day basis (and, alternatively, on whether pain leads to increased stress levels). Using an ecologically valid measurement design, we tested whether and how stress and pain are intertwined in participants with FMS. We additionally examined the role of the two major stress-responsive systems, the hypothalamic-pituitary-adrenal axis and the autonomic nervous system, as potential mediators of this relationship. METHODS An ambulatory assessment study was conducted over the course of 14 days. On each day, 32 females with FMS provided six diary entries on momentary stress and pain levels. Saliva samples were collected at the same time points to determine cortisol and alpha-amylase as indicators of stress-responsive systems. RESULTS Higher stress at a given measurement time point was associated with higher reported pain levels at the subsequent time point (UC=1.47, p<0.001), but not vice versa (UC<0.01, p=0.179). The stress-pain relationship was neither mediated by momentary cortisol nor by alpha-amylase; however, momentary cortisol was independently associated with momentary pain (UC=0.27, p=0.009). CONCLUSION Stress seems to be a powerful exacerbating factor for pain as experienced by patients with FMS in their everyday lives. Cortisol may be involved in the diurnal fluctuation of pain levels in patients with FMS. Future studies should identify relevant daily stressors in persons with FMS and scrutinize the mechanisms underlying the cortisol-pain relationship.
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Affiliation(s)
- Susanne Fischer
- Clinical Biopsychology, Department of Psychology, University of Marburg, Germany
| | - Johanna M Doerr
- Clinical Biopsychology, Department of Psychology, University of Marburg, Germany
| | - Jana Strahler
- Clinical Biopsychology, Department of Psychology, University of Marburg, Germany
| | - Ricarda Mewes
- Clinical Psychology and Psychotherapy, Department of Psychology, University of Marburg, Germany
| | - Kati Thieme
- Department for Medical Psychology, Medical School, University of Marburg, Germany
| | - Urs M Nater
- Clinical Biopsychology, Department of Psychology, University of Marburg, Germany.
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34
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Kratz AL, Schilling SG, Goesling J, Williams DA. Development and initial validation of a brief self-report measure of cognitive dysfunction in fibromyalgia. THE JOURNAL OF PAIN 2015; 16:527-36. [PMID: 25746197 DOI: 10.1016/j.jpain.2015.02.008] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Revised: 02/25/2015] [Accepted: 02/26/2015] [Indexed: 11/25/2022]
Abstract
UNLABELLED Pain is often the focus of research and clinical care in fibromyalgia (FM); however, cognitive dysfunction is also a common, distressing, and disabling symptom in FM. Current efforts to address this problem are limited by the lack of a comprehensive, valid measure of subjective cognitive dysfunction in FM that is easily interpretable, accessible, and brief. The purpose of this study was to leverage cognitive functioning item banks that were developed as part of the Patient Reported Outcomes Measurement Information System (PROMIS) to devise a 10-item short form measure of cognitive functioning for use in FM. In study 1, a nationwide (U.S.) sample of 1,035 adults with FM (age range = 18-82, 95.2% female) completed 2 cognitive item pools. Factor analyses and item response theory analyses were used to identify dimensionality and optimally performing items. A recommended 10-item measure, called the Multidimensional Inventory of Subjective Cognitive Impairment (MISCI) was created. In study 2, 232 adults with FM completed the MISCI and a legacy measure of cognitive functioning that is used in FM clinical trials, the Multiple Ability Self-Report Questionnaire (MASQ). The MISCI showed excellent internal reliability, low ceiling/floor effects, and good convergent validity with the MASQ (r = -.82). PERSPECTIVE This paper presents the MISCI, a 10-item measure of cognitive dysfunction in FM, developed through classical test theory and item response theory. This brief but comprehensive measure shows evidence of excellent construct validity through large correlations with a lengthy legacy measure of cognitive functioning.
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Affiliation(s)
- Anna L Kratz
- Department of Physical Medicine & Rehabilitation, University of Michigan, Ann Arbor, Michigan.
| | | | - Jenna Goesling
- Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan
| | - David A Williams
- Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan; Departments of Medicine (Rheumatology), Psychiatry, and Psychology, University of Michigan, Ann Arbor, Michigan
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35
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Miró E, Martínez MP, Sánchez AI, Prados G, Lupiáñez J. Men and women with fibromyalgia: Relation between attentional function and clinical symptoms. Br J Health Psychol 2014; 20:632-47. [PMID: 25557603 DOI: 10.1111/bjhp.12128] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2013] [Revised: 10/20/2014] [Indexed: 11/29/2022]
Abstract
OBJECTIVES This study was the first to explore whether individuals with fibromyalgia (FM) have different cognitive alterations (i.e., in alertness, orienting, and executive control) depending on their sex. We also analysed possible gender differences in the relationships between cognitive functioning and some of the main symptoms of FM. DESIGN Cross-sectional study. METHODS Two clinical groups with FM (n = 58 women and n = 20 men) and two healthy control groups (n = 21 women and n = 27 men) aged between 30 and 60 years old participated in this study. Pain intensity, sleep disturbance, depression, anxiety, pain catastrophizing, and daily functioning were evaluated with self-report measures. Attentional function was assessed with the ANT-I task (Attentional Network Test-Interactions). RESULTS Mixed ANOVAs showed impairment in vigilance and executive control in both male and female patients with FM compared with controls. Control men were faster than control women, but FM eliminated sex differences. In addition, attention deficit was associated with worse daily functioning in women but not in men with FM. Emotional distress and sleep disruption seemed to contribute differently to these cognitive alterations in both sexes. CONCLUSIONS Therapy strategies aimed at reducing emotional distress and sleep disruption are likely to improve cognitive function by enhancing vigilance. Therapies aimed at reducing emotional distress seem to improve attentional function more in women than in men; those aimed at improving sleep quality are likely to reduce a vigilance/alertness deficit in women and executive problems in men.
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Affiliation(s)
- Elena Miró
- Department of Personality, Assessment and Psychological Treatment, Mind, Brain, and Behavior Research Center, University of Granada, Spain
| | - María P Martínez
- Department of Personality, Assessment and Psychological Treatment, Mind, Brain, and Behavior Research Center, University of Granada, Spain
| | - Ana I Sánchez
- Department of Personality, Assessment and Psychological Treatment, Mind, Brain, and Behavior Research Center, University of Granada, Spain
| | - Germán Prados
- Department of Internal Medicine, Virgen de Las Nieves University Hospital, Granada, Spain
| | - Juan Lupiáñez
- Department of Experimental Psychology and Physiology of Behaviour, Mind, Brain, and Behavior Research Center, University of Granada, Spain
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Finance, fibromyalgia, caring, & communication. Br J Gen Pract 2014; 64:244. [DOI: 10.3399/bjgp14x679778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
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Spiritual needs in patients suffering from fibromyalgia. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2013; 2013:178547. [PMID: 24348691 PMCID: PMC3853480 DOI: 10.1155/2013/178547] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/04/2013] [Accepted: 09/30/2013] [Indexed: 11/17/2022]
Abstract
The objective of this study was to assess spiritual needs of patients with fibromyalgia syndrome (FMS) and to evaluate correlations with disease and health associated variables. Using a set of standardized questionnaires (i.e., Spiritual Needs Questionnaire, Fibromyalgia Impact Questionnaire, SF-36's Quality of Life, Brief Multidimensional Life Satisfaction Scale, etc.), we enrolled 141 patients (95% women, mean age 58 ± 10 years). Here, needs for inner peace and giving/generativity scored the highest, while existential needs and religious needs scored lowest. Particularly inner peace needs and existential needs correlated with different domains of reduced mental health, particularly with anxiety, the intention to escape from illness, and psychosocial restrictions. Thirty-eight percent of the patients stated needs to be forgiven and nearly half to forgive someone from their past life. Therefore, the specific spiritual needs of patients with chronic diseases should be addressed in clinical care in order to identify potential therapeutic avenues to support and stabilize their psychoemotional situation.
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