An exploratory study of the experience of fibromyalgia diagnosis in South Africa

Partners' Experiences of Chronic Pain: A Qualitative Evidence Synthesis

This systematic review of qualitative studies synthesised evidence on the experience chronic pain from the perspective of romantic partners. Medline via Ovid, Embase via Ovid, CINAHL via EBSCO, APA PsycInfo via Ovid, Scopus, and Web of Science databases were searched. Studies exploring the impact of chronic pain from partners' perspectives using qualitative data collection methods were eligible for inclusion. Thematic synthesis was conducted, and confidence in the review findings was assessed using GRADE CERQual criteria. A total of 198 participants were represented from 15 primary studies. Four interconnected analytical themes were developed: 'life is different', 'internal conflict between two worlds', 'togetherness vs separateness', and 'coping in the longer term'. Out of 27 review findings, 9 were assessed as high confidence, 12 as moderate confidence, 4 as low confidence, and 2 as very low confidence. Socially isolated partners, those in strained relationships, and partners who continually sacrificed their own needs were more likely to experience distressing emotions. Greater recognition of partners' needs is needed within pain management services.

Social support in low-income women with Fibromyalgia Syndrome from a sub-urban and peri-urban areas of Tenerife (Canary Islands, Spain): a mixed method study

BACKGROUND

Women with Fibromyalgia Syndrome (FMS) can benefit form adequate social support to fight the consequences of their illness, but the extent to which this is available to those with low incomes who live in depressed areas of Tenerife (Canary Islands, Spain) is currently unknown. The purpose of this study was to explore social support in low-incomes women with FMS in sub-urban and peri-urban areas of Tenerife.

METHODOLOGY

A sequential exploratory mixed method study was carried out from January 20, 2023, to June 10, 2023, at the Fibromyalgia and Chronic Fatigue Association of Tenerife (AFITEN) using non-probability convenience sampling. Social support was analyzed quantitatively through MOS-SSS survey and Duke-UNC-11 questionnaire, while qualitative data were obtained through semi-structured interviews to identify social support providers and analyze their satisfactions levels.

RESULTS

A total of 49 women, with a mean age of 57.80 years-old (SD = 13.25) were finally included in this study. MOSS-SSS and Duke-UNC-11 both indicated lower social support levels at 68.6 (SD =16.3) and 38.0 (SD = 9.74), respectively. The qualitative analysis revealed that partners and friends provided the most significant support with the highest satisfaction scores.

CONCLUSIONS

The socioeconomic status of low-income women with FMS living in sub-urban and peri-urban areas of Tenerife (Canary Islands, Spain) influences on their social support, with the affective support and confidentiality being the most affected dimensions.

"It's All in Your Head": A Meta-Synthesis of Qualitative Research About Disenfranchising Talk Experienced by Female Patients with Chronic Overlapping Pain Conditions

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.

Patient and primary care practitioners' perspectives on consultations for fibromyalgia: a qualitative evidence synthesis

BACKGROUND

Fibromyalgia presents a challenge to both the patients experiencing symptoms and the staff aiming to treat them. This qualitative review aimed to synthesise how patients and practitioners experience primary care consultations, develop a rounded picture of how they perceive each other, the challenges to primary care consultation and how they might be tackled.

METHODS

CINAHL, Embase, CENTRAL and Medline were searched from inception to November 2021. Qualitative studies were included if they explored the perspectives and experiences of either fibromyalgia patients or primary care practitioners. Quantitative data, studies not published in English, not set in primary care or that did not distinguish the type of patient or clinician were excluded. Included studies were analysed using thematic synthesis and their quality assessed.

RESULTS

In total, 30 studies met the inclusion criteria. Thematic synthesis identified three overarching themes: (1) life turned upside down - exploring the chaos experienced by patients as they seek help; (2) negative cycle - highlighting how patient and practitioner factors can create a detrimental cycle; and (3) breaking the cycle - validating patient-doctor relationships underpinned by clear communication can help break the negative cycle.

CONCLUSIONS

Fibromyalgia patients experience uncertainty and chaos that can clash with the attitudes of GPs and the help they can feasibly provide. Difficult consultations in which neither the GP nor patient are satisfied can easily occur. Promoting supportive, reciprocal and open patient-doctor relationships is essential. Future research is required to further explore GP attitudes and to develop an intervention that could improve consultations, patient outcomes and GP satisfaction.

Physical activity and quality of life of patients with fibromyalgia

Background

Fibromyalgia Syndrome (FMS) has been linked to decreased social functioning, poor mental health, and quality of life (QOL). Increased physical functioning and activity can result in improvements in social, mental and overall health, as well as lowered depression and anxiety levels.

Objectives

The aim of this study was to determine physical activity levels and QOL amongst patients diagnosed with fibromyalgia in the Johannesburg region of South Africa.

Methods

The research design was cross-sectional. Descriptive and quantitative data were collected. FMS patients (n=38) completed an online questionnaire on the Google Forms platform. The questionnaire was comprised of four components, namely Demographics, the Global Physical Activity Questionnaire (GPAQ), the Fibromyalgia Impact Questionnaire (FIQR), and the Short Form-36 (SF-36). During data analysis, descriptive characteristics and correlations were computed. The significance level was set at p ≤ 0.05.

Results

Results revealed high FIQR scores (67%) accompanied with low QOL scores (<50% in all domains). There was no correlation between physical activity and FIQR, and physical activity and QOL.

Conclusion

High scores on the impact of FMS were associated with lower overall QOL scores. However, the relationship between physical activity, and the impact of FMS and QOL remain inconclusive.

Defining patient's experiential knowledge: Who, what and how patients know. A narrative critical review

Experiential knowledge is today increasingly valued in health-care practices, public health policies and health research and education programs. However, despite popular and institutional success, the concept remains loosely defined with the result of weakening its heuristic scope and paving the way for its commodification. In this article, we seek to provide a finer characterisation of patients' experiential knowledge's features and specificities through a critical narrative review of humanities and social science (HSS) literature published in English and French (1976-2021). Inspired by Jovchelovitch's analysis of social knowledge, we seek to highlight the diversity and plurality of forms and articulations of knowledge that characterise experiential knowledge, as well as the gradual, dynamic and entangled process that leads from experience to knowledge and expertise. Our analysis points to the need for future research to adopt a resolutely pragmatic and situated orientation in the study of experiential knowledge and the new figures of the contemporary patient that they help to create.

"Can Someone as Young as You Really Feel That Much Pain?" - A Survey on How People With Fibromyalgia Experience Healthcare in Sweden

Research show that fibromyalgia has low credibility in healthcare, leading to poor treatment, lack of knowledge and disinterest. Therefore, people with fibromyalgia feel frustration, fear, anxiety and disappointment.

Objective: The aim of this study was to explore the experiences of people with fibromyalgia in their encounters with healthcare personnel in Sweden.

Method: A cross-sectional design, where 409 people with fibromyalgia answered an anonymous online patient-reported experience measure, developed specific for the study, with six closed questions and one open-ended question. Descriptive statistics were analysed by response frequencies. Correlation analysis were performed between demographic and clinical variables with the answers from the closed questions. Free-text answers were analysed with content analysis.

Results: A third experienced the treatment as bad (34%) and that they were not being taken seriously (30.5%). Almost half (47%) always or mostly felt fear of seeking healthcare related to fibromyalgia and that the health care personnel did not understand their diagnosis (46%). The majority (54%) experienced that the health care personnel did not understand how fibromyalgia affected them or how they could help them. The findings were confirmed in the free-text answers that were categorized into: Scepticism and disregard, Ignorance and disinterest and Professionalism and empathy. There were positive significant correlations between age and five of the questions (ρ = .105–.181, p < .05–p < .01), indicating that lower age is correlated with a worse experience. Furthermore, the duration of fibromyalgia showed a significant correlation with feeling afraid of seeking healthcare because of fibromyalgia (ρ = .144, p < .01), the shorter duration, the greater was the fear of seeking healthcare.

Conclusion: As a third of patients with fibromyalgia had bad experiences with healthcare, especially younger patients, knowledge about fibromyalgia needs to be increased and the patients should be taken seriously and treated respectfully, as well as given adequate support.

"No one wants to look after the fibro patient". Understanding models, and patient perspectives, of care for fibromyalgia: reviews of current evidence

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.

Mishel's Model of Uncertainty Describing Categories and Subcategories in Fibromyalgia Patients, a Scoping Review

The aim of this review was to demonstrate the presence of categories and subcategories of Mishel's model in the experiences of patients with fibromyalgia by reviewing qualitative studies. Uncertainty is defined as the inability to determine the meaning of disease-related events. A scoping review of qualitative studies was carried out. Twenty articles were included, with sample sizes ranging from 3 to 58 patients. Articles from different countries and continents were included. Three categories of the model and eight subcategories could be shown to be present in the experiences of fibromyalgia patients through the scoping review. The first category, concerning antecedents of uncertainty in patients with fibromyalgia, is constituted by the difficulty in coping with symptoms, uncertainty about the diagnosis and uncertainty about the complexity of the treatment. The second concerns the cognitive process of anxiety, stress, emotional disorder and social stigma. The third category refers to coping with the disease, through the management of social and family support and the relationship with health care professionals.

Post Your Journey: Instagram as a Support Community for People With Fibromyalgia

Fibromyalgia is a chronic illness with primary symptoms of widespread pain and fatigue. Social media applications have become a recent resource allowing individuals with fibromyalgia to interact in a virtual community devoted to the illness. This study explores how such a community develops and maintains itself on Instagram and the ways it creates social capital for its users. Data are derived from Instagram posts and open-ended questionnaires completed by users living with fibromyalgia who use the application. Using content analysis and semiotic methodology, the study analyzes the diverse ways in which users shared their experiences with fibromyalgia, the management of its symptoms, and issues encountered in accessing health care systems. Instagram aids in the development of a community by facilitating intimate and supportive interactions about the illness and the creation of personalized day-to-day narratives accessible to all. Norms of trust, acceptance, and reciprocity characterize the diversity of interactions in this community.