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Nishikawara RK, Schultz IZ, Butterfield LD, Murray JW. “You have to believe the patient”: What do people with fibromyalgia find helpful (and hindering) when accessing healthcare? Can J Pain 2023; 7:2176745. [PMID: 37025116 PMCID: PMC10072062 DOI: 10.1080/24740527.2023.2176745] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background Fibromyalgia (FM) is a complex, still poorly understood, and difficult-to-treat chronic pain condition for which many people struggle to find adequate care. Aims This study investigated the research question, "What do people accessing health care services for fibromyalgia perceive as helpful, hindering, and absent but desired?" with the aim of identifying clear, implementable changes for clinical practice. Materials and methods This study used the enhanced critical incident technique (ECIT), a qualitative research method that focuses on helping, hindering, and desired factors, to explore the health care experiences of 14 individuals (12 women and 2 men) diagnosed with FM. Results Using qualitative data analysis, results identified three categories of health care experiences: (1) systemic navigation, including financial and economic security; accessibility, flexibility, and continuity of care; and diversity of treatment options; (2) clinician-patient alliance, including invalidation and prejudice; therapeutic bond; and clinician-patient alignment on treatment plan; and (3) patient self-management strategies, including information-seeking and education, self-advocacy, social supports, symptom management strategies, and other coping strategies. Participants tended to conceptualize their health care concerns as a multilayered systemic problem. Conclusions Participants described a medical system they perceived as poorly equipped to support their needs and tended to invalidate their health concerns. Helping experiences tended to be the result of unique efforts on the part of individual clinicians. Findings emphasize the importance of recognizing the complexities and psychological impact of pain, trusting clinician-patient relationships, multidisciplinary/interdisciplinary care within a biopsychosocial framework, and improved education and awareness around psychosocial aspects of FM and effective management of chronic pain.
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Affiliation(s)
- Ria K. Nishikawara
- Educational and Counselling Psychology, and Special Education, The University of British Columbia, Vancouver, Canada
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2
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Mengshoel AM. A long, winding trajectory of suffering with no definite start and uncertain future prospects - narratives of individuals recently diagnosed with fibromyalgia. Int J Qual Stud Health Well-being 2022; 17:2056956. [PMID: 35356859 PMCID: PMC8979520 DOI: 10.1080/17482631.2022.2056956] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Purpose Fibromyalgia is a contested illness with unknown aetiology and poorly understood development. The present aim is to explore the pre-diagnostic illness trajectory narrated by individuals recently diagnosed with fibromyalgia (FM). Methods Individual interviews about the course of the illness were conducted with seven women and three men (age from early 20s to 50s) who had recently been diagnosed with FM. A narrative analysis of what the interviewees told and how the stories were narrated was conducted. Results The findings are expressed by three storylines. “Strenuous life and alerted body preluding illness” displays a difficult, unsupported life and bodily sensitivity to stimuli. “Recurrent pains unfolding to become a lasting and complex illness” describes individuals pushing themselves to meet social obligations until they come to a full stop. “Diagnosed but still uncertain presence and future” portrays satisfaction with finally being diagnosed with FM and being supported by others, but still there are no solutions as to do about it. Conclusions The three storylines portray a long, winding trajectory of suffering starting before the onset of illness, and unfolding illness gradually becoming persistent and overwhelming. Finally, a diagnosis of FM is arrived at, but how the situation will evolve is uncertain.
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Affiliation(s)
- Anne Marit Mengshoel
- Department of Interdisciplinary Health Sciences, Institute of Health and Society, Medical Faculty, University of Oslo, Oslo Norway
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Hypnotic predictors of agency: Responsiveness to specific suggestions in hypnosis is associated with involuntariness in fibromyalgia. Conscious Cogn 2021; 96:103221. [PMID: 34695719 DOI: 10.1016/j.concog.2021.103221] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 10/04/2021] [Accepted: 10/06/2021] [Indexed: 11/21/2022]
Abstract
Hypnosis is associated with alterations in the sense of agency which can play a role in its utilization as a nonpharmacological option for pain management. The goal of the current study was to examine the relationships between responsiveness to suggestions in hypnosis and alterations of the sense of agency among patients with fibromyalgia. Ninety-eight participants with fibromyalgia underwent two hypnotizability assessments followed by the Sense of Agency Rating Scale. Clinical pain measures were also collected. Involuntariness was predicted by responsiveness to control, ideomotor, and dissociation suggestions. Effortlessness was predicted by responsiveness to control and ideomotor suggestions, and age. Hypnotizability was associated with main clinical pain outcomes, but agency alterations were not. Results suggest a shared mechanism between responsiveness to specific suggestions and the sense of agency in hypnosis. We discuss theoretical and clinical implications for pain management and the need for further research.
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Abstract
This empirical study draws on insights from narrative theory to tease out
how women with a contested illness narrate their experiences on social
media. Based on 13 months of online observations between 2017 and
2019, I analyse how a sample of eight highly active Dutch female
social media users share their illness on YouTube and Instagram. In
addition, I interviewed five of them. Through their online
performances, the women in this study illustrate their investment in
self-care practices, whilst simultaneously laying bare the limits of
these practices in ensuring permanent well-being. Central to
transmitting their experiences is the performance of balanced
positivity; meaning that illness is dealt with in a
predominantly ‘positive’ way, as well as through the occasional
display of (moments of) hardship. I identify three main aspects of
this performance of balanced positivity, namely: (1) appearances, (2)
mindset, and (3) presence. The practice of balanced positivity is
congruent with the concept of legitimacy narratives, because it allows
women with a contested illness to show their efforts to cope with
their condition as well as the myriad challenges that remain despite
these efforts.
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5
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Mengshoel AM, Skarbø Å, Hasselknippe E, Petterson T, Brandsar NL, Askmann E, Ildstad R, Løseth L, Sallinen MH. Enabling personal recovery from fibromyalgia - theoretical rationale, content and meaning of a person-centred, recovery-oriented programme. BMC Health Serv Res 2021; 21:339. [PMID: 33853607 PMCID: PMC8045361 DOI: 10.1186/s12913-021-06295-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 03/18/2021] [Indexed: 12/27/2022] Open
Abstract
Background Fibromyalgia (FM) is a contested, chronic widespread pain syndrome on which recommended therapies have short-lasting, moderate effects. Nevertheless, some patients become symptom-free, and their recovery experiences inspired us to develop a patient-centred recovery-oriented programme (PROP) delivered in a group format. Presently, we describe the theoretical rationale, purpose and content of the PROP, and its meanings for clinicians and patients. Methods A multidisciplinary clinical team, a leader of a rehabilitation unit, and two researchers coproduced the PROP. Five full-day seminars were arranged to bridge research and clinical experiences. Qualitative studies about patients’ illness and recovery experiences and questions by researchers facilitated reflections on clinical experiences. The meaning of the PROP was examined using focus group and individual interviews with patients and clinicians immediately after completing the course and after 1–1.5 years. Results The biopsychosocial model displays the research evidence across biological, mental and social impacts of FM, justifying that life stress can be an illness-maintaining factor in FM. The content addresses enabling patients to heal their own life and self by modifying life stress. Patients engage in making sense of the relationship between FM, themselves, and life through exploring, discovering and creating appropriate solutions for their daily social life. The PROP reduced uncertainties and brought a positive attitude and hope to the groups. After 1 year, patients are still engaged in recovery work, experience more good days, and maintain hope for further recovery. By sharing and reflecting on clinical experiences, a unified clinical team was established that continues to develop their competency. Conclusion To our knowledge, the PROP is the first programme for patients with FM that results from a process of coproducing knowledge, is based on explicit theoretical rationale, and facilitates a personal experiential recovery process. PROP is found to be meaningful and to work by patients and clinicians. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06295-6.
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Affiliation(s)
- Anne Marit Mengshoel
- Department of Interdisciplinary Health Sciences, Faculty of Medicine, Institute of Health and Society, University of Oslo, Box 1089, Blindern, 0317, Oslo, Norway.
| | - Åse Skarbø
- Hospital for Rheumatic Diseases, Margrethe Grundtvigsvei 6, 2609, Lillehammer, Norway
| | | | - Tamara Petterson
- Hospital for Rheumatic Diseases, Margrethe Grundtvigsvei 6, 2609, Lillehammer, Norway
| | - Nina Linnea Brandsar
- Hospital for Rheumatic Diseases, Margrethe Grundtvigsvei 6, 2609, Lillehammer, Norway
| | - Ellen Askmann
- Hospital for Rheumatic Diseases, Margrethe Grundtvigsvei 6, 2609, Lillehammer, Norway
| | - Ragnhild Ildstad
- Hospital for Rheumatic Diseases, Margrethe Grundtvigsvei 6, 2609, Lillehammer, Norway
| | - Lena Løseth
- Hospital for Rheumatic Diseases, Margrethe Grundtvigsvei 6, 2609, Lillehammer, Norway
| | - Merja Helena Sallinen
- Department of Interdisciplinary Health Sciences, Faculty of Medicine, Institute of Health and Society, University of Oslo, Box 1089, Blindern, 0317, Oslo, Norway.,Faculty of Health and Welfare, Satakunta University of Applied Sciences, Pori, Finland
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6
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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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7
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Sallinen M, Mengshoel AM, Solbrække KN. "I can't have it; I am a man. A young man!" - men, fibromyalgia and masculinity in a Nordic context. Int J Qual Stud Health Well-being 2019; 14:1676974. [PMID: 31607231 PMCID: PMC6813418 DOI: 10.1080/17482631.2019.1676974] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/02/2019] [Indexed: 01/08/2023] Open
Abstract
Purpose: Research shows that gender has a substantial impact on the health behaviour such as expression of physical symptoms like persistent pains and aches. However, there is yet little knowledge about the gendered aspect of pain by men who suffer from typical female diseases like fibromyalgia. The purpose of the study was to elucidate the interplay between illness and gender by exploring life-stories of men who suffer from fibromyalgia. Methods: The data were collected through life-story interviews of eight men suffering from fibromyalgia. A narrative methodology for analysis was applied to explore the storytelling and the linguistic and performative aspects of the life-stories. Results: The masculine identity of the participants was re-negotiated by comparisons to other men and life before symptom onset, and by discussing expectations and beliefs of how men should act in contemporary societies. The transition from experiencing a strong, active and reliable body to experiencing a painful, vulnerable and helpless body was perceived as fundamental. Conclusions: Self-management and rehabilitation of fibromyalgia it is not only about learning to manage the symptoms but also about the struggle to find coherence in life through re-constructing gender identity that is acceptable both for the individual and for the community.
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Affiliation(s)
- Merja Sallinen
- Faculty of Health and Wellbeing, Satakunta
University of Applied Sciences, Pori, Finland
- Institute of Health and Society, University
of Oslo, Oslo, Norway
| | - Anne Marit Mengshoel
- Department of interdisciplinary health
sciences, Institute of Health and Society, University of Oslo, Oslo,
Norway
| | - Kari Nyheim Solbrække
- Department of interdisciplinary health
sciences, Institute of Health and Society, University of Oslo, Oslo,
Norway
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8
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Lor M, Vang X, Rabago D, Brown RL, Backonja M. “It Hurts as If…”: Pain-Associated Language, Visual Characterization, and Storytelling in Hmong Adults. PAIN MEDICINE 2019; 21:1690-1702. [DOI: 10.1093/pm/pnz268] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
AbstractObjectivePain is challenging to diagnose and manage in primary care, especially when patients have limited English proficiency (LEP). Little is known about whether LEP patients can provide pain information that is consistent with the process and the content that providers expect in a clinical interaction. We explore how LEP Hmong patients communicate their pain to providers in primary care settings.MethodsA qualitative study with 67 Hmong participants (63% female and x̄ age = 53.7 years) were recruited from a Midwestern state. Semistructured interviews on pain communication were conducted, audio-recorded, transcribed, and analyzed using directed content analysis.ResultsThe Hmong participants described pain using stories that generally had the same dimensions of information that providers require for pain assessment. These included references to time, causality, associated symptoms or related experiences, intensity, and consequences of pain. However, the participants expressed some pain dimensions in language that was not shared by providers: visual metaphors that were generally in reference to pain quality and fewer words for pain location, intensity, and some qualities. Participants used two strategies to decide whether they should tell their pain story: assessing the provider and determining whether their story was appreciated. The perception that providers underappreciated their stories resulted in dissatisfaction and undertreatment of pain. Ultimately, this resulted in having less frequent contact with providers or changing providers.ConclusionsFindings demonstrate a discordance in the expected process and content of the clinical interaction between LEP Hmong patients and providers, suggesting the need for culturally appropriate pain assessments in this population.
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Affiliation(s)
- Maichou Lor
- Columbia University School of Nursing, University of Wisconsin-Madison, School of Nursing, Madison, Wisconsin
| | - Xia Vang
- Department of Family Medicine and Community Health, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
| | - David Rabago
- Department of Family Medicine and Community Health, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
| | - Roger L Brown
- School of Nursing, University of Wisconsin-Madison, Madison, Wisconsin
| | - Miroslav Backonja
- Department of Neurology, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, USA
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9
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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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10
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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: 37] [Impact Index Per Article: 6.2] [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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Furness PJ, Vogt K, Ashe S, Taylor S, Haywood-Small S, Lawson K. What causes fibromyalgia? An online survey of patient perspectives. Health Psychol Open 2018; 5:2055102918802683. [PMID: 30275965 PMCID: PMC6158621 DOI: 10.1177/2055102918802683] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Fibromyalgia is a severe chronic pain condition that affects every aspect of life. Causes of the condition remain unclear, and quantitative research cannot account for patients' personal illness narratives and perceptions. This online survey gathered qualitative accounts of the perceived causes of their condition from 596 people with fibromyalgia, which were analyzed thematically. Themes were "Bodily assault, ill-health, and change"; "Emotional trauma and distress"; "Stress and vulnerability"; and "Explaining and authenticating fibromyalgia." Discussion focuses on the complexity of causation, the importance of understanding and having symptoms validated, and the potential for benefiting from patient expertise in building better practitioner-client relationships.
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12
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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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13
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Mengshoel AM, Grape HE. Rethinking physiotherapy for patients with fibromyalgia - lessons learnt from qualitative studies. PHYSICAL THERAPY REVIEWS 2017. [DOI: 10.1080/10833196.2017.1377975] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Anne Marit Mengshoel
- Department of Health Sciences, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Hedda Eik Grape
- Department of Health Sciences, Institute of Health and Society, University of Oslo, Oslo, Norway
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14
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Toye F, Seers K, Hannink E, Barker K. A mega-ethnography of eleven qualitative evidence syntheses exploring the experience of living with chronic non-malignant pain. BMC Med Res Methodol 2017; 17:116. [PMID: 28764666 PMCID: PMC5540410 DOI: 10.1186/s12874-017-0392-7] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Accepted: 07/10/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Each year over five million people develop chronic non-malignant pain and can experience healthcare as an adversarial struggle. The aims of this study were: (1) to bring together qualitative evidence syntheses that explore patients' experience of living with chronic non-malignant pain and develop conceptual understanding of what it is like to live with chronic non-malignant pain for improved healthcare; (2) to undertake the first mega-ethnography of qualitative evidence syntheses using the methods of meta-ethnography. METHODS We used the seven stages of meta-ethnography refined for large studies. The innovation of mega-ethnography is to use conceptual findings from qualitative evidence syntheses as primary data. We searched 7 bibliographic databases from inception until February 2016 to identify qualitative evidence syntheses that explored patients' experience of living with chronic non-malignant pain. RESULTS We identified 82 potential studies from 556 titles, screened 34 full text articles and included 11 qualitative evidence syntheses synthesising a total of 187 qualitative studies reporting more than 5000 international participants living with chronic pain. We abstracted concepts into 7 conceptual categories: (1) my life is impoverished and confined; (2) struggling against my body to be me; (3) the quest for the diagnostic 'holy grail'; (4) lost personal credibility; (5) trying to keep up appearances; (6) need to be treated with dignity; and (7) deciding to end the quest for the grail is not easy. Each conceptual category was supported by at least 7 of the 11 qualitative evidence syntheses. CONCLUSIONS This is the first mega-ethnography, or synthesis of qualitative evidence syntheses using the methods of meta-ethnography. Findings help us to understand that the decision to end the quest for a diagnosis can leave patients feeling vulnerable and this may contribute to the adversarial nature of the clinical encounter. This knowledge demonstrates that treating a patient with a sense that they are worthy of care and hearing their story is not an adjunct to, but integral to health care.
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Affiliation(s)
- Fran Toye
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Kate Seers
- Royal College of Nursing Research Institute, Warwick Medical School, University of Warwick, Coventry, UK
| | - Erin Hannink
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Karen Barker
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
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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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Briones-Vozmediano E. The social construction of fibromyalgia as a health problem from the perspective of policies, professionals, and patients. Glob Health Action 2017; 10:1275191. [PMID: 28333581 PMCID: PMC5405378 DOI: 10.1080/16549716.2017.1275191] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Revised: 10/30/2016] [Accepted: 11/02/2016] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Fibromyalgia is a painful chronic disease, suffered mainly by women, that consolidates a number of symptoms and skeletal muscle issues which are little understood. OBJECTIVES To explore the social construction of FM from the perspective of health policies, patients, and health professionals involved in their medical attention. METHODS I) Policy review of national and regional health plans in a national and international context, the clinical protocols for fibromyalgia in Spain, and the Parliamentary initials in the European and Spanish context; and ii) Qualitative study involving 28 personal interviews with 16 fibromyalgia patients and 12 interviews with health care professionals in Spain. RESULTS The findings show that in Spain, the fact that fibromyalgia lacks recognition still remains: in policies, in the clinical and professional fields, and in the patients' social circle. International health policy has not yet taken steps to reflect the emergence of this recently diagnosed disease. The care for patients suffering from fibromyalgia, who are mainly women, leads to frustration among the healthcare professionals and desperation among the patients themselves, as a resolutive treatment for the disease is not existing. Patients show resistance at assuming the sick role. They want to carry on undertaking their daily activities, both in the public sphere and in the private one. Roles involving the gendered division of labour were found to follow a rigid pattern, both prior to and subsequent to the disease, as the causes that led to frustration for men or women differ according to activities that are socially assigned to them. In practice, FM is conceived exclusively as a women's health problem, which may result in a gender-biased patient healthcare attention. CONCLUSION Political, professional and individual spheres have an influence on how this disease is constructed on a social level: as one of the "invisible women's diseases". It is recommended to resolve the disease's lack of recognition by i) implementing specific policies for FM and ii) increasing the training and sensitization of health providers about the severity of FM and the existence of gender prejudices biasing the attention.
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Affiliation(s)
- Erica Briones-Vozmediano
- Department and Faculty of Nursing and Physiotherapy, University of Lleida, Lleida, Spain
- Public Health Research Group of the University of Alicante, University of Alicante, Alicante, Spain
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Briones-Vozmediano E. The social construction of fibromyalgia as a health problem from the perspective of policies, professionals, and patients. Glob Health Action 2016; 9:31967. [PMID: 27989274 PMCID: PMC5165055 DOI: 10.3402/gha.v9.31967] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Revised: 10/30/2016] [Accepted: 11/02/2016] [Indexed: 11/15/2022] Open
Abstract
This article is a review of the PhD thesis written by Erica Briones-Vozmediano, entitled, 'The social construction of fibromyalgia as a health problem from the perspective of policies, professionals, and patients'. The findings show that in Spain, the fact that fibromyalgia (FM) lacks recognition still remains: in policies, in the clinical and professional fields, and in the patients' social circle. These three spheres have an influence on how this disease is constructed on a social level. International health policy has not yet taken steps to reflect the emergence of this recently diagnosed disease. The care for patients suffering from FM, who are mainly women, leads to frustration among the healthcare professionals and desperation among the patients themselves, as a resolutive treatment for the disease is not existing. Patients show resistance at assuming the sick role. They want to carry on undertaking their daily activities, both in the public sphere and in the private one. Roles involving the gendered division of labour were found to follow a rigid pattern, both prior to and subsequent to the disease, as the causes that led to frustration for men or women differ according to activities that are socially assigned to them. In practice, FM is conceived exclusively as a women's health problem, which may result in a gender-biased patient healthcare attention. It is recommended that the implementation of specific policies for FM which could resolve this evident shortcoming should take place. To draw attention on a social level to certain illnesses considered to be attributed to women, such as FM, is of utmost importance, in order to allow the patients to be socially recognised as suffering a real and disabling disease.
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Affiliation(s)
- Erica Briones-Vozmediano
- Department and Faculty of Nursing and Physiotherapy, University of Lleida, Lleida, Spain
- Public Health Research Group of the University of Alicante, University of Alicante, Alicante, Spain;
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Estévez-López F, Álvarez-Gallardo IC, Segura-Jiménez V, Soriano-Maldonado A, Borges-Cosic M, Pulido-Martos M, Aparicio VA, Carbonell-Baeza A, Delgado-Fernández M, Geenen R. The discordance between subjectively and objectively measured physical function in women with fibromyalgia: association with catastrophizing and self-efficacy cognitions. The al-Ándalus project. Disabil Rehabil 2016; 40:329-337. [PMID: 27973914 DOI: 10.1080/09638288.2016.1258737] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE People with fibromyalgia experience a disagreement between patient-reported (i.e., subjective) and performance-based (i.e., objective) status. This study aimed to (i) corroborate the discordance between subjectively and objectively measured physical function and (ii) examine whether catastrophizing (worrying, pain magnifying, and helpless cognitions) and self-efficacy (believing capable to manage pain) are independently associated with this discordance. METHODS This population-based cross-sectional study included 405 women with fibromyalgia and 193 age-matched female controls. Participants completed the Pain Catastrophizing Scale, Chronic Pain Self-efficacy Scale, and physical functioning subscales of the Revised Fibromyalgia Impact Questionnaire and Short Form-36 (SF-36) health survey. Objective physical function was measured with the Senior Fitness Test battery. Subjective and objective physical functions were expressed as deviation from the general population in standard deviation (SD) units using means and SD of the control group. RESULTS In fibromyalgia, subjective physical function was worse than objective physical function (p < 0.001). Higher catastrophizing was consistently associated with greater discordance between subjective and objective physical function, while self-efficacy was only significantly associated with this discordance when subjective physical function was assessed by means of the SF-36. CONCLUSIONS Subjective physical function is more impaired than objective physical function in fibromyalgia, yet both are markedly impaired. Catastrophizing cognitions are associated with this discordance. In particular, high catastrophizing may promote a feeling of reduced ability to do meaningful activities of daily living (i.e., restrictions) that people with fibromyalgia are actually able to. Therefore, catastrophizing should be assessed and potentially targeted when focusing on improving physical function in fibromyalgia. Implications for rehabilitation Rehabilitation should focus on physical exercise programs to help women with fibromyalgia to improve their reduced physical function. In rehabilitation settings, physical function of people with fibromyalgia should be evaluated by both subjective and objective assessments to fully understand physical functioning and to test the existence of discordance between both assessments. In case of a large discordance between subjective and objective physical function, a physical exercise program might be better complemented with cognitive management techniques to reduce catastrophizing and subjective physical dysfunction. When people with fibromyalgia experience high levels of catastrophizing, subjective assessments seem to be poor indicators of physical function.
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Affiliation(s)
- Fernando Estévez-López
- a Department of Physical Education and Sport, Faculty of Sport Sciences , University of Granada , Granada , Spain.,b Department of Psychology, Faculty of Social and Behavioural Sciences , Utrecht University , Utrecht , The Netherlands
| | - Inmaculada C Álvarez-Gallardo
- a Department of Physical Education and Sport, Faculty of Sport Sciences , University of Granada , Granada , Spain.,c Department of Physical Education, Faculty of Education Sciences , University of Cádiz , Cádiz , Spain
| | - Víctor Segura-Jiménez
- a Department of Physical Education and Sport, Faculty of Sport Sciences , University of Granada , Granada , Spain.,c Department of Physical Education, Faculty of Education Sciences , University of Cádiz , Cádiz , Spain
| | - Alberto Soriano-Maldonado
- a Department of Physical Education and Sport, Faculty of Sport Sciences , University of Granada , Granada , Spain.,d Department of Education, Faculty of Education Sciences , University of Almería , Almería , Spain
| | - Milkana Borges-Cosic
- a Department of Physical Education and Sport, Faculty of Sport Sciences , University of Granada , Granada , Spain
| | - Manuel Pulido-Martos
- e Department of Psychology, Faculty of Humanities and Sciences of Education , University of Jaén , Jaén , Spain
| | - Virginia A Aparicio
- f Department of Physiology, Faculty of Pharmacy, Faculty of Sport Sciences, and Institute of Nutrition and Food Technology , University of Granada , Granada , Spain.,g Department of Public and Occupational Health , EMGO + Institute for Health and Care Research, VU University Medical Centre , Amsterdam , The Netherlands
| | - Ana Carbonell-Baeza
- c Department of Physical Education, Faculty of Education Sciences , University of Cádiz , Cádiz , Spain
| | - Manuel Delgado-Fernández
- a Department of Physical Education and Sport, Faculty of Sport Sciences , University of Granada , Granada , Spain
| | - Rinie Geenen
- b Department of Psychology, Faculty of Social and Behavioural Sciences , Utrecht University , Utrecht , The Netherlands
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Grape HE, Solbrække KN, Kirkevold M, Mengshoel AM. Tiredness and fatigue during processes of illness and recovery: A qualitative study of women recovered from fibromyalgia syndrome. Physiother Theory Pract 2016; 33:31-40. [PMID: 27898261 DOI: 10.1080/09593985.2016.1247933] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Fibromyalgia syndrome (FMS), a chronic musculoskeletal pain condition, is often accompanied by fatigue. In this study, inspired by narrative approaches to health and illness, we explore how women who have regained their health after FMS describe tiredness along a storyline from before they fell ill, through their illness, recovery process, and present-day health. The data derive from qualitative interviews with eight Norwegian women who previously suffered from FMS but who no longer had the condition at the time of interview. We undertook a narrative analysis to understand the complexity of the stories about tiredness and fatigue and on this basis identified a storyline based on four sub-narratives: 1) Alarming but ignored tiredness (before illness); 2) paralyzing fatigue (during illness); 3) making sense of fatigue (recovery process); and 4) integrating tiredness into life (today). The findings highlight participants' different understandings and meanings of tiredness and fatigue and the ways in which these link past, present, and future. Significantly, a clear distinction between tiredness and fatigue was not always found. Overall, the storyline that emerges from the narratives is about balancing tiredness/fatigue with everyday life, and how this unfolds in different ways across the span of FMS, from falling ill to recovering and regaining health.
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Affiliation(s)
- Hedda Eik Grape
- a Faculty of Medicine , Institute of Health and Society, University of Oslo , Blindern , Oslo , Norway
| | - Kari Nyheim Solbrække
- a Faculty of Medicine , Institute of Health and Society, University of Oslo , Blindern , Oslo , Norway
| | - Marit Kirkevold
- a Faculty of Medicine , Institute of Health and Society, University of Oslo , Blindern , Oslo , Norway
| | - Anne Marit Mengshoel
- a Faculty of Medicine , Institute of Health and Society, University of Oslo , Blindern , Oslo , Norway
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20
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Hiort J, Lindau M, Löfgren M. Young pain patients’ experience in primary care. A qualitative study. NORDIC PSYCHOLOGY 2016. [DOI: 10.1080/19012276.2016.1178166] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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21
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Grape HE, Solbrække KN, Kirkevold M, Mengshoel AM. Staying healthy from fibromyalgia is ongoing hard work. QUALITATIVE HEALTH RESEARCH 2015; 25:679-688. [PMID: 25387910 DOI: 10.1177/1049732314557333] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Fibromyalgia syndrome (FMS) is a chronic musculoskeletal pain condition. Although studies have reported that some patients can become healthy again, little is known about what they tell about their lives after having FMS. In this study, we interviewed eight Norwegian women who had all recovered from FMS about their experiences when ill and subsequently being healthy. Inspired by narrative methods, we then conducted a thematic narrative analysis. The findings indicate that although women reported that life was better than before, they also reported investing considerable effort in remaining healthy. When ill, they struggled to maintain the routines of everyday life. Being healthy again, they put great effort into avoiding illness through diet, exercise, and relaxation. In conclusion, remaining healthy requires ongoing hard work to maintain the body, as well as profound changes in everyday life. At the same time, the narratives show continuity in the informants' self-presentation as hard-working women.
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Affiliation(s)
- Hedda Eik Grape
- University of Oslo, Institute of Health and Society, Oslo, Norway
| | - Kari N Solbrække
- University of Oslo, Institute of Health and Society, Oslo, Norway
| | - Marit Kirkevold
- University of Oslo, Institute of Health and Society, Oslo, Norway
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Lind AB, Delmar C, Nielsen K. Searching for existential security: a prospective qualitative study on the influence of mindfulness therapy on experienced stress and coping strategies among patients with somatoform disorders. J Psychosom Res 2014; 77:516-21. [PMID: 25481403 DOI: 10.1016/j.jpsychores.2014.07.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2014] [Revised: 07/16/2014] [Accepted: 07/17/2014] [Indexed: 12/25/2022]
Abstract
OBJECTIVE The aim was to explore how mindfulness group therapy for somatoform disorders influenced the patients' stress experiences, coping strategies and contextual psychosocial processes. METHODS A longitudinal pre- and post-treatment design, using 22 semi-structured individual pre- and post-treatment interviews. Data-analysis was based on a thematic methodology. RESULTS Pre-treatment patients were struggling in an existential crisis, feeling existentially insecure about their social identity, the causes, consequences and management of their illness; experiencing difficulties identifying and expressing stress-related cognitions, emotions and feelings, and low bodily and emotional self-contact; often leading to avoidant coping, making these individuals highly stress-vulnerable. Post-treatment, the overall change was conceptualized as increased existential security, defined by patients being more self-confident; more clarified with their social identity, the nature, management and future prospects of their illness; generally using more flexible coping strategies to reduce their daily stress experiences. Four related subthemes were identified contributing to increased existential security: 1) more secure illness perceptions - feeling existentially recognized as "really" ill, 2) enhanced relaxation ability - using mindfulness techniques, 3) increased awareness - connecting differently to mind and body 4) improved ability to identify and express needs and feelings of distress - more active communicating. Patients suggested that mindfulness therapy could be expanded with more time for group-discussions followed by additional individual therapy. CONCLUSION Generally, treatment positively influenced the patients' illness perceptions, stress-experiences, body- and self-awareness, coping strategies, self-image, social identity and social functioning. However, patients identified potentials for treatment improvements, and they needed further treatment to fully recover.
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Affiliation(s)
- Annemette Bondo Lind
- Department of Psychology and Behavioural Sciences, Aarhus University, Denmark; Department of Clinical Medicine, Aarhus University, Denmark.
| | - Charlotte Delmar
- Department of Clinical Medicine, Aarhus University, Denmark; Department of Science in Nursing, Aarhus University, Denmark
| | - Klaus Nielsen
- Department of Psychology and Behavioural Sciences, Aarhus University, Denmark
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Park J, Ryu YU. Online discourse on fibromyalgia: text-mining to identify clinical distinction and patient concerns. Med Sci Monit 2014; 20:1858-64. [PMID: 25287854 PMCID: PMC4199397 DOI: 10.12659/msm.890793] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND The purpose of this study was to evaluate the possibility of using text-mining to identify clinical distinctions and patient concerns in online memoires posted by patients with fibromyalgia (FM). MATERIAL AND METHODS A total of 399 memoirs were collected from an FM group website. The unstructured data of memoirs associated with FM were collected through a crawling process and converted into structured data with a concordance, parts of speech tagging, and word frequency. We also conducted a lexical analysis and phrase pattern identification. After examining the data, a set of FM-related keywords were obtained and phrase net relationships were set through a web-based visualization tool. RESULTS The clinical distinction of FM was verified. Pain is the biggest issue to the FM patients. The pains were affecting body parts including 'muscles,' 'leg,' 'neck,' 'back,' 'joints,' and 'shoulders' with accompanying symptoms such as 'spasms,' 'stiffness,' and 'aching,' and were described as 'sever,' 'chronic,' and 'constant.' This study also demonstrated that it was possible to understand the interests and concerns of FM patients through text-mining. FM patients wanted to escape from the pain and symptoms, so they were interested in medical treatment and help. Also, they seemed to have interest in their work and occupation, and hope to continue to live life through the relationships with the people around them. CONCLUSIONS This research shows the potential for extracting keywords to confirm the clinical distinction of a certain disease, and text-mining can help objectively understand the concerns of patients by generalizing their large number of subjective illness experiences. However, it is believed that there are limitations to the processes and methods for organizing and classifying large amounts of text, so these limits have to be considered when analyzing the results. The development of research methodology to overcome these limitations is greatly needed.
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Affiliation(s)
- Jungsik Park
- College of Humanities, Ajou University, Suwon-si, Korea
| | - Young Uk Ryu
- Department of Physical Therapy, Catholic University of Daegu, Gyeongsan-si, Korea
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Struggling in an emotional avoidance culture: a qualitative study of stress as a predisposing factor for somatoform disorders. J Psychosom Res 2014; 76:94-8. [PMID: 24439683 DOI: 10.1016/j.jpsychores.2013.11.019] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2013] [Revised: 11/28/2013] [Accepted: 11/29/2013] [Indexed: 01/30/2023]
Abstract
OBJECTIVE To explore patterns of experienced stress and stress reactions before the onset of illness in the life history of patients with severe somatoform disorders to identify predisposing stress-mechanisms. METHODS A systematic, thematic analysis was conducted on data collected from 24 semi-structured individual life history interviews. RESULTS Generally, patients had experienced high psychosocial stress during childhood/youth. However, there was considerable variability. Characteristic of all patients were narrations of how communication with significant adults about problems, concerns, and emotions related to stress were experienced to be difficult. The patients described how this involved conflicts stemming from perceived absent, insufficient, or dismissive communication during interactions with significant adults. We conceptualized this empirically based core theme as "emotional avoidance culture." Further, three related subthemes were identified: Generally, patients 1.) experienced difficulties communicating problems, concerns, and related complex feelings in close social relations; 2.) adapted their emotional reactions and communication to an emotional avoidance culture, suppressing their needs, vulnerability and feelings of sadness and anger that were not recognized by significant adults; and 3.) disconnected their stress reaction awareness from stressful bodily sensations by using avoidant behaviors e.g. by being highly active. CONCLUSION Patients adapted to an emotional avoidance culture characterized by difficult and conflicting communication of concerns and related emotions in social interactions with significant adults. Patients experienced low ability to identify and express stress-related cognitions, emotions and feelings, and low bodily and emotional self-contact, which made them vulnerable to stressors. Generally, patients resolved stress by avoidant behaviors, prolonging their stress experience.
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Juuso P, Söderberg S, Olsson M, Skär L. The significance of FM associations for women with FM. Disabil Rehabil 2013; 36:1755-61. [PMID: 24350657 DOI: 10.3109/09638288.2013.868046] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE Living with fibromyalgia (FM) means living with a long-term pain syndrome that is invisible to others. Support and understanding from others seem to be important to managing the affected daily life. The aim of this study was to describe the significance of FM associations for women with FM. METHODS Data collection was carried out through focus group discussions with seventeen women with FM. Data were analyzed through thematic content analysis. RESULTS The findings show that women experienced associations for people with FM as important as they gave access to contacts with others with similar experiences. Their need of togetherness was fulfilled at the association and they described being strengthened by the support received. Because of the lack of information and knowledge about FM, the association was described as an important venue for getting and mediating information about the illness. CONCLUSIONS At the association the women seem to be empowered, which increases their ability to manage their daily lives despite the limitations imposed by FM. Healthcare personnel could not satisfy the women's needs and to manage to support women with FM. There is a need for communication based on a shared understanding between the women and healthcare personnel. IMPLICATIONS FOR REHABILITATION This study highlighted the need for communication based on a shared understanding between people with chronic illness and healthcare personnel to support and strengthen women with FM in their daily lives. The FM associations meet the needs for togetherness, confirmation, and information that the women with FM in this study described and healthcare personnel could not satisfy. Healthcare personnel can learn from FM associations how to empower women with FM in their everyday lives.
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Affiliation(s)
- Päivi Juuso
- Division of Nursing, Department of Health Science, Luleå University of Technology , Luleå , Sweden
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Palstam A, Gard G, Mannerkorpi K. Factors promoting sustainable work in women with fibromyalgia. Disabil Rehabil 2013; 35:1622-9. [PMID: 23336119 DOI: 10.3109/09638288.2012.748842] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To examine and describe the factors promoting sustainable work in women with fibromyalgia (FM). METHODS A qualitative interview study. Twenty-seven gainfully employed women with FM participated in five focus group interviews. Their median age was 52 years, ranging from 33 to 62. The interviews were recorded, transcribed verbatim and analysed by qualitative latent content analysis. RESULTS Four categories were identified describing factors promoting sustainable work: the meaning of work and individual strategies were individual promoters while a favourable work environment and social support outside work were environmental promoters. The meaning of work included individual meaning and social meaning. The individual strategies included handling symptoms, the work day and long-term work life. A favourable work environment included the physical and psychosocial work environment. Social support outside work included societal and private social supports. CONCLUSIONS Promoting factors for work were identified, involving individual and environmental factors. These working women with FM had developed advanced well-functioning strategies to enhance their work ability. The development of such strategies should be supported by health-care professionals as well as employers to promote sustainable work in women with FM. IMPLICATIONS FOR REHABILITATION Work disability is a common consequence of fibromyalgia (FM). Working women with FM appear to have developed advanced well-functioning individual strategies to enhance their work ability. The development of individual strategies should be supported by health-care professionals as well as employers to promote sustainable work and health in women with FM.
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Affiliation(s)
- Annie Palstam
- Department of Rheumatology and Inflammation Research, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.
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