Management perspectives from patients with fibromyalgia experiences with the healthcare pathway: a qualitative study

Perceived benefits and limitations of a psychoeducation program for patients with fibromyalgia: an interpretative phenomenological analysis

Objective

To analyze the perceived benefits and limitations of a pain psychoeducation program as a non-pharmacological treatment for patients with fibromyalgia.

Methods

An interpretative phenomenological analysis was applied to analyze the subjective experiences of 11 patients with fibromyalgia who participated in a pain psychoeducation program. This program includes educational sessions that address pain understanding, coping strategies, and relaxation techniques. Semi-structured interviews were conducted, transcribed, and analyzed using ATLAS.ti software.

Results

Patients reported significant improvements in cognitive-functional capacity and socio-emotional ability, including better disease understanding and management, emotional stability, and interpersonal relationships. Despite these benefits, they identified limitations in program individualization and insufficient coverage of certain topics, such as sexual health and legal aspects of disability. Enhanced self-management skills were evident, with observed shifts in disease perception and coping strategies.

Conclusion

The psychoeducation program was viewed positively, influencing functional, cognitive, and emotional enhancements. Nonetheless, the need for increased program personalization and expanded socio-economic support was noted. Future research should focus on the long-term impacts of psychoeducation and the feasibility of tailored interventions.

Physiotherapists' adherence to Clinical Practice Guidelines in fibromyalgia: a cross-sectional online survey

To evaluate the level of knowledge and adherence to Clinical Practice Guidelines on fibromyalgia of physiotherapists in Spain. A cross-sectional study using an ad-hoc online survey was implemented to assess aspects on the assessment, treatment, and decision of the length of the therapeutic approach on fibromyalgia. Based on the results, professionals were classified as adherent, partially adherent, or non-adherent. The level of agreement with several statements on the condition was also evaluated across the professionals surveyed to evaluate the potential consensus. A total of 240 physiotherapists met inclusion criteria, amongst which 68 (28.33%) were adherent. The academic level of studies (Chi-square = 48.601, p-value = 0.001) and having had previous training in fibromyalgia (Chi-square = 151.011, p-value = 0.001) displayed statistically significant differences across adherence-based groups. Consensus was reached for 15 out of 24 statements. Our findings highlight the presence of an acceptable level of knowledge and adherence to clinical practice guidelines in the field of fibromyalgia among physiotherapists in Spain.Practice implicationsOur results also reveal the existence of an evidence-to-practice gap in the field, with potential room for improvement: further efforts on promoting and reinforcing the importance of evidence-based therapies are needed, from university teaching plans to clinical updates for daily practice.

Effectiveness of balneotherapy in reducing pain, disability, and depression in patients with Fibromyalgia syndrome: a systematic review with meta-analysis

Balneotherapy, using heated natural mineral waters at 36-38 °C, presents a comprehensive treatment approach for Fibromyalgia Syndrome (FMS). This study aims to assess the effect of balneotherapy in reducing pain intensity, disability, and depression in patients with FMS. We want to assess this effect at just four time-points: immediately at the end of the therapy, and at 1, 3, and 6 months of follow-up. Following PRISMA guidelines, we conducted an aggregate data meta-analysis, registered in PROSPERO CRD42023478206, searching PubMed Medline, Science Direct, CINAHL Complete, Scopus, and Web of Science until August 2023 for relevant randomized controlled trials (RCTs) that assess the effect of balneotherapy on pain intensity, disability, and depression in FMS patients. Methodological quality was assessed using the Cochrane methodology, and the pooled effect was calculated using Cohen's standardized mean difference (SMD) and its 95% confidence interval (95% CI) in a random-effects model. Sixteen RCTs were included in the meta-analysis. Balneotherapy is effective in reducing pain intensity (SMD - 1.67; 95% CI -2.18 to -1.16), disability (SMD - 1.1; 95% CI -1.46 to -0.7), and depression (SMD - 0.51; 95% CI -0.93 to -0.9) at the end of the intervention. This effect was maintained at 1, 3, and 6 months for pain intensity and disability. Balneotherapy improves both pain intensity and disability in patients with FMS, providing evidence that its positive effects are sustained for up to 6 months of follow-up. Nevertheless, it is important to note that the improvement in depression varies across different temporal phases.

[Psychocorporal approach to functional somatic disorders]

Functional somatic disorders (FSD) are common conditions that result in a significant deterioration of the quality of life. Their origin is multifactorial and poorly understood, and their management is often inadequately defined. Medications typically show limited effectiveness, while mind-body approaches play a central role, guided by three key principles: establishing an empathetic, respectful, and sincere doctor-patient relationship; promoting regular and gradual physical activity; and implementing cognitive behavioral therapy (CBT). Special attention must be devoted to establishing a trustworthy relationship between the physician and the patient. Recognizing the reality and severity of symptoms and providing a positive diagnosis as well as an explanatory model to account for them rationally are fundamental aspects of patient management. Cognitive and behavioral maintenance factors should be investigated and constitute therapeutic targets. Cognitive factors include focused attention on body functioning and catastrophizing. Patients frequently display avoidance behaviors, particularly in relation to physical exertion, and it is crucial to motivate them to reintroduce gradual physical activity customized to their abilities. This approach has demonstrated efficacy in improving fatigue, pain, and the physical and mental quality of life for patients with FSD. Among psychotherapeutic approaches, the benefit of CBT is well-established. The combination of gradual physical activity and CBT appears to be complementary. Other mind-body approaches such as mindfulness meditation might help although their level of evidence is weaker. Given the prevalence of FSD in the general population, it seems necessary for all physicians to be trained in managing this condition.

Early maladaptive schemas in female patients with migraine and tension-type headache

Chronic headache is a serious clinical problem in women which psychological factors play major role and requires an approach with bio-psycho-social integrity. Psychiatric comorbidities such as anxiety disorder and major depression are frequent. Young described Early Maladaptive Schemas (EMS) as maladaptive and dysfunctional patterns that appear due to unpleasant situations occurred between patient and people who were important to him. EMS affect perception, emotions, thoughts and behaviors that makes a basis for many disorders. EMS are found to be related with depression, anxiety and somatization within recent literature. In literature, chronic pain and migraine's relationship with EMS were studied before in a few separate articles. However, there is a lack of data that compares the relationship between EMS and clearly distinguished headache types: migraine (MH) and tension-type headache (TTH) especially in female patients who are more prone to somatic complaints/findings. Our study directly compared three groups, migraine and tension type headache and healthy controls. 150 female patients with chronic headache were enrolled for study in consecutive fashion. Exclusion criteria were as follows: age < 18 or > 60 years, male gender, existence of comorbidity affecting central nervous system, headache due to drug/substance abuse, previous diagnosis of migraine with aura, previous diagnosis of psychotic disease, mental retardation, cognitive disorders, being in delirium state. Patients were grouped into two categories according to type of headache and a third control group. All patients were evaluated with Young Schema Questionnaire (YSQ) and their scores were noted and categorized in related schema domains. Sociodemographic data were comparable among groups. However, there were significant differences in terms of previous psychiatric diagnosis and psychiatric drug usage. When we compared YSQ scores, groups differed in many schema categories. MH group showed significantly higher scores in dependency/incompetency, unrelenting standards and punitiveness schemas when compared to remaining two groups. TTH group had significantly more points in emotional deprivation, vulnerability to harm or illness schemas among all groups. On the other hand, control group had significantly higher scores in insufficient self-discipline and entitlement/grandiosity schemas when compared to both MH and TTH groups. Presence of EMS in female patients with headache significantly differed from control group. Types of EMS were also significantly different between patients with MH and TTH among this whole headache group. We suggest that a comprehensive psychotherapeutic approach that targets to improve coping methods for distinct EMS in distinct headache types would provide critical aid to general treatment of headaches especially in resistant cases.