Perceptions of people living with chronic illness change over time, contributing to health-related stress that necessitates coping skills. Self-efficacy operates as an important cognitive factor in the control of symptoms such as pain, with self-efficacy beliefs helping to explain many of the behaviors and disabilities of those with persistent symptoms (Figure 1). Fibromyalgia (FM) is an idiopathic chronic condition that causes widespread musculoskeletal pain, hyperalgesia and allodynia, affecting 2.10% (a total of 4% female and 2-5% male) of the world's population, 2.3% of the European population, 2.4% of the Spanish population [2,3]. In France, work productivity loss contributed almost 90% of the total costs incurred by patients with FM, with an economic cost of 13000 million euros annually which is around $100 billion in US [2,4,5]. Work disability was found to be 35% in US and Australia and 30% reported in Canada due to FM [6]. FM is more common in women compared to men, with a ratio of 2:1 [7] or 3:1 [8], although other studies say 85%-90% FM patients are middle aged women [9,10]. 30-50% of FM
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