Psychotherapy for Physical Pain in Patients with Fibromyalgia: A Systematic Review

Abstract

<jats:p><jats:italic>Objective</jats:italic>. To provide a brief and comprehensive summary of the recent evidence from clinical trials testing psychotherapeutic interventions in patients with fibromyalgia with particular interest in their possible effect on physical pain. <jats:italic>Methods</jats:italic>. Bibliographical search was performed in PubMed, PsycInfo, Web of Science, Scopus, and Cochrane Library databases. Content of the manuscripts was studied to obtain, if available, the following information: year of publication, location of the research team, design, type of psychotherapeutic intervention tested, pain measures, and a brief description of the psychotherapy, groups, and outcomes regarding physical pain. <jats:italic>Results</jats:italic>. Initial search eliciting 475 citations got reduced to 13 relevant papers. Most research studies from Spain (<jats:italic>n</jats:italic> = 8) are randomized control trials (<jats:italic>n</jats:italic> = 10) and used guided imagery (<jats:italic>n</jats:italic> = 5) or cognitive behavioral therapy (<jats:italic>n</jats:italic> = 4). The Visual Analogue Scale (<jats:italic>n</jats:italic> = 4) and the Fibromyalgia Impact Questionnaire (<jats:italic>n</jats:italic> = 4) were the physical pain measures mostly used. Improvements on physical pain were reported on all studies with published results; nevertheless, only in five cases, differences were significant. <jats:italic>Conclusions</jats:italic>. Evidence on the effect of psychotherapy on physical pain in patients with FS was divergent; though most studies report a reduction in pain, this was not always lasting and/or significant. Diversity of the results might be due to the selected psychotherapeutic approaches, assessment tools, and other internal (e.g., personality traits, (sub)clinical psychiatric symptoms, and treatment adherence) and external (e.g., family environment and social support) variables worth to be considered in the future research.</jats:p>

Psychoeducation for Patients with Fibromyalgia: A Systematic Review

“…Pain was the outcome measure common to all the studies, with an overall significant decrement in all groups receiving psychoeducation. A recent review [ 19 ] regarding the use of psychotherapy for physical pain in patients with FM found that CBT and imagery were the most commonly used approaches. Although improvements on physical pain were reported on all studies, results were not lasting and/or significant.…”

“…Psychotherapeutic interventions in patients with FM include CBT, guided imagery, hypnosis, acceptance and commitment therapy, and mindfulness, among other approaches [ 19 , 20 , 21 ]. A recent review [ 19 ] on psychotherapy for the management of physical pain in patients with FM found that CBT and guided imagery were the two most commonly used strategies. Moreover, although most studies reported a reduction in pain, this was not always significant and/or lasting.…”

“…Psychology, in the form of psychotherapy or psychoeducation, provides complementary treatment to help patients improve their skills to control negative emotions that may trigger or worsen FM physical symptoms. Systematic reviews have synthesized the results from psychotherapeutic interventions implemented in patients with FM [ 26 ], for instance, for the management of physical pain [ 19 ], the use of CBT [ 27 ], mindfulness [ 28 ], or guided imagery and hypnosis [ 29 ], and the group [ 20 ] or Internet [ 30 ] modalities. Psychoeducation programs provide the patient the opportunity to learn about this condition and to develop emotional skills for self-management.…”

Hyperbaric oxygen therapy ameliorates pain in overweight or obese patients diagnosed with fibromyalgia

“…Fatigue is an important symptom that contributes to the decline of the quality of life of patients with fibromyalgia (5,6). This symptom was evaluated using the FACIT-F questionnaire of 13 factors, which were scored as follows: 0, no fatigue; 1, minimal fatigue; 2, some; 3, quite a bit; and 4, significant fatigue.…”

“…In 2016, the latest revision of these criteria re-established the importance of generalized pain as the main symptom (3), but also considered other symptoms equally as important for the diagnosis considering these criteria. The estimated global population affected by this disease ranges between 0.5-5.8% (4), and the disease particularly affects women (2.4-6.8%) (5). Fibromyalgia is a disabling syndrome with no effective pharmacological cure; thus, recent alternative therapeutic strategies have been proposed to mitigate pain and fatigue, and avoid the side-effects of polypharmacy (6).…”