Pain Management Remains Challenging for Patients with Fibromyalgia

Results of a database search revealed the management of pain symptoms remains a continued source of frustration and an unmet need for patients with fibromyalgia, according to a study published in Disability and Rehabilitation.¹

Guidelines suggest an interdisciplinary approach to managing the symptoms of fibromyalgia, including education, exercise, and cognitive behavioral therapy. However, the efficacy and approach to treatment varies widely among patients, due in part to delays in care and the long time to diagnosis (median 6.42 years).²

Although previous research has observed frustrations among patients and clinicians regarding effective treatment for this patient population, patient-centered approaches are often linked to better health outcomes and the development of effective self-management strategies.³

“However, healthcare professionals may use less patient-centered approaches in people with fibromyalgia compared to conditions with visible physical symptoms,” wrote lead investigator Carol Climent Sanz, PhD, researcher at the Department of Nursing and Physiotherapy, University of Lleida, Spain, and the Health Care Research Group (GRECS), and colleagues. “Therefore, exploring and describing patient experiences with prescribed treatments and self-management strategies for fibromyalgia pain alleviation is necessary for the development of more patient and person-centered treatment approaches, while reducing the epistemic injustice faced by this patient group.”

Investigators used a comprehensive search strategy using PubMed, ISI Web of Science, Scopus, and Cinahl Plus databases to identify studies in which adult patients with fibromyalgia discussed their pain management and their perceptions of the efficacy of their prescribed treatments. The confidence of findings was evaluated using the GRADE-CERQual framework and results were assessed using an inductive thematic analysis approach.

Ultimately, 35 studies comprised of 728 patients were included in the analysis, with the confidence in results ranging from low to high. Six themes emerged based on patient perspectives: pharmacological treatments, exercise and physical activity, psychological approach to pain management, disengagement from pain, a desire to better understand fibromyalgia and pain management, and complementary and alternative therapies.

The searched indicated pharmacological treatment was often rejected by patients due to the side effects, lack of efficacy, and fear of addiction. Patients often reported feeling like “walking chemists” or a “walking pharmacy.” Regarding exercise, patients either felt it helped keep their pain intensity under control or it exacerbated their symptoms. While going to the gym was mentioned as a main pain management strategy, some patients were fearful of physical activity due to previous negative experiences.

Patients touted psychological support as an essential factor in the management of their fibromyalgia. However, many patients believed telephone-based cognitive behavioral therapy was ineffective as it did not individualize treatment and increased feelings of stigma.

Although natural and complementary therapies, such as massage, acupuncture, and herbal products, had short-term benefits, patients noted combining therapy with physical exercise was a more effected approach. Most patients were interested in better understanding their condition and learning strategies to reduce their symptoms of pain, which included disengaging from pain.

Investigators believe these findings represent the heterogeneous nature of the condition, as underscored by the variety of perspectives on pain treatment approaches reported. Therefore, they urge clinicians to adopt a patient-centered, individualized approach to treatment

Although fibromyalgia can lead to a multitude of symptoms, including fatigue and poor sleep quality, investigators focused their analysis on pain. Therefore, they encourage future research to study other psychological and physiological symptoms of the condition that impact a patient’s daily life.

“Taking everything into account, the lack of effective treatments for fibromyalgia resulting in long-term relief proves frustrating for patients and healthcare providers,” investigators concluded. “These findings provide crucial insight for providers and researchers; and support the need for fibromyalgia phenotyping and precision medicine approaches to pain management.”

References

1. ^{Climent-Sanz C, Hamilton KR, Martínez-Navarro O, et al. Fibromyalgia pain management effectiveness from the patient perspective: a qualitative evidence synthesis. Disabil Rehabil. Published online November 15, 2023. doi:10.1080/09638288.2023.2280057}
2. ^{Gendelman O, Amital H, Bar-On Y, et al. Time to diagnosis of fibromyalgia and factors associated with delayed diagnosis in primary care. Best Pract Res Clin Rheumatol. 2018;32(4):489–499. doi:10.1016/j.berh.2019.01.019.}
3. ^{Macfarlane GJ, Kronisch C, Dean LE, et al. EULAR revised recommendations for the management of fibromyalgia. Ann Rheum Dis. 2017;76(2):318–328. doi:10.1136/annrheumdis-2016-209724.}