Increasing Activity, Reducing Stress Led to Symptom Improvement in Fibromyalgia

In an analysis of patients with chronic widespread pain (CWP), such as fibromyalgia, experiences of health improvement involved actively chosen changes in addition to contextual factors, including seeking support, reducing stressors, and balancing activities and rest, according to a study published in Disability and Rehabilitation.¹

Fibromyalgia is a subgroup of CWP, affecting approximately 10 – 15% of patients with CWP, in which patients often exhibit more severe symptoms. The condition has also been associated with symptoms besides pain, such as cognitive dysfunction, psychological distress, fatigue, tenderness, and activity limitations.²

“Despite several previous studies, knowledge is still lacking regarding the self-reported experiences of improvement in persons with CWP, since most previous long-term studies of symptom changes focused on quantitative data,” wrote lead investigator Sofia Juhlin, doctoral student at the Institute of Neuroscience and Physiology/Physiotherapy, Sahlgrenska Academy, University of Gothenburg, Sweden, and colleagues. “In this study, we seek deeper knowledge regarding how the participants, women with CWP, experienced an improvement in symptoms and general health over time to help in the rehabilitation for these persons.”

Women with CWP who participated in a 10- to 12-year follow-up study of a randomized controlled intervention trial were recruited into the qualitative interview study. Eligible patients were those who improved at least 30% on a visual analog scale of pain intensity from baseline to follow-up.

In total, 17 women (mean age 58.06 years) were included in the study and participated in semi-structured interviews conducted in 3 Swedish cities between November 2017 and February 2018. The semi-structured approach allowed investigators to cover the desired topics while giving participants an opportunity to discuss the subjects that were most important for them.

Topics focused on the patient’s perception of the factors that led to their improvement over the follow-up period, symptom management strategies, changes in symptoms, and life changes. A qualitative content analysis evaluated the data.

Health improvement themes regarding experience of improvement, developing strategies for better health, and contextual factors supporting improvement, were observed during the interview analysis. Subcategories within the “experience of improvement” theme were feeling better despite symptoms and the ability to perform more activities. The “developing strategies for better health” theme included changing one’s view of oneself and their life, developing a more productive mental health approach to the illness, and actively choosing to improve health through action. Lastly, the “contextual factors supporting improvement” theme focused on receiving support from healthcare, social support, and a reduced load in daily life.

Most patients reported experiencing fewer symptoms at follow-up compared with baseline, including less pain and fatigue, as well as an increase in better sleep, mood, and quality of life. They were also more active when compared the beginning of the study. By developing strategies for better health, the women described accepting their symptoms, without letting them determine their behavior, and learning how to handle both pain and other setbacks in life during the follow-up period. Regarding contextual factors, patients found that by reducing stress levels, such as changing occupations, they were able to ultimately decrease pain levels.

“Clinical implications of this study are that increased knowledge regarding pain management, increased physical activity, and reduced stress could contribute to symptom improvement in persons with CWP,” investigators concluded.

References

1. ^{Juhlin S, Mannerkorpi K, Bergenheim A. Factors promoting improvements in symptoms and health in women with fibromyalgia and chronic widespread pain: a qualitative interview study [published online ahead of print, 2023 Jun 1]. Disabil Rehabil. 2023;1-6. doi:10.1080/09638288.2023.2218655}
2. ^{Wolfe F, Smythe HA, Yunus MB, et al. The American college of rheumatology 1990 criteria for the classification of fibromyalgia. Report of the multicenter criteria committee. Arthritis Rheum. 1990;33(2):160–172.}