BACKGROUND: There has been increased interest in pain neuroscience education (PNE) as a therapeutic approach for the management of fibromyalgia (FM).
METHODS: A multicentre randomized, open-label, controlled trial was conducted to assess the effectiveness of a structured group intervention based on PNE in patients with FM. A total of 139 patients were included in the study and randomized to the intervention group (7 group sessions of education in neurobiology of pain) or to the control group (treatment as usual only). The primary outcome was the improvement of functional status and pain measured with the Fibromyalgia Impact Questionnaire (FIQ), and secondary outcomes were the reduction in the impact of pain and other symptoms (catastrophizing, anxiety and depression) and number of patients reaching no worse than moderate functional impairment (FIQ score <39). Differences between groups were calculated by linear mixed-effects (intention-to-treat approach) and mediational models through path analyses.
RESULTS: At 1 year, improvements in FIQ scores were higher in the intervention group with moderate or high effect size, and decreases of ≥20% in 69.1% of patients (20.9% in the control group) and of ≥50% in 39.7% (4.5% in the control group). Also, 52.9% of patients had a FIQ <39 points (13.4% in the control group).
CONCLUSIONS: In this sample of patients with FM, the improvement in quality of life and control of symptoms obtained by adding a PNE intervention showed promising results, equalling or surpassing previously reported outcomes.
SIGNIFICANCE: A structured group intervention based on pain neuroscience education for 1 year in patients with fibromyalgia was associated with significant amelioration of the impact of the disease on scores of the Fibromyalgia Impact Questionnaire, the Health Assessment Questionnaire, the Hospital Anxiety and Depression Scale, the Pain Catastrophizing Scale and the Polysymptomatic Distress Scale as compared with only treatment as usual. These findings are clinically relevant considering the challenges posed by fibromyalgia to clinicians and patients alike.
AIM: The aim of this study was to investigate the effectiveness of pain neuroscience education (PNE) in addition to usual treatment in patients with fibromyalgia syndrome.
METHODS: Forty patients were randomized into 2 groups. The experimental group underwent PNE sessions over 6 weeks in addition to pharmacological treatment, and the control group was given only pharmacological treatment. The primary outcome measure was functional status and the secondary outcome measures were widespread pain pressure threshold and kinesiophobia level. All assessments were conducted before the intervention and at the end of the 6th and 12th weeks by the same blinded researcher.
RESULTS: The intervention group had significantly greater improvement than the control group in terms of the mean total scores in the Fibromyalgia Impact Questionnaire (P = .001) and the Tampa Scale of Kinesiophobia (P = .001) with large effect sizes. The intervention group also had significantly greater improvement in the pain pressure threshold values of the cervical (P = .040), thoracic (P = .001), lumbar (P < .001), elbow (P = .005) and calf (P = .006) regions with moderate-to-large effect sizes.
CONCLUSION: This study showed that the addition of 6-week PNE sessions to pharmacological treatment was successful in improving functional status, widespread pain pressure threshold, and level of kinesiophobia in patients with fibromyalgia syndrome during a 12-week follow-up period.
Ambas intervenciones farmacológicas y no farmacológicas han demostrado eficacia en el tratamiento de la fibromialgia (FM). Intervenciones no farmacológicas sin embargo, son mucho menos susceptibles de ser utilizados en la práctica clínica, en parte debido al acceso limitado. Este manuscrito presenta los resultados de un rastro controlado aleatorio de un ejercicio basado en Internet y un programa de auto-manejo del comportamiento para FM diseñado para su uso en el contexto de una atención clínica de rutina. 118 personas con FM fueron asignados al azar a (a) la atención estándar o (b) la atención estándar, además de acceso a un programa de Autogestión del Comportamiento mejorado de Web (WEB-SM) basado en los principios de manejo del dolor cognitivas y conductuales. Los individuos fueron evaluados al inicio del estudio y otra vez a los 6 meses para los principales criterios de valoración: la reducción del dolor y una mejora en el funcionamiento físico. Los resultados secundarios incluyeron la fatiga, el sueño, la ansiedad y los síntomas depresivos, y una impresión global del paciente de mejoría. Las personas asignadas a la condición WEB-SM reportaron una mejoría significativamente mayor en el dolor, la función física, y la mejoría global en general. Ejercicio y técnicas de relajación son las habilidades más utilizadas en todo el período de 6 meses. Una, la intervención de la autogestión sin contacto, basado en Internet ha demostrado eficacia en los resultados clave para FM. Aunque se espera que no todo el mundo a beneficiarse de este enfoque, este estudio demostró que las intervenciones no farmacológicas pueden integrarse eficazmente en la práctica clínica habitual con resultados positivos.
OBJECTIVE: To assess the impact of a programme of health education on the quality of life and frequency of attendance of persons with fibromyalgia.
DESIGN: Community clinical trial with randomised allocation.
SETTING: Sant Joan Despí urban Health District (Barcelona), with a population of 13 282 inhabitants.
PARTICIPANTS AND METHODS: 67 women who attended our centre for consultation and were diagnosed with fibromyalgia by the Area Rheumatologist using the criteria of the American College of Rheumatology (1990). They were distributed at random into control and intervention groups.
MAIN MEASUREMENTS: Social and demographic variables (age, marital status, educational background, job situation), health variables (physical exercise taken, current treatment, symptoms evolution time) and frequency of attendance were gathered. The Nottingham Health Profile (NHP) for measuring quality of life was administered. The presence of psychological malaise was determined through the Mini International Neuropsychiatric Interview. After the intervention, which consisted of four health education sessions, the NHP was administered again and frequency of attendance was measured again.
RESULTS: The most important dimension on the NHP prior to intervention was pain (78.6 points), which was not modified either by physical exercise or the disease s time of evolution. Prevalence of psychological malaise was 64.6%. After the intervention there was a significant improvement in the pain dimension (P=.003).
CONCLUSIONS: Health education for people with fibromyalgia modifies their perception of quality of life and reduces their pain. In addition, this kind of activity increases understanding of illness and reduces dependence on the health services.
RESUMEN: Se evaluaron los efectos de la educación (IE) y las intervenciones conductuales (BI) a través de un período de tratamiento de 10 semanas ya los 6 meses de seguimiento de diversas variables (por ejemplo, lidiar con el dolor) para los pacientes con fibromialgia (FM). También se analizaron los efectos de la IE y BI vs el grupo de control en lista de espera (WLC). La IE no condujo a ningún cambio significativo. El BI llevó a beneficios en el uso de estrategias de afrontamiento al dolor, incapacidad funcional, la percepción del dolor y la calidad del sueño de los pacientes. Con la excepción de la calidad del sueño, estos efectos desaparecieron en el seguimiento. El WLC se deterioró en algunas de las Estrategias cuestionario de afrontamiento (CSQ) y el Cuestionario de Dolor de McGill (MPQ) subescalas. El BI hizo un poco mejor que el IE, en particular, pero sólo la mejora en la calidad del sueño se mantuvo con el tiempo. Llegamos a la conclusión de que las mejoras fueron escasas después del tratamiento y todo, pero uno, desaparecieron durante el seguimiento. Esencialmente, no hubo diferencias entre las tres condiciones en términos de eficacia. Más ...
There has been increased interest in pain neuroscience education (PNE) as a therapeutic approach for the management of fibromyalgia (FM).
METHODS:
A multicentre randomized, open-label, controlled trial was conducted to assess the effectiveness of a structured group intervention based on PNE in patients with FM. A total of 139 patients were included in the study and randomized to the intervention group (7 group sessions of education in neurobiology of pain) or to the control group (treatment as usual only). The primary outcome was the improvement of functional status and pain measured with the Fibromyalgia Impact Questionnaire (FIQ), and secondary outcomes were the reduction in the impact of pain and other symptoms (catastrophizing, anxiety and depression) and number of patients reaching no worse than moderate functional impairment (FIQ score <39). Differences between groups were calculated by linear mixed-effects (intention-to-treat approach) and mediational models through path analyses.
RESULTS:
At 1 year, improvements in FIQ scores were higher in the intervention group with moderate or high effect size, and decreases of ≥20% in 69.1% of patients (20.9% in the control group) and of ≥50% in 39.7% (4.5% in the control group). Also, 52.9% of patients had a FIQ <39 points (13.4% in the control group).
CONCLUSIONS:
In this sample of patients with FM, the improvement in quality of life and control of symptoms obtained by adding a PNE intervention showed promising results, equalling or surpassing previously reported outcomes.
SIGNIFICANCE:
A structured group intervention based on pain neuroscience education for 1 year in patients with fibromyalgia was associated with significant amelioration of the impact of the disease on scores of the Fibromyalgia Impact Questionnaire, the Health Assessment Questionnaire, the Hospital Anxiety and Depression Scale, the Pain Catastrophizing Scale and the Polysymptomatic Distress Scale as compared with only treatment as usual. These findings are clinically relevant considering the challenges posed by fibromyalgia to clinicians and patients alike.
Diseño del estudio»Ensayo controlado aleatorizado (ECA)
