Factors promoting improvements in symptoms and health in women with fibromyalgia and chronic widespread pain: a qualitative interview study.

PURPOSE: To describe experiences of improvement among women with chronic widespread pain (CWP). MATERIALS AND METHODS: Recruitment was made from a cohort of women with CWP who participated in a 10- to 12-year follow-up study in 2016. The inclusion criterion was an improvement of at least 30% on a visual analog scale of pain intensity between baseline and follow-up. Seventeen women participated in semi-structured interviews. Data were analysed using qualitative content analysis. RESULTS: The analysis resulted in three categories with eight subcategories: Experience of improvement included feeling better despite persisting symptoms and to be capable of more activity. Developing strategies for better health included choosing to act to improve health, developing a constructive mental approach to the illness, and changing one's view of oneself and one's life. Contextual factors supporting improvement included support from healthcare, social support from one's environment, and reduced load in daily life. CONCLUSIONS: Experiences of health improvement involved active changes as well as contextual factors. 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.

The women's own actively chosen changes and contextual factors appear to be important for the improvement of chronic widespread pain.Treatments that contribute to increased knowledge regarding pain management, increased level of physical activity, and reduced stress were found to be of importance for the improvement of chronic widespread pain.Women with chronic widespread pain could be gained by person-centered rehabilitation based on their individual needs and resources.

Physical activity with person-centred guidance supported by a digital platform for persons with chronic widespread pain: A randomized controlled trial.

OBJECTIVE: To determine the effectiveness of a person-centred intervention, including advice on physical activity, for improving pain intensity, physical activity, and other health-related outcomes in persons with chronic widespread pain , when delivered with digital eHealth support compared with standard telephone follow-up. DESIGN: Randomized controlled trial. SUBJECTS: Individuals with chronic widespread pain (n = 139), aged 20-65 years, who had previously participated in a pain educational programme at primary healthcare units, were contacted during the period 2018-19 and randomized to an intervention group (n = 69) or an active control group (n = 70). METHODS: Together with a physiotherapist, participants in both groups developed person-centred health plans for physical activity. The intervention group was supported via a digital platform for 6 months. The active control group received support via one follow-up phone call. Primary outcome was pain intensity. Secondary outcomes were physical activity and other health-related outcomes. RESULTS: No significant differences were found between the groups after 6 months, except for a significant decrease in global fatigue in the active control group compared with the intervention group. CONCLUSION: Future development of interventions supporting persons with chronic pain to maintain regular exercise is warranted.

Stress levels predict substantial improvement in pain intensity after 10 to 12 years in women with fibromyalgia and chronic widespread pain: a cohort study.

BACKGROUND: Previous studies of prognosis for women with Fibromyalgia (FM) or chronic widespread pain (CWP) show contradictory results. However, some women appear to improve in pain and other core symptoms over time. There is limited knowledge about predictors of substantial improvement in pain intensity over a longer period of time. The primary objective of this study was to investigate the natural course of pain intensity and distribution of pain over 10 to 12 years in a cohort of 166 women with FM or CWP. Secondarily we wanted to investigate predictors of substantial improvement (≥50%) in pain intensity after 10 to 12 years. METHODS: The study is a longitudinal prospective cohort study. 166 women with FM or CWP were followed up after 10 to 12 years. 126 women (76%) participated in the follow-up and completed a battery of questionnaires concerning pain intensity, pain distribution and other physical and mental aspects of health. Differences in symptoms within the cohort over 10 to 12 years and predictors of substantial improvement (≥50%) in pain intensity were calculated. RESULTS: Pain had improved at the 10 to 12 year follow-up (p < 0.001) with a mean change of - 9.2 mm (SD 23.3, 95% CI: - 13.3; - 5.0) for pain intensity and - 2.0 sites (SD 4.2, 95% CI: - 2.7; - 1.2) for pain distribution. Nine percent of the 126 women showed an individual moderate improvement in pain intensity while 16% showed a substantial improvement at the follow-up as compared to baseline. Lower symptoms of stress and higher pain intensity at baseline predicted higher probability of reporting at least 50% less pain intensity after 10 to 12 years as compared to baseline. CONCLUSIONS: A majority of women with FM and CWP appear to have a positive course of pain over time, which should be communicated to these patients in health care. Reducing stress levels might contribute to better chances of improvement over time. TRIAL REGISTRATION: Clinicaltrials.gov NCT02872129, registered 06/30/2016.