Narrativas de vida de mulheres com fibromialgia: autogerenciamento da dor crônica / Life narratives of women with fibromyalgia: self ­ management of chronic pain

A Fibromialgia é uma doença crônica, de etiologia multifatorial complexa cujo principal sintoma é a dor física. No entanto, as repercussões são imensuráveis, causando transtornos psíquicos, emocionais, cognitivos e limitações no cotidiano das pessoas, que passam a viver em função da doença e do tratamento, se abstendo da vida funcional. Portanto é fundamental a compreensão de que é possível, não apenas ter o controle da situação, mas também gerenciar a própria dor, entendendo como e quando ela se desencadeia, prevenindo o aparecimento, investindo no autocuidado, prezando a conscientização corporal, mudanças nos hábitos de vida, levando em consideração a cultura, o contexto em que vivem e a visão de mundo. Objetivo geral: analisar a experiência de mulheres que vivenciam a Fibromialgia em relação ao estilo de vida e suas repercussões no autogerenciamento cotidiano da dor. Objetivos específicos: Identificar nas narrativas de vida de mulheres com Fibromialgia situações que expressem as experiências de dor; descrever as atividades relacionadas à cultura e transformações do estilo de vida; discutir recursos para o autogerenciamento da dor a partir da perspectiva transcultural. Utilizou-se como referencial teórico o Cuidado Transcultural de Madeleine Leininger. Trata-se de uma pesquisa de natureza qualitativa, guiada pelo método Narrativas de Vida, desenvolvida em 2019, com 14 mulheres que vivenciam a fibromialgia, integrantes do grupo interdisciplinar de tratamento e acompanhamento no Laboratório de Fisiologia Aplicada à Educação Física do Instituto de Educação Física e Desportos da Universidade do Estado do Rio de Janeiro (LAFISAEF-IEFD/UERJ). A pesquisa foi aprovada pelo Comitê de Ética da UERJ sob o Protocolo n°04899018.1.0000.5282. Os dados foram produzidos por meio da entrevista aberta e observação participante seguido da análise temática orientada por Bertaux. A partir da organização dos dados emergiram três categorias: "Processo de adoecimento e as experiências de dor", "Os fenômenos culturais e mudanças de estilo de vida" e "Reaprendendo a (con)viver e autogerenciar a dor". A análise foi fundamentada na Teoria Transcultural em diálogo com outros autores da literatura pertinente, que possibilitou a análise a partir de uma perspectiva de valorização e compreensão dos aspectos culturais, crenças e significados deste grupo de mulheres. A cultura permite compreender a sua in­fluência nas questões ligadas à saúde, es­clarecendo fenômenos e fatos específicos de grupos, uma vez que cada família possui suas próprias formas de cuidar, herdadas cultural­mente. As participantes ressignificaram seus modos de viver, transformando padrões comportamentais em relação a alimentação, atividade física, relações familiares, sociais, aprenderam a lidar com suas emoções e na capacidade de resolução de problemas, no autogerenciamento da dor, com mais autonomia, domínio e autoconhecimento, melhorando a qualidade de vida. As questões que desencadeavam a dor foram identificadas e trabalhadas no grupo. Este estudo contribui para a saúde das pessoas que vivenciam a fibromialgia ressaltando os benefícios quando elas conseguem autogerenciar os sinais e sintomas que desencadeiam a dor e quando assumem o protagonismo do próprio processo.

Fibromyalgia is a chronic disease of complex multifactorial etiology whose main symptom is physical pain. However, the repercussions are immeasurable, causing psychic, emotional, cognitive disorders and limitations in the daily lives of people, who live due to the disease and treatment, abstaining from functional life. Therefore, it is essential to understand that it is possible not only to have control of the situation, but also to manage the pain itself, understanding how and when it triggers, preventing the onset, investing in self-care, valuing body awareness, changes in the habits of the patient, considering the culture, the context in which they live and worldview. The main purpose is to analyze the experience of women who experience fibromyalgia regarding to their lifestyle habits and its repercussions on daily pain management. Specific purposes: to identify, in life narratives of women with Fibromyalgia, situations that express the pain experiences; to describe the activities related to culture and lifestyle changes; to discuss resources for pain self-management from transcultural perspective. The theoretical framework used was Madeleine Leininger's Transcultural Care. This is a qualitative research, guided by the Narratives of Life method, developed in 2019, with 14 women who experience fibromyalgia, members of the interdisciplinary treatment and monitoring group at the Laboratory of Physiology Applied to Physical Education of the Institute of Physical Education. and Sports at the Rio de Janeiro State University (LAFISAEF-IEFD / UERJ). The research was approved by the UERJ Ethics Committee under Protocol No. 04899018.1.0000.5282. Data were produced through open interview and participant observation followed by thematic analysis guided by Bertaux. From the organization of the data emerged three categories: "Process of illness and pain experiences", "Cultural phenomena and lifestyle changes" and "Relearning to (live) and self-manage pain". The analysis was based on the Transcultural Theory in dialogue with other authors of the pertinent literature, which allowed the analysis from a perspective of valorization and understanding of the cultural aspects, beliefs and meanings of this group of women. Culture allows us to understand its influence on health issues, clarifying group-specific phenomena and facts, as each family has its own culturally inherited forms of care. The participants re-signified their ways of living, transforming behavioral patterns in relation to food, physical activity, family and social relationships, learned to deal with their emotions and problem solving skills, self-management of pain with more autonomy, mastery and self-knowledgement, improving the quality of life. The issues that triggered the pain were identified and worked on in the group. This study contributes to the health of people experiencing fibromyalgia by emphasizing the benefits when they can self-manage the signs and symptoms that trigger pain and when they take the lead in the process itself.

Diagnosis and Treatment of Common Pain Syndromes and Disorders.

Management of chronic pain has become a significant challenge for primary care providers, and the population of patients with chronic pain is expected to increase. Common syndromes seen in the primary care setting include myofascial pain syndrome, fibromyalgia, chronic postsurgical pain, complex regional pain syndrome, and painful diabetic neuropathy. This article describes these syndromes and presents current treatment options.

Community-Based Care of the Fibromyalgia Patient: Strategies to Promote Self-Management.

Along with a variety of distressing symptoms, a diagnosis of fibromyalgia (FM) brings with it substantial physical, psychosocial, and financial costs. Research shows that self-management is an effective means to manage FM and can lead to fewer healthcare visits. Yet due to the complexity of this disorder, healthcare providers need to be able to tailor treatment to individual patients by understanding effective treatment interventions. Home healthcare nurses (HHNs) are in a unique position to assess and implement effective treatment recommendations in the home setting and as such could consider incorporating self-management strategies into the home visit with the FM patient. Therefore, the purpose of this article is to use a case study to describe the assessment of FM patient's functional ability and quality of life and how the HHN may integrate self-management teaching into the established home care visit. A review of the literature and discussion of self-management interventions for the FM patient is presented. A summary of the case study and proposed clinical implications is offered.

Perceptions about the sexuality of women with fibromyalgia syndrome: a phenomenological study.

AIMS: The aim of this study was to explore and understand the perceptions and experiences of women with fibromyalgia syndrome regarding their sexuality. BACKGROUND: Fibromyalgia syndrome is a chronic pathology, which compromises a woman's physical, mental and emotional health. Although concerns related to sexuality are commonly reported, research has tended to focus on the physical symptoms. DESIGN: An interpretive qualitative research methodology using Gadamer's philosophical hermeneutics was carried out. METHODS: This qualitative study explores the sexuality of women with fibromyalgia syndrome. A focus group and semi-structured interviews were conducted with 13 women with fibromyalgia syndrome. Data were collected between April - June 2014. Participants were recruited until findings reached saturation. FINDINGS: Three themes define the perception of sexuality for these women: (i) Physical impact: don't touch, don't look; (ii) Sexuality and identity: fighting against their loss; (iii) Impact on the relationship: sexuality as a way of connecting the couple. CONCLUSION: Despite limitations, sexuality is important for the identity and quality of life of women with fibromyalgia syndrome. Together with the physical symptomology, guilt, fear and a lack of understanding compromise the coping process. Women need the support of their partner, their socio-family environment and health professionals. Nurses can aid the successful adjustment to sexual problems related to fibromyalgia syndrome.

A família como rede de apoio às pessoas com fibromialgia: estratégias de cuidado interdisciplina / The Family as a support network for people with fibromyalgia: interdisciplinary care strategies

No decorrer do processo de adoecimento surgem situações inesperadas, sobrecargas repetitivas que afetam integralmente a família fazendo com que esta adquira posturas e atitudes, ora de compaixão, ora de incompreensão, impaciência e falta de apoio, que podem influenciar negativamente o tratamento e a recuperação de pessoas com problemas crônicos de saúde. O objeto deste estudo aborda a família como rede de apoio às pessoas com fibromialgia: estratégias de cuidado interdisciplinar. O objetivo geral é compreender como as redes familiares influenciam no processo saúde, adoecimento e cuidado de pessoas com fibromialgia. E os objetivos específicos: identificar as mudanças na rotina da família; descrever como a família se organiza para ajudar a pessoa com fibromialgia e discutir as estratégias de cuidado desenvolvidas pelas redes familiares. O referencial teórico provém da teoria libertadora freireana. Trata-se de uma pesquisa de natureza qualitativa, de abordagem participativa, desenvolvida em 2016, no Laboratório de Fisiologia aplicada à Educação Física da Universidade do Estado do Rio de Janeiro, com 15 participantes. O estudo foi aprovado pelo Comitê de Ética e Pesquisa da UERJ sob o Nº 1.587.664. A produção de dados abrangeu o Mapa Falante, World Café e Questionário. A organização e categorização dos achados seguiram a orientação de análise de conteúdo de Bardin, emergindo três categorias: As necessidades de mudanças no enfrentamento do adoecimento; Organização da família diante do processo saúde/doença e As estratégias de cuidado desenvolvidas pela família a partir do adoecimento. Os achados foram analisados de acordo com a teoria de Freire. Conclui-se que a rede familiar fica abalada pela falta de conhecimento para lidar com as peculiaridades do processo de adoecimento por fibromialgia, além das mudanças significativas geradas na rotina, fazendo com que o indivíduo e família se organizem de maneiras diferentes para manter o relacionamento e as atividades do cotidiano. Como meio de se adequar a essas alterações e de auxiliar no cuidado a pessoa adoecida, a família procura desenvolver estratégias de cuidado a partir da co-criação do conhecimento. Há evidências nos depoimentos que o grupo interdisciplinar possui papel importante na mediação das relações, auxiliando na construção do conhecimento, no processo de autocuidado e nas estratégias necessárias a manutenção da rede familiar de forma saudável e harmoniosa. Ressaltando que a pesquisa participativa foi uma estratégia eficaz na emancipação dos participantes.

During the disease process, unexpected situations arise, repetitive overloads that affect the family integrally, causing it to acquire attitudes and postures, sometimes compassion, sometimes incomprehension, impatience and lack of support, which can negatively influence the treatment and recovery of people with chronic disease. The main search object of this study is the family as a support network for people with fibromyalgia: interdisciplinary care strategies. The general objective is to understand how family networks can influence the process of health, illness and care of people with fibromyalgia. And the specific objectives: to identify the changes in the family routine; to describe how the family organizes itself to help the person with fibromyalgia and discuss the care strategies developed by the family networks. The theoretical referential comes from Freirean liberation theory. This is a qualitative research, with a participative approach, developed in 2016, in the Laboratory of Physiology applied to Physical Education of the University of the State of Rio de Janeiro, with 15 participants. The study has been approved by the Ethics and Research Committee of UERJ under number 1,587,664. Data production included the Talking Map, World Café and Questionnaire. The organization and analysis of the data have been performed according to Bardin, emerging 3 categories: The needs of changes in confrontation of the illness; The family organization faced the health/illness process and The care strategies developed by the family from the illness. The findings were analyzed according to Freire's theory. It is concluded that the family network is shaken in this situation, once fibromyalgia generates several changes in the routine and it already makes that the person and the family organize themselves in different ways to maintain their daily activities. As a mean of adapting to the changes and assisting in the person with fibromyalgia care, the family seeks to develop several care strategies based on co-creation. There is evidence in the family members' reports that the nursing professional holds an important role in mediating relationships, assisting in the co-creation of necessary strategies and maintaining the family network in a healthy and harmonious way. Emphasizing that participatory research was an effective strategy in the emancipation of participants.

Interdisciplinary care praxis in groups of people living with fibromyalgia. / Práxis interdisciplinar de cuidado em grupo de pessoas que vivem com fibromialgia.

OBJECTIVES:: to analyze the integrated community therapy model for the empowerment of people living with fibromyalgia and discuss the impact of this interdisciplinary intervention in the health-disease process and self-care. METHOD:: a participatory-approach qualitative study, developed in 2015 with 11 participants at the Laboratory of Physiology Applied to Physical Education of the Rio de Janeiro State University, RJ. Data production comprised World Café, participant observation and semi-structured interview. The analysis was performed according to Bardin, through data triangulation in dialogue with the relevant literature. RESULTS:: the integrated community therapy group is a driving force in building and expanding knowledge about fibromyalgia and in self-care empowerment. CONCLUSION:: this group strategy proved to be an interdisciplinary praxis tool that enables the development of solidary care networks. Thus, shared knowledge was generated, transformed into a listening and reflection environment to manage personal and family obstacles.

Práxis interdisciplinar de cuidado em grupo de pessoas que vivem com fibromialgia / Praxis interdisciplinaria del cuidado en grupo de personas que viven con fibromialgia / Interdisciplinary care praxis in groups of people living with fibromyalgia

RESUMO Objetivos: analisar o modelo da terapia comunitária integrativa para o empoderamento de pessoas que vivem com fibromialgia e discutir a repercussão dessa intervenção interdisciplinar no processo saúde-doença e autocuidado. Método: estudo qualitativo de abordagem participativa, desenvolvido em 2015 com 11 participantes, no Laboratório de Fisiologia aplicada à Educação Física da Universidade do Estado do Rio de Janeiro, RJ. A produção de dados abrangeu o World Café, a observação participante e entrevista semiestruturada. A análise foi realizada segundo Bardin, pela triangulação de dados em diálogo com a literatura pertinente. Resultados: o grupo de terapia comunitária integrativa é um dinamizador na construção e ampliação do conhecimento sobre a fibromialgia e no empoderamento para o autocuidado. Conclusão: esta estratégia de grupo revelou-se um instrumento de práxis interdisciplinar que permite construir redes solidárias de cuidado. Desse modo, gerou-se o conhecimento compartilhado, transformado em ambiente de escuta e reflexão para gerir os obstáculos pessoais e familiares.

RESUMEN Objetivos: analizar el modelo de terapia comunitaria integradora para el empoderamiento de las personas que viven con fibromialgia y discutir el impacto de esta intervención interdisciplinaria en el proceso de salud-enfermedad y autocuidado. Método: estudio cualitativo de enfoque participativo, desarrollado en 2015 con 11 participantes en el Laboratorio de Fisiología aplicada a la Educación Física de la Universidade do Estado do Rio de Janeiro, RJ. La producción de datos incluyó el World Café, la observación participante y la entrevista semi-estructurada. El análisis se realizó de acuerdo con Bardin por la triangulación de los datos en diálogo con la literatura relevante. Resultados: el grupo de terapia comunitaria integradora es una fuerza impulsora en la construcción y ampliación de conocimientos sobre la fibromialgia y el empoderamiento para el autocuidado. Conclusión: esta estrategia de grupo ha demostrado ser una herramienta de praxis interdisciplinaria que permite la construcción de redes de solidaridad de la atención. Así, se ha generado conocimiento compartido, transformado en un ambiente de escucha y reflexión para manejar los obstáculos personales y familiares.

ABSTRACT Objectives: to analyze the integrated community therapy model for the empowerment of people living with fibromyalgia and discuss the impact of this interdisciplinary intervention in the health-disease process and self-care. Method: a participatory-approach qualitative study, developed in 2015 with 11 participants at the Laboratory of Physiology Applied to Physical Education of the Rio de Janeiro State University, RJ. Data production comprised World Café, participant observation and semi-structured interview. The analysis was performed according to Bardin, through data triangulation in dialogue with the relevant literature. Results: the integrated community therapy group is a driving force in building and expanding knowledge about fibromyalgia and in self-care empowerment. Conclusion: this group strategy proved to be an interdisciplinary praxis tool that enables the development of solidary care networks. Thus, shared knowledge was generated, transformed into a listening and reflection environment to manage personal and family obstacles.

Implementation of Health Information Technology in Routine Care for Fibromyalgia: Pilot Study.

Fibromyalgia management remains complicated and challenging. Health information technology is an evidence-based, nonpharmacological self and symptom management strategy, but few studies have evaluated its feasibility for managing fibromyalgia patients in clinical practice. FibroGuide is an example of an evidence-based, interactive, and computer-based program comprised of 10 educational modules on fibromyalgia. Study aims were to: (1) develop a process for implementing FibroGuide into the routine care of patients with fibromyalgia, (2) evaluate the overall impact on fibromyalgia before and after a 12-week implementation, and (3) assess patient perspectives on using FibroGuide health information technology to assist in self-management. In this pilot study, 35 participants with fibromyalgia were recruited from an Advanced Practice Registered Nurse's outpatient clinic. Using a descriptive design, quantitative data analysis was employed to address study aims. Based on data collection pre- and post-intervention using paired samples testing, a statistically significant change (p = .017) was observed in overall fibromyalgia impact (improved symptom severity, activity, and function). Majority felt that FibroGuide was helpful as part of their routine care, and nearly half reported that it assisted in their self-management. Although 65% noted that technology was an effective and efficient way to receive education for fibromyalgia management, 57% preferred talking to healthcare providers. Larger longitudinal studies are needed on the use of health information technology in fibromyalgia, evaluating both statistical and clinical significance, while decreasing barriers to participant use for this promising adjunct to clinical management. Providers need to be well educated on supporting self-management strategies and health information technology.

O empoderamento e a práxis do cuidado interdisciplinar de pessoas com fibromialgia: desafios para enfermagem / The empowerment and the practice of interdisciplinary care of people with fibromyalgia: challenges for nursing

A educação em saúde, o acompanhamento de pessoas com problemas crônicos e a implementação de metodologias participativas desenvolvidas em grupo tem sido fortemente recomendado pelas Organizações Mundiais de Saúde e pelas Diretrizes de Doenças Crônicas. Este estudo tem como objetivo geral compreender os efeitos de grupo de terapia integrativa no empoderamento de pessoas que vivem com fibromialgia. E como objetivos específicos: descrever o conhecimento dos participantes acerca do processo saúde adoecimento e autocuidado antes do início das atividades do grupo; analisar a repercussão do grupo de terapia integrativa no processo ensino saúde adoecimento e autocuidado; e discutir o empoderamento das participantes após o término da prática educativa em saúde desenvolvida no grupo de terapia integrativa. Trata-se de uma pesquisa de natureza qualitativa, de abordagem participativa. O cenário de estudo foi Laboratório de Fisiologia aplicada à Educação Física (LAFISAEF) da Universidade do Estado do Rio de Janeiro, localizado no município do Rio de Janeiro. Os dados foram coletados em 2015 por meio do questionário para avaliação do conhecimento acerca do processo saúde adoecimento e autocuidado para pessoas com problemas crônicos de saúde, observação direta e entrevista semiestruturada realizada com 11 participantes do grupo de adaptação. Para análise dos dados obtidos utilizou-se a análise de conteúdo de Bardin emergindo duas categorias: O grupo de terapia comunitária integrativa como dinamizador para a construção do conhecimento e o empoderamento dos participantes por meio do Grupo Interdisciplinar de TCI. Conclui-se que o conhecimento das participantes foi ampliado e que o grupo foi uma estratégia eficaz para o ensino aprendizagem para o processo saúde e adoecimento. Da mesma forma, notou-se que as estratégias influenciaram o empoderamento das participantes, onde estas, empoderadas, foram motivadas a praticarem o autocuidado de maneira eficaz e capazes de mudar os hábitos de vida diminuindo as crises álgicas, restabelecendo autoestima e contribuindo para a autonomia. Acreditamos que abordagem do empoderamento para o fortalecimento do autocuidado em situações crônicas de saúde através das tecnologias educacionais apresenta resultados satisfatórios, contribuindo para ampliação das práticas de enfermagem.

Health education, monitoring of people with chronic problems and the implementation of participatory methodologies developed group has been strongly recommended by the World Health Organizations and the Guidelines for Chronic Diseases. This study has the general objective of understanding the integrative therapy group effects in empowering people living with fibromyalgia. And the following objectives: to describe the knowledge of the participants about the health illness and self-care before the start of the group's activities; establish the role of integrative therapy group in the teaching health illness and self-care; and discuss the empowerment of participants after completion of educational practice in health developed in integrative therapy group. It is a qualitative research, participatory approach. The study setting was Physiology Laboratory applied to Physical Education (LAFISAEF) of Rio de Janeiro State University, located in the municipality of Rio de Janeiro. Data were collected in 2015 through the questionnaire to assess the knowledge of the health illness and self-care for people with chronic health problems, direct observation and semi-structured interviews with 11 participants of the adaptation group. For data analysis we used the Bardin content analysis emerging two categories: The integrative community therapy group as a facilitator for the construction of knowledge and empowerment of participants through the Interdisciplinary Group of TCI. We conclude that the knowledge of participants was expanded and the group was an effective strategy for teaching learning process for health and illness. Similarly, it was noted that strategies influenced the empowerment of participants, where they, empowered, were motivated to practice self-care effectively and able to change the habits of life reducing the painful crises, restoring self-esteem and contributing to the autonomy. We believe that the empowerment approach to strengthen self-care in chronic health conditions through educational technologies presents satisfactory results, contributing to the expansion of nursing practices.

Empowering Patients with Persistent Pain Using an Internet-based Self-Management Program.

New strategies are needed to improve access to cognitive and behavioral therapies for patients with persistent pain. The purpose of this randomized, controlled trial was to determine the effectiveness of the Chronic Pain Management Program, an 8-week online intervention targeting cognitive, emotional, behavioral, and social pain determinants. Program efficacy and engagement was evaluated for 92 individuals with a diagnosis of chronic noncancer pain who had a current opioid prescription. Participants were recruited from primary care practices and Internet sites, then randomly assigned to receive access to the intervention either immediately (treatment group) or after an 8-week delay (wait-list comparison). Biweekly self-report measurements were collected using online surveys on pain, depressive symptoms, pain self-management behaviors, and health care utilization during the 8-week trial. Additional measurements of opioid misuse behaviors, pain self-efficacy, and medicine regimens were completed at baseline and week 8. Engagement was evaluated by examining completion of program learning modules. The results from analysis of variance showed that at week 8, the treatment group had significantly greater improvements on pain self-efficacy and opioid misuse measures than the wait-list comparison group. Engagement level was positively associated with improvements in pain intensity, pain interference, and pain self-efficacy. In conclusion, patients on opioids were able to engage and demonstrate positive outcomes using an Internet-based self-management program. Future efforts toward heightening engagement could further maximize impacts.

Neural and psychosocial mechanisms of pain sensitivity in fibromyalgia.

Fibromyalgia is a chronic musculoskeletal pain disorder that affects an estimated 5 million adults in the U.S. The hallmark is burning, searing, tingling, shooting, stabbing, deep aching, or sharp pain. Fibromyalgia is generally considered to be a "central sensitivity syndrome" where central sensitization is regarded as the cause of pain in its own right. Nonetheless, the case continues to be made that all central and spatially distributed peripheral components of fibromyalgia pain would fade if the peripheral generators could be silenced. Although neural mechanisms are clearly important in pain sensitivity, cognitive and social mechanisms also need to be considered. The aim of this review is to examine four mechanisms responsible for heightened pain sensitivity in fibromyalgia: peripheral sensitization, central sensitization, cognitive-emotional sensitization, and interpersonal sensitization. The purpose of framing the review in terms of pain sensitivity in fibromyalgia is to highlight that different mechanisms of sensitization are appropriately regarded as intervening variables when it comes to understanding individual differences in the experience of pain. The paper concludes by considering the implications of the findings of the review for explanations of fibromyalgia pain by nurses working in multidisciplinary teams. The trend appears to be able to explain the cause of fibromyalgia pain in terms of sensitization per se. The recommended alternative is to explain fibromyalgia pain in terms of changes in pain sensitivity and the role of underlying neural and psychosocial mechanisms.

La compleja vivencia de la fibromialgia / The complex experience of fibromyalgia

La fibromialgia es una enfermedad de etiología desconocida que se caracteriza principalmente por dolor y cansancio crónico. El relato que se presenta a continuación es de una persona que padece esta enfermedad desde hace cinco años; en él se muestra su periplo por los diferentes especialistas hasta el momento del diagnóstico, así como las diferentes esferas en que se ve afectada su vida cotidiana. La experiencia negativa con los profesionales sanitarios le hará abandonar el tratamiento convencional, centrando su principal queja en que apenas fue escuchada por éstos, lo que ocasionó que optara por terapias naturales, un cambio brusco en su alimentación y estilo de vida. En estos momentos sigue con esa dieta estricta, con la práctica de yoga y ejercicios moderados que son los que mejor se adaptan para que ella se encuentre bien, aunque con sus brotes y sus dolores que intenta superar día tras día

Fibromyalgia is a disease of unknown etiology that is characterized primarily by pain and fatigue. The story that follows is of a person who is suffering this disease for five years, and shows her tour through various specialists until the time of diagnosis and the different areas that affected her daily live. The negative experience with healthcare professionals made her stop conventional treatment her main complaint is that she did not received enough attention by the professionals, this fact made that she try to treating her illness with natural therapies, a sudden change in her diet and lifestyle. Right now continues with the strict diet, the practice of yoga and moderate exercises that are best for her wellness although she is still having her breakdowns and pain which overcome every day

The 6-minute walk test in female fibromyalgia patients: relationship with tenderness, symptomatology, quality of life, and coping strategies.

The purpose of this study was to examine the relationship between the 6-minute walk test (6-MWT) and tenderness, symptomatology, quality of life, and coping strategies in women with fibromyalgia. One hundred eighteen women with fibromyalgia aged 51.9 ± 7.3 years participated in the study. The examination included the 6-MWT, tender points, and the following questionnaires: Fibromyalgia Impact Questionnaire (FIQ), Short-Form Health Survey 36 (SF-36), and Vanderbilt Pain Management Inventory. Fair correlations between the 6-MWT and the subscales of physical impairment (FIQ) and physical function (SF-36) were observed (ρ -0.365 and 0.347, respectively, both p < .001). The 6-MWT showed a weak relationship with tenderness (ρ 0.201 and -0.191 for algometer score and tender points count, respectively, both p < .05). The relationship between the 6-MWT and global score of FIQ, and FIQ subscales of pain and fatigue were weak (ρ -0.201, -0.211, and -0.226, respectively, all p < .05). The 6-MWT showed a weak relationship with bodily pain and vitality scales of SF-36 (ρ 0.256 and 0.258, respectively, both p = .005) and with passive and active coping strategies (ρ -0.255 and 0.223, both p < .05). This study in women with fibromyalgia shows significant relationships, ranging from weak to fair, between the 6-MWT and tenderness, symptomatology, quality of life, and coping strategies. These findings indicate that functional capacity, as assessed by the distance walked in 6 minutes, might be important when planning the assessment, treatment, and monitoring of patients with fibromyalgia.

Early experience with a brief, multimodal, multidisciplinary treatment program for fibromyalgia.

Fibromyalgia is a complex heterogeneous disorder for which a multidisciplinary individualized approach is currently advocated. We executed a 1-week multidisciplinary fibromyalgia clinical program with seven patients, based on our experience with our existing 1.5-day multidisciplinary fibromyalgia program that has demonstrated both short- and long-term benefits. The current expanded program was not designed as a clinical study, but rather as a clinical feasibility assessment, and it was multidisciplinary in nature, with cognitive behavioral therapy, activity pacing, and graded exercise therapy as major components. We assessed changes in individual patients at 1 week and 3 months after the program with the use of validated self-report measures of pain, fatigue, and self-efficacy. All patients indicated at least small improvements in pain and physical symptoms at both 1 week and 3 months, and all but one patient showed improvement in self-efficacy at 1 week and 3 months. Similar trends were observed for fatigue. Based on our early clinical experience, we conclude that the 1-week multidisciplinary fibromyalgia program is logistically feasible and has potential for clinical efficacy. Further research is needed and is planned to test the clinical efficacy of this program and compare it with other interventions.

Cranial electrical stimulation improves symptoms and functional status in individuals with fibromyalgia.

To investigate the effects of microcurrent cranial electrical stimulation (CES) therapy on reducing pain and its associated symptoms in fibromyalgia (FM), we conducted a randomized, controlled, three-group (active CES device, sham device, and usual care alone [UC]), double-blind study to determine the potential benefit of CES therapy for symptom management in FM. Those individuals using the active CES device had a greater decrease in average pain (p = .023), fatigue (p = .071), and sleep disturbance (p = .001) than individuals using the sham device or those receiving usual care alone over time. Additionally, individuals using the active CES device had improved functional status versus the sham device and UC groups over time (p = .028).

Effect of music as nursing intervention for people diagnosed with fibromyalgia.

Primary fibromyalgia, a poorly understood chronic pain syndrome, is a disorder of uncertain etiology. The ultimate goal of fibromyalgia treatment is to develop a multimodal therapy. In recent years, the use of music as an intervention for the pain management and other symptoms has increased. The purpose of this study was to investigate the effects of music on pain and depression for people diagnosed with fibromyalgia using Rogers' theory of the unitary human being as the theoretical framework. An experimental 4-week longitudinal trial design was undertaken. Sixty patients diagnosed with fibromyalgia were randomly assigned to either a music intervention group or a control group. Music interventions consisted of listening to music once a day for 4 consecutive weeks using two types of CDs. Pain was measured with the McGill Pain Questionnaire Long Form and depression with the Beck inventory; a 100-mm visual analog scale was used to measure pain and depression. The treatment group reported a significant reduction in pain and depression at week 4 compared with the control group. Members of the control group reported no differences in pain. The findings of this pilot study suggest the importance of music therapy as a nursing intervention and justify further investigation into music as a self-management intervention to reduce pain and depression.

The impact of a nurse-led chronic musculoskeletal pain clinic on healthcare utilization.

AIMS AND OBJECTIVES: To determine whether a nurse-led chronic musculoskeletal pain clinic for fibromyalgia patients can reduce utilization of healthcare services. BACKGROUND: People with fibromyalgia often consult multiple specialities due to the vast nature of their symptoms but receive little or no help in managing their symptoms. DESIGN: A retrospective evaluation of a nurse consultant-led chronic pain management clinic. METHODS: The frequency of hospital attendances in the five years before and three years after pain clinic attendance was evaluated. General practitioner (GP) attendances in the 12-month period before and after pain clinic attendance were compared with attendances for two groups of patients from an established GP cohort: (i) patients referred to rheumatology new patient clinics and (ii) all patients with fibromyalgia referred to any hospital new patient clinic. RESULTS: In the three years following attendance at the pain clinic, the mean number of hospital appointments fell significantly from 2.8 to 1.4 per annum (p < 0.001). The mean reduction seen in hospital clinic attendances in the first year (0.8/annum) improved in the second (1.2/annum) and third (2.1/annum) years. Seventy-eight per cent of pain clinic patients reduced their visits to their GP in the 12 months following treatment in the pain service, compared with 53% of patients referred to rheumatology clinics and 46% of patients with fibromyalgia. CONCLUSION: A nurse-led chronic pain clinic for fibromyalgia patients can have a positive impact on primary and secondary healthcare utilization. RELEVANCE TO CLINICAL PRACTICE: Having a designated nurse-led pain clinic can enable patients to access the appropriate service at an earlier stage in their condition and receive the support needed to manage the impact of their pain.

Fibromyalgia: diagnosing and managing a complex syndrome.

PURPOSE: The purpose of this clinical review is to clarify and discuss the diagnosis and management of fibromyalgia. This includes typical signs and symptoms, pathophysiology, concomitant disease states, differential diagnoses, and recommended pharmacologic and nonpharmacologic treatment modalities. DATA SOURCES: The search included Evidence Based Medicine Reviews, Ovid MEDLINE, PubMed, and CINAHL. Search terms used: fibromyalgia diagnosis, fibromyalgia pathophysiology, incidence of fibromyalgia, fibromyalgia comorbidities, etiology of fibromyalgia, fibromyalgia treatment, American College of Rheumatology criteria. Search limited to sources from 1990 to 2010. CONCLUSIONS: Fibromyalgia is a complex muscular rheumatism that is not fully understood and often misdiagnosed. Signs and symptoms may overlap with many other conditions that must be properly ruled out to prevent diagnosis based upon arbitrary clinical judgment. Treatment is most beneficial when tailored to individual patient presentation, and further research is warranted, particularly in the domains of pathophysiology and efficacy of treatment options. IMPLICATIONS FOR PRACTICE: An accurate knowledge of current research will aid the nurse practitioner in effectively prescribing evidence-based clinical interventions. Optimal fibromyalgia management can be achieved through a multifaceted treatment approach and is enhanced with early identification of the disease process.