The Impact of a Group-Based Multidisciplinary Rehabilitation Program on the Quality of Life in Patients With Fibromyalgia: Results From the QUALIFIBRO Study.

BACKGROUND AND OBJECTIVE: Patients with fibromyalgia (FM) have a substantially reduced health-related quality of life (HRQoL). Their management should preferably focus on multidisciplinary nonpharmacological interventions. However, the long-term impact of such multicomponent therapies is not fully established. Waiting lists for patients seeking medical treatment are long, making individual-based approaches often unfeasible. The aim of our pragmatic study was to evaluate long-term HRQoL benefits of a comprehensive 8-week group-based multidisciplinary rehabilitation program focusing on patients' coping ability and self-care. METHODS: A total of 94 patients with clinically confirmed FM agreed to participate in this study. Before entering the program based on group-based cognitive behavioral therapy and graded activity training, patients completed questionnaires to screen for comorbidities. Health-related quality of life was assessed at the start, at 8 weeks, 6 months, and 1 year using the 36-Item Short-Form Health Survey instrument. Changes in HRQoL scores were analyzed according to linear mixed regression modeling. RESULTS: Baseline findings confirmed the substantially low physical and mental HRQoL in FM patients as well as high levels of depression, anxiety, and burnout. Only 2 patients left the program prematurely; 89% participated in the 1-year assessment. By the end of the program, HRQoL was significantly improved in all domains. This effect was maintained at 6 months and 1 year for all subscales. Changes at 1 year were greater in younger patients and those with depressive feelings before the start of treatment. CONCLUSIONS: Our group-based program offered to FM patients proved successful with significant improvements in their HRQoL both in the short and long term.

Attention to pain and fear of pain in patients with chronic pain.

To investigate how acceptance of illness affects chronic pain in terms of attention towards pain and fearful thinking of pain. 62 participants (50 women) with chronic pain carried a palmtop computer for 2 weeks. Eight times each day auditory signals were delivered to cue participants to complete questions about their experience. Multilevel analyses indicated that on moments with more intense pain, more fearful thinking about pain, and less positive emotions, attention to pain was increased. Illness acceptance did not moderate the relation between pain intensity and attention to pain. Results further indicated that on moments with more intense pain, more negative emotions, and less positive emotions, fearful thinking about pain was increased. Of particular interest was the finding that the relationship between pain intensity and fearful thinking about pain was less strong for those high in acceptance. Pain captures attention and elicits fearful thinking about pain. Acceptance may be a useful avenue to lower negative thinking about pain, and to increase well-being in patients with chronic illnesses.

Acceptance of the unpleasant reality of chronic pain: effects upon attention to pain and engagement with daily activities.

This paper investigates whether acceptance was related to less attention to pain, and to more engagement with daily activities. The results of two studies are reported. In a first cross-sectional study, 501 chronic pain patients completed self-report instruments on pain severity, attention to pain and acceptance. In a second diary study, 62 patients with chronic pain reported pain intensity, attention to pain and characteristics of goal-directed behaviour 8 times a day using an experience sampling method. Acceptance was measured using a self-report instrument. It was found that acceptance was related to less attention to pain (study 1 and study 2), more engagement with daily activities, a higher motivation to complete activities and a better efficacy to perform daily activities (study 2). Results are discussed in terms of how a positive life despite pain may be preserved by a flexible adjustment of personal goals to current limitations and adversities.

Acceptance of pain is an independent predictor of mental well-being in patients with chronic pain: empirical evidence and reappraisal.

This paper reports upon: (1) the value of acceptance of pain in predicting well-being in patients suffering from chronic pain and (2) the construct validity of acceptance by comparing two questionnaires designed to measure acceptance (the Chronic Pain Acceptance Questionnaire, CPAQ, unpublished doctoral dissertation, University of Nevada, Reno, NV, 1992 and the Illness Cognitions Questionnaire, ICQ, J Consult Clin Psychol 69 (2001) 1026). The results of two independent cross-sectional studies are reported. Study 1 included 120 patients seeking help in tertiary care settings. In Study 2, 66 patients were recruited from a self-support group for fibromyalgia patients and from a pain clinic. Both studies revealed that acceptance of pain predicted mental well-being beyond pain severity and pain catastrophizing, but did not account for physical functioning. In both instruments, it was found that acceptance of pain was strongly related to engagement in normal life activities and the recognition that pain may not change. Acceptance in both instruments was strongly related to a cognitive control over pain. Study 2 further revealed that the correlation between the CPAQ and the ICQ is moderate, indicating that both instruments measured different aspects of acceptance. It is concluded that acceptance of chronic pain is best conceived of as the shift away from pain to non-pain aspects of life, and the shift away from a search for a cure with an acknowledgement that pain may not change.