Fibromyalgia pain management effectiveness from the patient perspective: a qualitative evidence synthesis

Abstract

Purpose

This qualitative evidence synthesis aimed to identify and integrate findings where adults with fibromyalgia discussed how they managed their pain, and their perceptions of prescribed treatments from healthcare professionals.

Materials and Methods

A comprehensive search strategy was implemented in PubMed, Scopus, ISI Web of Science, and Cinahl Plus databases. The GRADE-CERQual framework was used to evaluate the findings confidence. The findings were analyzed using an inductive thematic analysis approach.

Results

A total of 35 studies (N = 728) were included. The confidence in the findings ranged from high to low confidence. Patients with fibromyalgia often do not benefit from seeking medical attention due to provider stigma, and have varying views on medication effectiveness commonly reporting feeling like “walking chemists.” They find mixed effects from exercise, and consider psychological support essential, although the benefits of cognitive-behavioral therapy were controversial. Combining cognitive-behavioral therapy with physical exercise appears more effective, while natural and complementary therapies have short-term benefits and high costs.

Conclusions

Pain management is a source for frustration and an unmet need for patients with fibromyalgia. The current findings provide crucial insight for providers and researchers; and support the need for fibromyalgia phenotyping and precision medicine approaches to pain management.

Implications for Rehabilitation

• Chronic widespread pain is the defining feature of fibromyalgia, yet pain reduction is often an unmet need for these individuals.

• The lack of effective treatments resulting in long-term relief proves frustrating for patients and healthcare providers.

• Rehabilitation professional should consider the unique insight into this complex, heterogeneous condition that this qualitative synthesis provides to better understand their patient’s perspective on pain management.

• Given the differing perspectives on pain treatment approaches individuals with fibromyalgia report, providers should discuss with each patient their current strategies and take a patient-centered, individualized approach to form an effective treatment plan.

Keywords:

• Fibromyalgia
• qualitative evidence synthesis
• qualitative research
• patients experience
• pain management

Author contributions

CCS, KRH, EBV, MGL, FVP: Made substantial contributions to conception and design, or acquisition of data; CCS, KRH, OMN, EBV, HFL, FVP, MGL, PHF: Involved in analysis and interpretation of data, drafting the manuscript or revising it critically for important intellectual content and gave final approval of the version to be published. All authors agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

CCS received a Margarita Salas grant fellowship from the Ministry of Universities of the Government of Spain funded by the European Union – NextGenerationUE. KRH was supported under the National Institutes of Health T32 Interdisciplinary Training in Biobehavioral Pain Research program at Johns Hopkins [T32NS070201]. The funding sources were not involved in the study design, collection, analysis and interpretation of data, the writing of the report, or the decision to submit the article for publication.