Dr Philip Lage-Hansen and colleagues used the EULAR Congress to share their new data on the prevalence of fulfilment of survey-based criteria for fibromyalgia among 248 newly referred patients in a rheumatic outpatient clinic. This observational cohort study also aimed to compare the use of secondary health care services between survey-based fibromyalgia and nonfibromyalgia cases.
Dr Philip Lage-Hansen and colleagues used the EULAR Congress to share their new data on the prevalence of fulfilment of survey-based criteria for fibromyalgia among 248 newly referred patients in a rheumatic outpatient clinic. This observational cohort study also aimed to compare the use of secondary health care services between survey-based fibromyalgia and non-fibromyalgia cases.

Of those completing the questionnaire, 36% fulfilled fibromyalgia criteria at enrolment. These cases were primarily women, and received more public economical support than those without fibromyalgia. At 7 years follow up, adjusted results showed that fibromyalgia cases had higher number of hospital courses, and had undergone more invasive procedures; however, differences concerning number of diagnoses between groups were small.

The study also found that the burden to the secondary health care system is significant. Neurologists, gastroenterologists, endocrinologists, pain-specialists, psychiatrists, and abdominal surgeons were all consulted more often by people with fibromyalgia compared to those without. However, there was minimal difference between the groups with regards resulting diagnoses. This finding underlines that prolonged and excessive use of health care services with referral to multiple specialists should be avoided. A timely and coordinated effort across medical specialties, could reduce diagnostic delay, facilitate management, and reduce health care utilisation in people with fibromyalgia.

EULAR evidence-based recommendations for the management of fibromyalgia state that optimal management should focus on prompt diagnosis, patient education and non-pharmacological treatments. In addition, a recent systematic review showed a small to moderate beneficial health effect for mindfulness and acceptance-based interventions for patients with fibromyalgia. Dr Heidi Zangi presented results from such an intervention – followed by low threshold physical exercise counselling – compared to treatment as usual for patients diagnosed with fibromyalgia.

Overall, 56.5% of those randomized to the intervention group responded to the questionnaires; of these, only 15% reported clinically relevant improvement. However, there were small improvements evident in pain, fatigue, and self-efficacy for physical activity.

The improvement seen in patients’ tendency to be mindful at 12 months was sustained, although only 58% were in paid work compared to 70% at baseline. Although patients still reported high symptom burden and no improvement in their health status, there was no worsening of symptoms, which might have been the case without any intervention.

Daren Jaime sits with the Owner of Washington Heights Wellness, Dr. Rosanna De La Cruz to discuss the upcoming seminar focusing on natural medicine for fibromyalgia

Personal construct therapy improves symptoms of depression in women with fibromyalgia CREDIT Chronic Joy Ministry

Fibromyalgia is a rheumatic disease of unknown origin, which is characterized by chronic pain and often accompanied by symptoms of depression. It mainly affects women, and there is no cure, but various treatments can help relieve the symptoms.

Cognitive-behavioural psychological therapy has proven to be a useful tool in this area. Now, a multicentre study involving researchers at the Universitat Oberta de Catalunya (UOC), the University of Barcelona (UB) and the Universidad de Las Américas (UDLA) in Ecuador, and published in open access format in the journal International Journal of Clinical and Health Psychology, has recently proven that another form of psychological therapy, called personal construct therapy, is just as effective in reducing depressive symptoms and improving patients’ quality of life. According to Mari Aguilera, a researcher belonging to the GRECIL interuniversity group, as well as a professor in the Faculty of Psychology and Education Sciences at the UOC and the UB and the co-lead author of the study with the researcher at the Universidad de Las Américas in Ecuador Clara Paz, these results make it possible to “expand the range of effective therapies and increase the flexibility to adapt to each patient’s particular characteristics and needs“.

106 women in a pioneering multicentre study

The study, which was coordinated by the UB full professor of Psychology faculty and the Institute of Neurosciences Guillem Feixas, included 106 women with fibromyalgia and depressive symptoms who were treated in ten different places: two mental health centres and eight primary healthcare centres. The association between fibromyalgia and depression is common in these patients, and appears to work both ways: each one increases the risk and aggravates the characteristics of the other.

The volunteers followed a weekly course of psychological therapy for approximately four months. Half of them received standard cognitive-behavioural therapy, which has already been shown to be moderately effective in this type of patient. The other half followed a treatment based on personal construct therapy – a different approach “focused on people’s identity, how they see themselves, how they see what happens to them and how they see others,” explained Joan Carlos Medina, a member of the Faculty of Psychology and Education Sciences at the UOC, and a researcher at the UB.

The results of the study show that both the therapies reduced symptoms of depression in approximately 60% of the women taking part, and that there were no significant differences between the treatments. Furthermore, they also showed improvements in terms of the disease’s impact on their daily functioning and in terms of pain. In specific terms, approximately one in four patients who received personal construct therapy significantly improved their functioning in the medium term, and one in six experienced reduced pain.

More tools for personalization

“Fibromyalgia has no specific known cause and there is no cure, but a psychological improvement has an impact on physical health,” explained Aguilera. This is particularly important in a disease “which is still questioned by some doctors, and which is often considered less important due to the fact that it mainly affects women,” she added.

The standard cognitive-behavioural therapy “is more interested in how to change behaviour than the reason behind it,” said Aguilera, while personal construct therapy is focused in particular “on how you build your world and what you give meaning to. But it’s not so much about setting them against each other, as seeing whether the two of them can be useful from a different perspective.”

Some studies have shown that personal construct therapy could be useful in treating depression, for example, but apart from a small pilot study, “this is the first time that this type of therapy has been studied and shown to be helpful for fibromyalgia patients,” explained Medina. Having more proven resources means that they can be adapted to the patients’ preferences. “It helps us to personalize treatments, and adapt them better. We have more tools for listening, learning and proposing strategies,” he concluded.