Postural counseling represents a novel option in pain management of fibromyalgia patients

Abstract

Background: Chronic pain is a key symptom in fibromyalgia (FM), and its management is still challenging for rheumatologists in daily practice. FM patients show psychological and psychiatric manifestations, going from mood and emotional disorders to depression and alexithymia that negatively impact their quality of life, limiting their daily activities. Since pharmacological strategies have a limited efficacy in FM pain, alternative or complementary non-pharmacological approaches have been introduced in the clinical management of FM.

Patients and methods: This is a retrospective study on FM patients (n=52) treated with a novel integrated postural counseling (PC) rehabilitation program carried out by a counselor physiotherapist. The clinical impact of PC was evaluated by 1) a semi-structured interview using an ad hoc modified questionnaire McGill Illness Narrative Interview (MINI) 1 to obtain data on pain management by highlighting everyday experience of living with pain and 2) an FM impact questionnaire (FIQ) total score.

Results: Two main structures of narrative emplotment of FM illness were recognized: 1) the cumulative life narrative structure (46.15%) and 2) the broken life (53.85%) narrative structure. Baseline FIQ score was 77.38±7.77, and it was significantly reduced after PC to 39.12±13.27 (P<0.0001). Although well-being still requires further definition as outcome in pain management, it is important for FM patients, dealing with pain-related sensations, thoughts and feelings and limiting their daily activities. In our study, 87.5% of interviewed FM patients reported an improvement in their well-being after PC.

Conclusion: Our data suggest that an integrated PC program positively impacts chronic pain and fatigue based on self-management strategies. PC allows FM patients to resume their own life and regenerate their own image. Finally, we propose the introduction of the evaluation of the ability to resume daily activities as the target of rehabilitation programs in FM.

Keywords: NSAIDs; anticonvulsants; fatigue; self-management; sense of self; serotonin-norepinephrine reuptake inhibitors; tricyclic drugs.

Figure 1

Tree diagram of the study involving pts with FM treated with integrated PC. Abbreviations: FM, fibromyalgia; PC, postural counseling; pts, patients.

Figure 2

Histogram depicting individual variations on FIQ score in FM patients who completed the study protocol. Note: FIQ was collected before and after PC program. Abbreviations: FIQ, FM impact questionnaire; FM, fibromyalgia; PC, postural counseling.

Figure 3

A clinical model of care in FM patients based on PC program outcomes. Notes: The clinical care in FM should take into account the contextual factor as well as societal and individual perspective in designing a rehabilitation program such as a PC program. This successfully impacts both individual perspective of FM and the ability of patients to deal with FM symptoms, such as pain and fatigue daily. Abbreviations: FM, fibromyalgia; PC, postural counseling.