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

Abstract

Carla Galvani,1 Paola Caramaschi,1 Paolo Mura,2 Antonella Paladini,3 Alba Piroli,3 Elisa Arnaudo,4 Lucia De Franceschi,5 Maurizio Evangelista,6 Alice Pari,4 Giovanna Ongaro,1 Gabriele Finco,2 Anna Ciannameo,4 Antonio Carletto,1 Giustino Varrassi,3,7 Domenico Biasi1 1Rheumatology Unit, Department of Medicine, University of Verona, Verona, Italy; 2Anesthesia, Intensive Care and Pain Therapy Unit, Department of Medical Science “M. Aresu”, University of Cagliari, Cagliari, Italy; 3Department of MESVA, University of L’Aquila, L’Aquila, Italy; 4Department of Internal Medicine, University of Bologna, Bologna, Italy; 5Internal Medicine Unit, Department of Medicine, University of Verona, Verona, Italy; 6Emergency Department, Institute of Anesthesia, Resuscitation and Pain Medicine, Catholic University of Sacred Heart, Rome, Italy; 7Paolo Procacci Foundation, Rome, Italy 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: self-management, sense of self, fatigue, serotonin–norepinephrine reuptake inhibitors, tricyclic drugs, anticonvulsants, NSAIDs

Keywords

• self-management
• sense of self
• fatigue
• serotonin-norephinephrine re-uptake inhibitors
• tricyclic drugs
• anti-convulsants
• non-steroidal anti- inflammatory drugs