Background & Aims

Fibromyalgia (FM), which affects 2.7% of the global population (Queiroz, 2013), primarily affects women aged 40-50, leading to chronic musculoskeletal pain, fatigue, and sleep issues, often accompanied by anxiety (13%–63.8%) and depressive disorders (20%–80%) (Häuser et al., 2015).
The gold-standard approach for fibromyalgia typically involves multicomponent strategies, combining therapeutic exercise with psychotherapy or education (Thieme et al., 2017). However, existing treatments are non-curative and often exhibit limited efficacy (Häuser et al., 2015).
This study aims to identify sociodemographic and clinical characteristics that pinpoint patients with fibromyalgia particularly resistant to multicomponent interventions. By identifying such features, the allocation of healthcare resources may be improved, enabling a more targeted approach within the field of personalized medicine (Edwards et al., 2023).

Methods

This study explored potential predictive sociodemographic and clinical variables in a sample of 905 patients diagnosed with FM (ACR 2010/2011 criteria) at Vall d’Hebron Barcelona Hospital’s Central Sensitivity Syndromes Specialized Unit. The primary objective was to anticipate the absence of a clinically significant response following a multicomponent intervention, defined as less than a 20% improvement (Bennett, 2009) in the gold-standard measure for fibromyalgia, the Fibromyalgia Impact Questionnaire-Revised (FIQR). Using a multivariable logistic regression (backward method), the analysis predicted the binary outcome (response/non-response) and encompassed a comprehensive set of sociodemographic factors (e.g., age, gender) and clinical measures as predictive variables (e.g., main comorbidities, years with fibromyalgia, fibromyalgia impact – FIQR, depressive and anxiety symptoms – Hospital Anxiety and Depression Scale (HADS), kinesiophobia – Tampa Scale of Kinesiophobia (TSK)).

Results

The study sample (n=905) predominantly consisted of middle-aged individuals (M=52.40 years old, SD=9.26), with women comprising 96% of the participants, and a substantial history of dealing with fibromyalgia (M=14.30 years, SD=10.36). Employing a backward logistic regression method on the entire sample, we derived a parsimonious model explaining approximately 11% of the variance in the binary variable for treatment response based on the Fibromyalgia Impact Questionnaire-Revised (FIQR) (Nagelkerke R2= .112). This model accurately classified 63.6% of cases (i.e., 75.9% of non-responders) based on pre-treatment variables. The results revealed that lower depression symptoms (B=.049, p=.01), fibromyalgia impact (B=.022, p=.006), and kinesiophobia (B=.020, p=.07) were predictive of a poor treatment outcome in response to multicomponent interventions.

Conclusions

Clinical variables such as fibromyalgia impact, kinesiophobia, and depressive symptoms were identified as valuable predictors of treatment non-response to multicomponent interventions for fibromyalgia. Incorporating these predictive clinical measures into routine practice can empower healthcare professionals in optimizing treatment planning and resource allocation, ensuring targeted interventions for patients prone to not responding to gold-standard treatment approaches. This study establishes the groundwork for developing practical applications that integrate these predictive measures into everyday clinical decision-making, thereby advancing the realm of personalized medicine in fibromyalgia management.

References

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Queiroz L. P. (2013). Worldwide epidemiology of fibromyalgia. Curr. Pain Headache Rep. 17, 356. doi:10.1007/s11916-013-0356-5
Serrat M., Albajes K., Navarrete J., Almirall M., Lluch Girbé E., Neblett R., et al. (2022b). Effectiveness of two video-based multicomponent treatments for fibromyalgia: The added value of cognitive restructuring and mindfulness in a three-arm randomised controlled trial. Behav. Res. Ther. 158, 104188. doi:10.1016/j.brat.2022.104188
Serrat M., Almirall M., Musté M., Sanabria-Mazo J. P., Feliu-Soler A., Méndez-Ulrich J. L., et al. (2020). Effectiveness of a multicomponent treatment for fibromyalgia based on pain neuroscience education, exercise therapy, psychological support, and nature exposure (NAT-FM): A pragmatic randomized controlled trial. J. Clin. Med. 9, 3348. doi:10.3390/jcm9103348
Serrat M., Coll-Omaña M., Albajes K., Solé S., Almirall M., Luciano J. V., et al. (2021a). Efficacy of the FIBROWALK multicomponent program moved to a virtual setting for patients with fibromyalgia during the COVID-19 pandemic: A proof-of-concept RCT performed alongside the state of alarm in Spain. Int. J. Environ. Res. Public Health 18, 10300. doi:10.3390/ijerph181910300
Serrat M. (2022a). Integrating pain neuroscience education in multicomponent approaches for people with fibromyalgia: A practical guide for clinicians. Unpublished.
Serrat M., Sanabria-Mazo J. P., Almirall M., Musté M., Feliu-Soler A., Méndez-Ulrich J. L., et al. (2021b). Effectiveness of a multicomponent treatment based on pain neuroscience education, therapeutic exercise, cognitive behavioral therapy, and mindfulness in patients with fibromyalgia (FIBROWALK study): A randomized controlled trial. Phys. Ther. 101, pzab200. pzab 200. doi:10.1093/ptj/pzab200
Thieme, K., Mathys, M., & Turk, D. C. (2017). Evidenced-based guidelines on the treatment of fibromyalgia patients: are they consistent and if not, why not? Have effective psychological treatments been overlooked?. The Journal of Pain, 18(7), 747-756.

Presenting Author

Albert Feliu-Soler

Poster Authors

Albert Feliu-Soler, PhD

PhD

Department of Clinical and Health Psychology, Autonomous University of Barcelona

Lead Author

E-mail

Mayte Serrat

PhD

Hospital Vall d'Hebron

Lead Author

E-mail

Rodrigo López

Lead Author

E-mail

Jaime Navarrete

Teaching, Research & Innovation Unit, Parc Sanitari Sant Joan De Déu

Lead Author

E-mail

Estibaliz Royuela-Colomer

Lead Author

E-mail

Juan V Luciano

Department of Clinical and Health Psychology, Autonomous University of Barcelona

Lead Author

E-mail

Rubén Nieto

PhD

Universitat Oberta de Catalunya

Lead Author

E-mail

Topics

  • Specific Pain Conditions/Pain in Specific Populations: Fibromyalgia