Background & Aims
Fibromyalgia (FM) is a common illness characterized by chronic widespread pain, sleep problems, physical exhaustion, and cognitive difficulties (1). The management based on exercise-based therapeutic methods (ET), pain neuroscience education (PNE), and cognitive-behavioral therapy (CBT) have shown robust effects on physical and psychological function (2-7). Nevertheless, the presence of cognitive disturbances, such as mild cognitive impairment (MCI), may introduce distortions in the results when implementing the aforementioned treatments in a sample of women suffering from FM. Therefore, the objective of this study was to assess the effectiveness of resistance exercise-based therapeutic methods (RE) and pain neuroscience education (PNE) on both physical and cognitive-affective aspects, while comparing women with FM with and without MCI.
Methods
A pilot trial was undertaken involving subjects diagnosed with FM with and without MCI. Participants meeting inclusion criteria were allocated to the intervention group consisting of an 8-week RE and PNE protocol performed in Asociacion de Fibromialgia y Síndrome de Fatiga cronica (Tenerife, Spain) between February, 1 st 2023 to June, 2nd 2023. RE was divided into warm-ups that lasted for 10 minutes and included a routine of general mobility exercises. The main phase spanned 30 minutes, comprising active dynamic exercises (2-3 sets of 15-30 repetitions for each exercise at a frequency of 1.5Hz). The cool-down phase consisted of 10 minutes of the Jacobson relaxation technique. Furthermore, PNE was administered in 6 individual sessions of 1.5 hours of duration in which patients were enhanced to promote a reconceptualization of fundamental pain concepts. Follow-up assessments were conducted at pre-intervention, as well as at the 4th, 6th, and 8th weeks.
Results
There were statistically significant differences favored the FM group without MCI (n=32, 70.5 ± 4.92 yrs.) at all measurement points for pain neuroscience knowledge (TS=-6.36, -26.39 [CI 95% -34.7 to -18.08], p<0.001), and at 8-wks for Physical Function (TS=2.243, 6.25 [CI 95% 0.672 to 11.84], p=0.029) and Catastrophizing (TS=2.104, 6.11 [CI 95% 0.294 to 11.93], p=0.040). Conversely, the FM group with MCI (n=36, mean age 70.9 ± 4.18 years) exhibited significant disparities favoring them in Hypervigilance at 4 weeks (TS=-2.009, [CI 95% -5.86 to -0.009, p=0.049), 6 weeks (TS=-7.147, [CI 95% -13.65 to -7.67, p<0.001), and 8 weeks (TS=-7.941, [CI 95% -16.04 to -9.57, p<0.001). Noteworthy is the absence of significant differences within groups concerning the Central Sensitization Inventory and Fear-Avoidance beliefs.
Conclusions
RE and PNE show efficacy in enhancing both physical and cognitive-affective functions among women diagnosed with FM irrespective of the presence of MCI. Nevertheless, to establish more robust and conclusive findings, additional studies with refined methodologies and larger sample sizes are warranted.
References
1. Häuser W, Ablin J, Fitzcharles MA, Littlejohn G, Luciano JV, Usui C, Walitt B. Fibromyalgia. Nat Rev Dis Primers. 2015 Aug 13;1:15022. doi: 10.1038/nrdp.2015.22.
2. Larsson A, Palstam A, Löfgren M, Ernberg M, Bjersing J, Bileviciute-Ljungar I, Gerdle B, Kosek E, Mannerkorpi K. Resistance exercise improves muscle strength, health status and pain intensity in fibromyalgia–a randomized controlled trial. Arthritis Res Ther. 2015 Jun 18;17(1):161. doi: https://doi.org/10.1186/s13075-015-0679-1
3. Park HK, Song MK, Kim DJ, Choi IS, Han JY. Comparison of core muscle strengthening exercise and stretching exercise in middle-aged women with fibromyalgia: A randomized, single-blind, controlled study. Medicine (Baltimore). 2021 Dec 17;100(50):e27854. doi: https://doi.org/10.1097/MD.0000000000027854
4. Atan T, Karavelio?lu Y. Effectiveness of High-Intensity Interval Training vs Moderate-Intensity Continuous Training in Patients With Fibromyalgia: A Pilot Randomized Controlled Trial. Arch Phys Med Rehabil. 2020 Nov;101(11):1865-1876. doi: https://doi.org/10.1016/j.apmr.2020.05.022
5. Areso-Bóveda PB, Mambrillas-Varela J, García-Gómez B, Moscosio-Cuevas JI, González-Lama J, Arnaiz-Rodríguez E, Del Barco MBA, Teodoro-Blanco PS. Effectiveness of a group intervention using pain neuroscience education and exercise in women with fibromyalgia: a pragmatic controlled study in primary care. BMC Musculoskelet Disord. 2022 Apr 4;23(1):323. doi: https://doi.org/10.1186/s12891-022-05284-y
6. Barrenengoa-Cuadra MJ, Muñoa-Capron-Manieux M, Fernández-Luco M, Angón-Puras LÁ, Romón-Gómez AJ, Azkuenaga M, Etxebarria A, Orrantia G, Pikaza A, Uribe-Etxebarria L, Zorrilla A, Larrinaga G, Arana-Arri E, Gracia-Ballarín R; FIMIDOC Working Group researchers. Effectiveness of a structured group intervention based on pain neuroscience education for patients with fibromyalgia in primary care: A multicentre randomized open-label controlled trial. Eur J Pain. 2021 May;25(5):1137-1149. doi: https://doi.org/10.1002/ejp.1738
7. Serrat M, Sanabria-Mazo JP, Almirall M, Musté M, Feliu-Soler A, Méndez-Ulrich JL, Sanz A, Luciano JV. 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. 2021 Dec 1;101(12):pzab200. doi: https://doi.org/10.1093/ptj/pzab200
Presenting Author
Sebastián Eustaquio Martín Pérez
Poster Authors
Sebastián Eustaquio Martín Pérez
MSc
UNIVERSIDAD EUROPEA DE CANARIAS
Lead Author
Yaiza Hernández Pérez
Faculty of Health Sciences, Universidad Europea de Canarias, Spain
Lead Author
Alejandro López Mejías
Faculty of Health Sciences, Universidad Europea de Canarias, Spain
Lead Author
Francisco Javier Torres Rojano
Faculty of Health Sciences, Universidad Europea de Canarias, Spain
Lead Author
Isidro Miguel Martín Pérez
Department of Pharmacology and Physical Medicine, Universidad de La Laguna, Spain
Lead Author
Jorge Hugo Villafañe
IRCCS Fondazione Don Carlo Gnocchi, Italy
Lead Author
José Luis Alonso Pérez
Department of Physiotherapy, Faculty of Sport Sciences, Universidad Europea de Madrid
Lead Author
Topics
- Patient Engagement and Co-Creation in Research and Education