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Behavior and Pain in Patients with Fibromyalgia

Full Title: A Mixed Methods Cross-Sectional Investigation of the Influence of Behavioral and Psychological Status in the Pain Perception of Patients with Fibromyalgia


Author: Cheryl Mazzeo


Institutional Affiliation: Northcentral University


Location of Work: United States


Year Completed: 2019


Not Submitted for Publications Because: Partially Completed Paper


Topic: Psychology


Keywords: Behavior, psychology, fibromyalgia




Chapter 1: Introduction

Fibromyalgia is a chronic pain disorder that is characterized by fatigue, poor concentration, depression, and additional symptoms (Hegewald, Markewitz, & Elliott, 2007). It was first identified and defined in the 1990s (Freundlich & Leventhal, 1990). A 2008 study conducted by the German Fibromyalgia Association (GFA) aimed to fully describe the symptoms that occur most frequently among patients with the disease, which is classified as a chronic pain disorder (Häuser et al., 2009). The most common symptom associated with fibromyalgia is the sensation of muscle pain throughout the body, and common secondary symptoms are pain in the lower back and morning stiffness. Additional consequences may include low levels of productivity, an inability to work, and forgetfulness (Palstam & Mannerkorpi, 2017). As such, fibromyalgia is associated with a reduced quality of life for many patients (Luciano et al., 2016). For many patients with fibromyalgia, their symptoms are not well-controlled. The literature reveals that clinical treatment alone is insufficient to meet the clinical and mental health needs of patients (Kia & Choy, 2017). Fibromyalgia is considered to be a complex condition, with causative factors related to biological, psychological, and behavioral elements. Thus, treatment that focuses on clinical applications alone are insufficient. It is therefore advantageous to assess how the behaviors of patients with fibromyalgia are related to pain and symptom severity in a manner that will contribute to an improved quality of clinical and psychological care.

Patients who have been diagnosed with fibromyalgia often experience high levels of pain, in a manner dependent upon direct and indirect associations with their diagnosis (Ablin et al., 2013). According to the 2012 National Health Interview Survey, 1.75% of the population likely has fibromyalgia based on their presentation of symptoms, but only one-third of cases have been formally diagnosed (Walitt, Nahin, Katz, Bergman, & Wolfe, 2015). Research has been conducted to characterize the role of behavior and mental status in chronic pain disorders, such as rheumatoid arthritis (van den Hoek et al., 2016). However, the relationship between these identified characteristics and fibromyalgia is not well-understood. For instance, in fibromyalgia, psychosomatic triggers and neural overstimulation could produce a pain response (Martinez-Lavin, 2013; Rubin, 2005). It is challenging to objectively measure pain and symptom severity (Williams & Arnold, 2011). Adding to the challenge, some patients with mental health comorbidities, such as depression, tend to report higher levels of pain associated with their conditions (Chang et al., 2015).

Some sources in the literature report that alcohol use exacerbates fibromyalgia pain, while others suggest that moderate consumption of alcohol is protective against pain and does not contribute to an increased risk of mental disorders, such as depression (Chung & Wang, 201l; Ortolá, García-Esquinas, Galán, & Rodríguez-Artalejo, 2016). These findings present contradictory conclusions about this common behavior. This information can be applied by health care professionals as an evidence-based approach to assist with the management of fibromyalgia (Bushnell, Čeko, & Low, 2013). Collecting information about how pain is perceived differently by patients may contribute to knowledge regarding effective treatment methods for these subpopulations. Information about pain level in response to additional disease and substance use as well as information that pertains to effective treatment strategies will, therefore, be retrieved from patients with fibromyalgia. This knowledge will be utilized to offer recommendations to enhance their control over their symptoms.

At present, fibromyalgia pain is reported through the use of a Likert-like scale, in which the patient reports the intensity of his or her pain using a pain using a numerical scale, with ratings from levels of 1 to 10. A score of 1 represents the lowest level of pain, while a pain score of 10 represents the greatest level of pain (Fussner et al., 2019). The health care provider may also request information about the patient’s average level of pain, as well as their present level of pain at the time of the visit. A thorough assessment may assess the pain levels present in different parts of the body (Steiner, Bigatti, Slaven, & Ang, 2016). However, these questions do not fully describe the intensity of the symptoms experienced. To do so, it is meaningful to assess how the patient’s behavioral and psychological states interact to produce perceived increased level of pain.

Research has likewise shown that psychological factors can be utilized to characterize a patient’s chronic pain symptoms (Haefeli & Elfering, 2006). Individuals who experience greater psychological well-being, such as those who have a generally positive outlook and a high level of self-efficacy, will report less pain; meanwhile, those experiencing psychological distress report greater levels of pain (Joharatnam et al., 2015). Thus, the reliability of chronic pain measurement testing is dependent on the psychological well-being of the patient. Since patients with fibromyalgia have many overlapping and distinct symptoms, an examination of the behaviors that are related to the expression of these symptoms would allow the intensity of the disease to be accurately reported (Knoerl, Lavoie Smith, & Weisberg, 2015). As such, psychological and physiological symptoms should be considered in conjunction as a part of the diagnostic and follow-up processes (Segura-Jiménez et al., 2015). Behavioral components likewise play a key role in this relationship (Peñacoba, Pastor, López-Roig, Velasco, & Lledo, 2016). Since behavioral factors interact with psychological and physiological outcomes and can be controlled by the patient, it is essential to include an assessment of behavior as a part of the treatment process for patients with fibromyalgia.

Assessing the behavioral and psychological influences of pain for patients with fibromyalgia will allow for tracking the severity of specific symptoms in response to specific patient behaviors (Arnold, Gebke, & Choy, 2016; Burns et al., 2015). The proposed investigation has the potential to increase the quality of pain management and quality of life for patients with fibromyalgia. This knowledge is potentially meaningful to health care professionals as well as patients. Incorporating implications concerning patient behavior in practice could help reduce pain and the severity of symptoms. As such, it is advantageous to assess the behavioral characteristics and mental factors that result in an increased level of perceived pain among patients with fibromyalgia.

Statement of the Problem

The purpose of the study is to assess the relationship between psychological status, behavior, and pain levels in patients with fibromyalgia. Present treatments offer limited clinical efficacy (Arnold & Clauw, 2017). As a result, men and women with fibromyalgia often experience uncontrolled disease and a reduced quality of life (Sener et al., 2013). Present research reveals that little is known about the physiological nature of fibromyalgia, which means that patients are at risk of clinical overtreatment (Cohen, 2017). As a consequence of this gap in knowledge, it is meaningful to explore the psychological and behavioral characteristics that exacerbate fibromyalgia in an effort to improve patient outcomes. It is advantageous to apply the biopsychosocial model to an understanding of the complex relationship present between these factors, and the model can be applied to rectify the present limitations associated with treatment (Baria, Pangarkar, Abrams, & Miaskowski, 2018). Such research could support the development of improved clinical and psychological procedures for the purposes of pain control and reduction (LaRowe et al., 2018; Miki et al., 2018; Toussaint, Whipple, & Vincent, 2015). If this study were not conducted, patients with fibromyalgia will continue to receive treatment that does not fully address their comfort and independence.

To improve the quality of fibromyalgia treatment in practice, it is advantageous to define and describe the variables that can be used to characterize pain (Boomershine, 2010; Crofford, 2015; Fiz, Durán, Capellà, Carbonell, & Farré, 2011). Once these trends are targeted, it will be possible for health care professionals to offer their patients personalized pain management interventions. Describing how these factors interact with fibromyalgia pain can offer health care professionals access to evidence-based knowledge to improve patient quality of life and well-being (Halpern, Shah, Cappelleri, Masters, & Clair, 2015; Veehof, Trompetter, Bohlmeijer, & Schreurs, 2016).

Purpose of the Study

The purpose of this concurrent mixed-methods study is to identify the behaviors and mental statuses that are associated with an exacerbation of pain and discomfort in patients with fibromyalgia (Venkatesh, Brown, & Sullivan, 2016). Since there is limited knowledge pertaining to the causes of fibromyalgia, it is difficult to treat; as such, it is necessary to examine psychological and behavioral characteristics as contributing factors to the disease. The study will explore the extent to which psychological and behavioral characteristics influence fibromyalgia discomfort, and this knowledge can be applied by health care professionals as a part of the treatment process The investigation will apply a cross-sectional approach, using a concurrent mixed methods protocol, in which study participants will be asked to respond to a series of qualitative and quantitative questions addressing their health statuses and behaviors at the same point in time.


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