Effectiveness of a group intervention using pain neuroscience education and exercise in women with fibromyalgia: a pragmatic...., 2022, Areso-Bóveda

Full title: Effectiveness of a group intervention using pain neuroscience education and exercise in women with fibromyalgia: a pragmatic controlled study in primary care

Abstract

Background
Very positive effects have been described in the application of pain neuroscience education (PNE) to chronic pain and migraine. However, there are few data on the applicability of this therapeutic approach in actual clinical practice in a primary care (PC) setting. The aim of this study was to explore the efficacy in fibromyalgia (FM) of an intervention based on PNE and exercise compared to treatment as usual (TAU).

Methods
Pragmatic nonrandomised controlled trial set in 5 healthcare centres and one physiotherapy centre in PC. Fifty-three women with FM (2010 American College of Rheumatology Diagnostic Criteria for Fibromyalgia) were studied, 35 in the intervention group (IG) and 18 in the control group (CG). The women in the IG were interviewed individually and then received 6 weekly sessions plus one review session (1 month later): those in the CG received their TAU. The subject assignation to the CG or the IG was determined according to their availability to attend the sessions. They all filled in several questionnaires (prior to and 1 year after the intervention) to evaluate the impact of FM in their daily lives, catastrophism, anxiety and depression, severity and impact of pain in daily personal performance and functional capacity.

Results
The reductions (improvements) in the scores of all tests (baseline-final) were greater in the IG (p < 0.05) when adjusted for age and baseline values, with moderate or high effect size. After 1 year, 20% (CI − 1 to 42%) more women in the IG, compared to the CG, had a FIQ score < 39 (mild functional impairment). 17/38 (49%) women in the IG no longer met FM criteria at the end of follow-up.

Conclusions
An intervention based on PNE and exercise in patients with FM is feasible and seems effective in PC.

Open access, https://bmcmusculoskeletdisord.biomedcentral.com/articles/10.1186/s12891-022-05284-y

 

Paul Garner, the gift that keeps giving (my bolding)...

"Very positive effects have been described as regards the application of this therapeutic approach to chronic pain [18,19,20,21,22] and migraine [23, 24], with clinical and functional improvements in patients, including FM sufferers, both as the main therapy [25, 26] and as part of a multidisciplinary approach [27, 28]. Even in the current pandemic due to SARS-CoV-2 infection, some authors such as A. Goicoechea or P. Garner have proposed its use in patients with long COVID-19 due to the similarities of this entity with FM and other central sensitisation syndromes [29, 30]. Nevertheless, there is little data regarding the applicability of this method in real clinical practice in a primary care (PC) setting or of its medium- and long-term effectiveness. For this reason, we undertook a pragmatic study to explore, prospectively, the effectiveness of a double PNE intervention, at group and individual levels, coupled with conscious movement techniques, as compared with treatment as usual (TAU), in PC."

 

They are studying the feasibility of something that has been tried with identical methodology hundreds of times and used, at times coercively, for many years on probably millions. And somehow no one is bothered by that. They just keep doing the same things over and over again and no one cares.

But I'm sure it has a new hat and a sticker that says "Brand new!" on it, right next to the sticker that says "Trusted by experts for over 10 years!".

 

In the very brief report of a type of multi-factor intervention of 35 patients (drop out number?) that has been in use for at least twenty years for FM and chronic pain patients.

The patients were assigned to the treatment group or the control group based on whether they could attend the weekly (6 weeks) sessions and followup. That prejudices the results or could have. Not enough elaboration in the report to know.

Also, the questionnaires (instruments) used to assess the outcomes of the intervention were not mentioned by name. Are these instruments valid, have they been validated?

The measurement at one-year-post intervention could be the result of the natural course of adaptation to FM, a natural temporary or permanent lessening of symptoms, or something other than the intervention.