Abstract
A recent study (FIBROWALK) has supported the effectiveness of a multicomponent treatment based on pain neuroscience education (PNE), exercise therapy (TE), cognitive behavioral therapy (CBT), and mindfulness in patients with fibromyalgia. The aim of the present RCT was: (a) to analyze the effectiveness of a 12-week multicomponent treatment (nature activity therapy for fibromyalgia, NAT-FM) based on the same therapeutic components described above plus nature exposure to maximize improvements in functional impairment (primary outcome), as well as pain, fatigue, anxiety-depression, physical functioning, positive and negative affect, self-esteem, and perceived stress (secondary outcomes), and kinesiophobia, pain catastrophizing thoughts, personal perceived competence, and cognitive emotion regulation (process variables) compared with treatment as usual (TAU); (b) to preliminarily assess the effects of the nature-based activities included (yoga, Nordic walking, nature photography, and Shinrin Yoku); and (c) to examine whether the positive effects of TAU + NAT-FM on primary and secondary outcomes at post-treatment were mediated through baseline to six-week changes in process variables. A total of 169 FM patients were randomized into two study arms: TAU + NAT-FM vs. TAU alone. Data were collected at baseline, at six-week of treatment, at post-treatment, and throughout treatment by ecological momentary assessment (EMA). Using an intention to treat (ITT) approach, linear mixed-effects models and mediational models through path analyses were computed. Overall, TAU + NAT-FM was significantly more effective than TAU at posttreatment for the primary and secondary outcomes evaluated, as well as for the process variables. Moderate-to-large effect sizes were achieved at six-weeks for functional impairment, anxiety, kinesiophobia, perceived competence, and positive reappraisal. The number needed to treat (NNT) was 3 (95%CI = 1.6–3.2). The nature activities yielded an improvement in affective valence, arousal, dominance, fatigue, pain, stress, and self-efficacy. Kinesiophobia and perceived competence were the mediators that could explain a significant part of the improvements obtained with TAU + NAT-FM treatment. TAU + NAT-FM is an effective co-adjuvant multicomponent treatment for improving FM-related symptoms.
Highlights
Fibromyalgia (FM) is a syndrome that affects around 2% of the general population [1] and has a strong impact on activities of daily living [2]
Most patients 59% were married or living with a partner, 63% lived accompanied, 50% had completed secondary studies, 50% were in paid employment, and 50% were processing some kind of disability certification at baseline
Our results indicate that these beneficial outcomes are achieved as therapy progresses, but at six-weeks there is already a significant improvement in the main outcomes analyzed in these FM patients
Summary
Fibromyalgia (FM) is a syndrome that affects around 2% of the general population [1] and has a strong impact on activities of daily living [2]. In the pathogenesis of central sensitization syndromes (SSC) such as FM, the phenomenon of CS is considered to be more relevant than that of peripheral sensitization, it has been accepted that both can be involved [8]. CS is a broad concept involving a large variety of complex pathophysiological mechanisms [9,10] that represents a challenge for researchers and clinicians in the field of SSC
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