Abstract
Chronic widespread pain (CWP) including fibromyalgia has a prevalence of up to 15% and is associated with substantial morbidity. Supporting psychosocial and behavioural self-management is increasingly important for CWP, as pharmacological interventions show limited benefit. We systematically reviewed the effectiveness of interventions applying self-management principles for CWP including fibromyalgia. MEDLINE, Embase, PsycINFO, The Cochrane Central Register of Controlled Trials and the WHO International Clinical Trials Registry were searched for studies reporting randomised controlled trials of interventions adhering to self-management principles for CWP including fibromyalgia. Primary outcomes included physical function and pain intensity. Where data were sufficient, meta-analysis was conducted using a random effects model. Studies were narratively reviewed where meta-analysis could not be conducted Evidence quality was rated using GRADE (Grading of Recommendations, Assessment, Development and Evaluations) (PROSPERO-CRD42018099212). Thirty-nine completed studies were included. Despite some variability in studies narratively reviewed, in studies meta-analysed self-management interventions improved physical function in the short-term, post-treatment to 3 months (SMD 0.42, 95% CI 0.20, 0.64) and long-term, post 6 months (SMD 0.36, 95% CI 0.20, 0.53), compared to no treatment/usual care controls. Studies reporting on pain narratively had greater variability, however, those studies meta-analysed showed self-management interventions reduced pain in the short-term (SMD -0.49, 95% CI -0.70, -0.27) and long-term (SMD -0.38, 95% CI -0.58, -0.19) compared to no treatment/usual care. There were few differences in physical function and pain when self-management interventions were compared to active interventions. The quality of the evidence was rated as low. Reviewed studies suggest self-management interventions can be effective in improving physical function and reducing pain in the short and long-term for CWP including fibromyalgia. However, the quality of evidence was low. Future research should address quality issues whilst making greater use of theory and patient involvement to understand reported variability.
Highlights
Chronic widespread pain (CWP) has a reported prevalence of between 9.6%-15% in the general population [1, 2] and is diagnosed when long-lasting pain occurs across multiple body sites [2]
MEDLINE, Embase, PsycINFO, The Cochrane Central Register of Controlled Trials and the WHO International Clinical Trials Registry were searched for studies reporting randomised controlled trials of interventions adhering to self-management principles for CWP including fibromyalgia
Despite some variability in studies narratively reviewed, in studies meta-analysed self-management interventions improved physical function in the short-term, post-treatment to 3 months (SMD 0.42, 95% confidence intervals (CIs) 0.20, 0.64) and longterm, post 6 months (SMD 0.36, 95% CI 0.20, 0.53), compared to no treatment/usual care controls
Summary
Chronic widespread pain (CWP) has a reported prevalence of between 9.6%-15% in the general population [1, 2] and is diagnosed when long-lasting pain occurs across multiple body sites [2]. Guidelines for the management of CWP including fibromyalgia recommend non-pharmacological interventions as first-line care [6,7,8], with a limited number of pharmacotherapies used to manage severe symptoms [e.g. pain, sleep problems]. Self-management refers to an individual’s ability to monitor their health condition and effect the behavioural, cognitive and emotional responses required to support a satisfactory quality of life [10]. Support for self-management should cover multiple domains; providing the greatest opportunity for individuals to gain the understanding necessary to appropriately regulate the behavioural, cognitive and affective impacts of chronic illness. Chronic widespread pain (CWP) including fibromyalgia has a prevalence of up to 15% and is associated with substantial morbidity. Supporting psychosocial and behavioural self-management is increasingly important for CWP, as pharmacological interventions show limited benefit.
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