Fibromyalgia: adapted, positive, and fit people: Breaking stereotypes!

The rationale of the present thesis is provided in chapter I. Briefly, the aims of this thesis were (i) to better understand the characteristics of fibromyalgia, chapters II-V; (ii) to either confirm or identify resilience and vulnerability resources involved in adaptation to fibromyalgia, chapters VI-X; (iii) to identify clinically meaningful subgroups of people with fibromyalgia, chapter XI. To address these aims, and many others that are not part of this thesis, the al-Ándalus project was conducted in a large and representative sample of people with fibromyalgia from Andalusia (southern Spain). The al-Ándalus project included an extensive set of objective and subjective measures related to symptoms (e.g., pain, fatigue, and sleep quality) as well as physical (e.g., body composition, physical fitness, and physical activity), psychological (e.g., positive and negative affect, catastrophizing, and health-related quality of life), and cognitive (e.g., working and declarative memory). The main findings of the present thesis highlight a number of facts. First, people with fibromyalgia appraise their physical functioning worse than they perform. Second, this discordance between subjective and objective assessment of physical function must not be interpreted as malingering, instead, it may be a consequence of maladapted either associative learning or pain-related cognitions (i.e., pain catastrophizing). Third, physical activity, physical fitness, and subjective well-being –positive affect particularly- have potential as key players of resilience in adaptation to living with fibromyalgia. Fourth, fibromyalgia is a heterogeneous population as reflected in subjective and objective assessments of resilience and vulnerability factors related to physical and psychological functioning. Moreover, successful adaptation to fibromyalgia is strived for and possible. If these findings are corroborated in future longitudinal (observational and experimental) research, individualised approaches to the assessment, monitoring, and treatment of fibromyalgia seem to be worthwhile in order to comprehensively, and leaving stereotypes out, understand both the experience of people with fibromyalgia and their disease. We believe that from a clinical perspective, research is sometimes artificial by focusing on finding unidirectional causal relationships excessively. By contrast, adaptation to fibromyalgia may encompass the interplay of many biological, psychological, and social factors. Therefore, we welcome future experience sampling designs elucidating whether, how, and to what extent the nature of this interplay is different between people and if it is static or dynamic within a person