Psychological treatment for fibromyalgia: a meta-analysis & qualitative exploration

Meta-analysis: Aim: This meta-analysis aimed to review the evidence base for the use of cognitive behavioural ‘pain management programmes’ (PMPs), to determine the effectiveness of these group programmes for treating people with fibromyalgia. Methods: The databases ‘Psychinfo’, ‘Psycarticles’, ‘Medline’, ‘Embase’ and ‘Web of Science’ were searched systematically for key words ‘cognitive behavioural therapy’ (CBT), ‘fibromyalgia’ and ‘group psychotherapy’ to December 2019. The reference sections of previous systematic reviews and meta-analyses were also reviewed to identify relevant papers. Randomised controlled trials comparing CBT interventions to a control group were analysed. The outcomes reviewed were reduction in fibromyalgia symptomatology and pain. Effect sizes were summarised using standardised mean differences (SMD). Studies were rated for their methodological quality and their fidelity to treatment guidelines for PMPs. Results: 35 relevant papers were identified of which 17, with a total of 1026 participants, were included in the analysis. Random effects and quality effects meta-analyses were conducted on the included studies. Group CBT showed a significant treatment effect size for both reduction in fibromyalgia symptomatology (SMD= -0.4060, 95%CI= -0.6397 to -0.1723, p = < 0.0007) and pain (SMD = -0.3047, 95% CI= -0.5489 to -0.0606, p = < 0.0144). A subgroup analysis, of studies rated ‘poor’ and ‘average’ for fidelity to British Pain Society guidelines, was completed to determine the efficacy of this guidance. For reduction in fibromyalgia symptomatology, studies with average ratings of treatment fidelity produced marginally better outcomes than those with a poor rating (SMD= -0.46 vs. -0.34); this result was not statistically significant (p= 0.6487). Pain reduction outcomes for studies with average treatment fidelity produced slightly worse outcomes compared to those with poor fidelity (SMD= -0.14 vs. -0.50); this result was not statistically significant (p= 0.125). The quality effects model suggested that the methodological quality of the included studies did not adversely impact the meta-analysis. Conclusion: Results replicated previous meta-analyses on the effectiveness of group CBT in fibromyalgia symptomatology and pain. There is no strong evidence that fidelity to guidelines for PMPs creates an improvement in outcomes for reduction in fibromyalgia symptomatology or pain in people with fibromyalgia. Recommendations for future research and clinical applications of this review are suggested. Empirical Paper: Background: People with fibromyalgia experience mental health issues related to their condition, which is frequently treated within pain management settings. The Improving Access to Psychological Therapies (IAPT) programme is expanding to provide psychological treatment to people with fibromyalgia within primary care. There is little qualitative research exploring the experiences of people with fibromyalgia accessing mental health services. Aim: The aim of this research was to describe and explore the experiences of psychological treatment of people with fibromyalgia. Method: Eight female participants (mean age= 43 years; SD= 11), who had previously attended psychological treatment as part of a pain management programme (PMP), were recruited from a pain management service and interviewed about their experiences. The study took a phenomenological approach to enquiry, aiming to describe the meaning and sensemaking people with fibromyalgia made of their lived experiences of psychological treatment. Interview transcripts were analysed using Template Analysis (TA) to provide a detailed exploration of the participants’ experiences of psychological treatment and the services in which these treatments were based. Analysis: The analysis produced nine iterations of the research template. The final template yielded three superordinate themes, with ten ordinate themes and nine subordinate themes. The three superordinate themes were ‘Frustration and uncertainty about psychological approaches’, ‘Ambivalence about the group setting’ and ‘Making sense of and reactions to psychological approaches’. Conclusion: The clinical and service applications of this research are discussed. The contribution of this study to the literature is described, with the strengths and limitations of the research and directions for future research in this area