A modern neuropsychological approach to the treatment of patients with fibromyalgia: a literature review

Uvod: Fibromialgija je pogosto stanje nepojasnjenih kroničnih bolečin, ki prizadene predvsem ženske. Najverjetneje je pojav bolezni posledica prepleta več dejavnikov, vendar točen vzrok za sprožitev bolezni še ni znan. Zaradi stalnih bolečin in občutka nerazumljenosti lahko fibromialgija vpliva na zmanjšanje telesne dejavnosti, omejuje socialne stike, povečuje tveganje za razvoj depresije in tesnobnosti. Namen: Namen diplomskega dela je bil s pomočjo pregleda literature ugotoviti učinkovitost sodobnih nevroznanstvenih in psiholoških pristopov pri obravnavi bolnikov s fibromialgijo. Metode dela: V diplomskem delu je bila uporabljena deskriptivna metoda raziskovanja s pregledom literature. Uporabljeni časovni okvir za izbor ustrezne literature je bil od leta 2012 do 2022. V podatkovnih bazah PubMed in Cochrane Library smo s ključnima besedama fibromyalgia AND neuroscience iskali ustrezno literaturo. Z vključitvenimi in izključitvenimi merili smo izbrali šest raziskav. Rezultati: Bolniki s fibromialgijo pogosto poročajo o močni bolečini, večjem številu bolečih točk, funkcijskih okvarah, kineziofobiji, depresiji in tesnobnosti. Avtorji rezultatov obravnavanih raziskav poročajo o pozitivnih učinkih uporabe nevroznanstvenih in psiholoških pristopov v kombinaciji s tradicionalnim zdravljenjem. Pisne ali spletne intervencije za obravnavo bolečine predstavljajo finančno in časovno razbremenitev zdravstvenega sistema, vendar osebni stik z bolnikom prinaša boljše spreminjanje neustreznih vzorcev. Dejavnosti, ki se izvajajo v naravi večinoma, pripomorejo k izboljšanju vzburjenja, dominantnosti in samopodobe ter zmanjšajo stres, bolečino in utrujenost. Razprava in zaključek: Ker je nevroznanstveni pristop h kronični bolečini razmeroma nov, je bilo najdeno manjše število kakovostne literature. V raziskavah so bila uporabljena zelo raznolika merilna orodja, kljub temu so vsa merila le subjektivni vidik doživljanja bolnikov. Prihodnje raziskave bi za povečanje posplošljivosti lahko uporabile/izdelale objektivno merilno orodje, uporabile bolj homogene vzorce bolnikov in izvedle intervencije v okolju primarne oskrbe z nižjimi izbornimi merili. Osebni stik je nenadomestljiv, a njegovo vlogo morda lahko zmanjša dolgotrajni program z izobraževalnimi videoposnetki. Dosedanje raziskave potrjujejo učinkovitost nevroznanstvenih in psiholoških pristopov za obravnavo fibromiaglije, saj vplivajo na zmanjšanje zaznane bolečine, funkcionalnih okvar, depresije, tesnobnosti in utrujenosti ter izboljšujejo možganske in psihološke atribucije za bolečino in pripravljenost za spremembe.Introduction: fibromyalgia is a common condition of unexplained chronic pain, affecting mainly women. Most likely, the occurrence of the disease is due to a combination of several factors, but the exact trigger is still unknown. Due to the constant pain and feelings of not being understood, fibromyalgia can lead to a decrease in physical activities, limit social contact, and increase the risk for depression and anxiety. Purpose: The purpose of this thesis was to determine the effectiveness of modern neuroscientific and psychological approaches in the treatment of fibromyalgia patients by conducting a literature review. Methods: The thesis used a descriptive research method with a literature review. The time frame for selecting relevant literature was from 2012 to 2022. We searched the PubMed and Cochrane Library databases for appropriate English-language literature using the keywords "fibromyalgia" AND "neuroscience". Six studies were selected based on inclusion and exclusion criteria. Results: Fibromyalgia patients frequently report severe pain, multiple tender points, functional impairment, kinesiophobia, depression, and anxiety. The authors of the results of the studies reviewed report a positive effect of neuroscientific and psychological approaches in combination with traditional treatment. Written or online interventions for pain management are one way to reduce the financial and time burden on the health care system, but face-to-face contact with the patient leads to better changes in inappropriate patterns. Activities in nature usually contribute to the improvement of arousal, dominance and self-image and have an effect on the reduction of stress, pain and fatigue. Discussion and conclusion: Because the neuropsychological approach to chronic pain management is recent, a smaller number of high-quality papers were found. Studies used a wide range of measurement instrumentshowever, all measurements captured the subjective aspect of patients\u27 experiences. To increase generalizability, future studies could use/develop an objective measurement tool, use a more homogeneous patient sample, and conduct interventions in a primary care setting with lower selection criteria. Face-to-face contact is irreplaceable, but its role may be attenuated by a long program of educational videos. Recent studies confirm the efficacy of neuroscientific and psychological approaches to the treatment of fibromyalgia in reducing pain perception, functional impairment, depression, anxiety, and fatigue, and in improving brain and psychological attributions to pain and readiness to change