Self-management for chronic widespread pain including fibromyalgia: A systematic review and meta-analysis

• Published in: PloS one Vol. 16; no. 7; p. e0254642
• Main Authors: Geraghty, Adam W. A., Maund, Emma, Newell, David, Santer, Miriam, Everitt, Hazel, Price, Cathy, Pincus, Tamar, Moore, Michael, Little, Paul, West, Rachel, Stuart, Beth
• Format: Journal Article
• Language: English
• Published: San Francisco Public Library of Science 16.07.2021; Public Library of Science (PLoS)
• Subjects: Biology and Life Sciences; Care and treatment; Chronic illnesses; Chronic pain; Clinical trials; Exercise; Fibromyalgia; Funding; Intervention; Management; Medical education; Medicine; Medicine and Health Sciences; Meta-analysis; Methods; Morbidity; Pain; Physical fitness; Physical Sciences; Population; Primary care; Principles; Quality of life; Reporting; Research and Analysis Methods; Self-care, Health; Social Sciences; Subject heading schemes; Systematic review; United Kingdom; United Kingdom > UK
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0254642

Background 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. Methods 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). Results 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. Conclusion 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.