Page 80 - JCTR-11-5

Journal of Clinical and
Translational Research Fibromyalgia: Examination across life domains

Table 4. Comparisons of domains assessed by participants before and after fibromyalgia diagnosis
Domains W p‑value Hodges‑Lehmann Effect a 95% CI
Lower Upper
Leisure 1,230.50 <0.001 3.00 0.60 0.37 0.76
Ability to work 1,336.50 <0.001 3.50 0.67 0.48 0.81
Self-care 1,529.50 <0.001 3.50 0.67 0.48 0.80
Overall functionality 1,356.00 <0.001 4.00 0.70 0.51 0.82
Ability to exercise 1,550.00 <0.001 3.50 0.69 0.51 0.82
Quality of life 1,263.00 <0.001 4.00 0.70 0.51 0.83
a
Notes: Point-biserial correlation; W derived from the Wilcoxon test.
Abbreviations: SD: Standard deviation; CI: Confidence interval.
et al., which stresses the interconnected relationships proposed by Edwards et al., are interdependent, rather
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among physical symptoms, psychological well-being, self- than one domain being the primary driver of changes in the
care, and social/occupational functioning in chronic pain other. This interdependence highlights the importance of
conditions. Therefore, a significant reduction in self-care preventive and intervention programs that target multiple
scores indicates deterioration in patients’ ability to maintain domains simultaneously. Specifically, because declines
personal care routines. This finding corresponds with in both physical and psychological domains often occur
research documenting progressive limitations in activities of together, integrated treatments may yield more effective
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daily living among fibromyalgia patients. Indeed, evidence outcomes than treatments focusing on one area alone.
suggests that self-care activities are often compromised as Studies have shown that multimodal treatment programs,
pain conditions progress, partly due to increased fatigue, which combine physical and psychological interventions,
reduced physical capacity, and cognitive difficulties. 45-47 achieve better results than single-modal approaches in
fibromyalgia treatment. 21,44,51 Notably, studies have repeatedly
3.3. Limitations and implications for theory and demonstrated that physical activity is a vital element in
practice the management of fibromyalgia. A review of 18 studies
The pattern of functional decline across various domains involving 1,184 participants found that physical exercise,
lends robust support to the allostatic load model of chronic especially when tailored to an individual’s requirements, has
pain, as proposed by Borsook et al., in which persistent positive effects on pain, depression, and quality of life. 52
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pain imposes progressively heavier physiological and Research has consistently demonstrated that
psychological loads on adaptive systems, ultimately customized exercise plans, comprising aerobic exercises,
resulting in accelerated deterioration across multiple strength training, and mind–body disciplines such as
functional areas. The current results showed substantial yoga and tai chi, can boost functional capacity, alleviate
effect sizes across all functional domains, even among symptoms, and enhance quality of life. 11,27,36 Typically, an
participants with long-standing pain conditions, consistent optimal exercise routine comprises moderate-intensity,
with this theoretical framework. tailored plans that balance physical activity with periods of
The present results also offer empirical evidence for the rest to prevent the worsening of symptoms. 11,45 In addition
fear-avoidance model. This concept may be of paramount to physical activity, psychological treatments also play
interest to society, healthcare professionals, and the a crucial role in fibromyalgia management. Approaches
broader healthcare system because it suggests that fear of such as cognitive-behavioral therapy, mindfulness-based
pain causes individuals to shun physical activity, resulting stress reduction, and acceptance and commitment therapy
in physical deconditioning and subsequent functional have shown effectiveness in enhancing psychological
deterioration. 49,50 The observed declines in physical activity well-being and quality of life in fibromyalgia patients.
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and functioning across various domains (e.g., leisure These interventions work by empowering patients with
and exercise) and aspects (e.g., work and self-care) are coping strategies to control pain and enhance their
consistent with the model’s forecasted cyclical pattern capacity for daily tasks, thereby promoting self-care and
of deterioration. Moreover, the findings also strengthen independence. Moreover, group-based interventions
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the theoretical understanding of the connection between have shown promising results in diverse settings, including
physical capabilities and mental health in chronic pain primary care. A notable example is the Amigos de Fibro
situations. Physical and psychological deterioration, as (Fibro Friends) program developed in the State of São

Volume 11 Issue 5 (2025) 74 doi: 10.36922/JCTR025290042