Page 6 - JCTR-9-6

370 Sempere-Rubio et al. | Journal of Clinical and Translational Research 2023; 9(6): 369-380
system disturbances, and alterations in the quality of sleep [1]. It is therefore that the main aim of this umbrella review was to
Several investigations have suggested that one of the mechanisms assess the effectiveness of HEIs in patients with FMS.
that may be involved in the FMS is a process of central
hyperexcitability [2,3]. This process involves an amplification 2. Methods
of signaling at the neuronal level in the medullary and This study was conducted in accordance with the Preferred
supramedullary centers, which may lead to increased sensitivity Reporting Items for Overviews of SR including harm checklist
to pain, lowering the excitability threshold of afferent sensory (PRIO-harms), which consists of 27 items (56 sub-items), followed
inputs with painful information [4]. On an epidemiological level, by a 5-stage process flow diagram (identification, screening,
FMS has a prevalence in the general population between 0.5% eligibility, inclusion, and separation of relevant studies) [24]. This
and 5% [5]. The prevalence is higher in women than in men [5]. review was previously registered in the international prospective
Regarding mortality, the recent study conducted by Treister- register of SR: PROSPERO (CRD42022368068).
Goltzman and Peleg [6] showed that FMS is associated with
an increased mortality rate from all causes, especially suicidal 2.1. Review inclusion criteria
ideation, accidents, and the presence of infections. The inclusion criteria employed in this article were based
Nowadays, there seems to be no objective test that can help
clinicians make an accurate pathophysiological diagnosis of on methodological and clinical factors such as population,
intervention, control, outcomes, and study design [25].
FMS [7]. To date, most of the tools and criteria used for the
diagnosis of FMS are vaguely specific [8]. This situation, together 2.1.1. Population
with the difficulty of subclassifying patients with FMS, poses
a huge challenge when treating patients with FMS [8]. Despite The participants selected for the articles were patients with
this, in 2016 the American College of Rheumatology (ACR) FMS. Included SR had to explicitly state that they included
established some criteria [9]. In the revised 2016 ACR criteria, patients with FMS in their inclusion criteria. We excluded all SR
generalized pain (rather than widespread pain) in at least four of that include patients with other chronic conditions with persistent
five distinct body regions is required for a diagnosis of FMS along pain.
with persistent symptoms for more than 3 months, and also high 2.1.2. Intervention and control
scores on indices of widespread pain and symptom severity [9].
Regarding the treatment of FMS, the effectiveness of some The intervention consisted of HEI (PNE) (i.e.: Neurophysiology
treatments has been evaluated. For example, previous systematic of pain, differences between “pain” and “nociception”, factors
reviews (SR) have assessed the effectiveness of some important contributing to the perpetuation of pain, or the influence of
interventions such as pharmacological treatment [10,11], thoughts (cognitions) or emotions on pain experience), PNpE (i.e.:
psychological therapies [12,13] as well as exercise-based neurophysiology of the central nervous system, central/peripheral
interventions [14,15] to manage the described main symptoms of hyperexcitability or sensitization/habituation concepts), and
FMS. However, most of the clinical interventions evaluated do not therapeutic education (TE) (i.e.: FMS symptoms information,
incorporate educational features in them. Education is fundamental active coping strategies, or self-management strategies) conducted
in the management of patients with persistent pain, as it improves in isolation, in conjunction or combined with other treatments. The
the influence of psychosocial variables that can modulate pain education sessions could be individual or group-based and could
perception [16]. Within the biopsychosocial perspective, some contain any semantic resources for a better understanding (such as
health educational interventions (HEI) have been proposed as an the presence of metaphors). Interventions based on psychological
alternative, with the aim of reconceptualizing the pain experience, treatment or cognitive behavioral therapy were excluded from the
improving coping strategies toward pain, or improving knowledge study. The comparator groups used the following interventions:
regarding the disease process to improve some clinical variables no intervention, minimal interventions in isolation or combined
of interest such as disability and quality of life in patients with to form a multicomponent approach. (e.g.: information about
FMS. Educational strategies such as pain neuroscience education relaxation, analgesic drugs, therapeutic exercise, or exercises
(PNE) or pain neurophysiology education (PNpE) are among the information booklets), or waiting list.
most studied educational interventions for patients with persistent Regarding the intervention studied:
pain [17,18]. The number of research studies evaluating the effect • TE is a therapeutic modality that explicitly involves a non-
of HEI on patients with FMS has grown in recent years [19-23], directional dynamic interaction with the patient, based on
and so far, no research studies have pooled and analyzed these a biobehavioral paradigm, which includes educational or
results. Moreover, the SR published so far are not consistent training activities that promote learning and acquisition of
with the results obtained. We believe that a general overview that adaptive skills to improve self-management and knowledge
encompasses all of them allows us to analyze the effectiveness that facilitate changes in beliefs, attitudes, and behaviors
of these interventions in depth, as well as to analyze and extract associated with disability. TE aims to change maladaptive
possible lines of improvement so that research may continue to be beliefs, reconceptualize aspects related to pain, implement
carried out in the near future. educational processes on the importance of therapeutic

DOI: http://dx.doi.org/10.18053/jctres.09.202306.23-00108