Fibromyalgia Patients and Cognitive Behavioral Therapy Treatment

Introduction

Fibromyalgia is usually chronic and shows symptoms which causes widespread pain, fatigue, disturbances in the sleep cycle and cognitive dysfunction. (Wolfe et al., 2011). Its aetiology is idiopathic, but the latest development in researches talks about few of the biochemical, metabolic and immunoregulatory abnormalities linked with fibromyalgia. Hence, the chronicity and the various etiological factors makes it more challenging through the management perspective (Firdous Jahan et al.,2012). In order to execute a good rehabilitation in chronic musculoskeletal patient population a combination of central (neural) and peripheral (join-level) alteration is necessary (Roy JS et al.,2017). While evaluating clinically an assessment of cognitive-emotional aspects should be considered, which includes fear avoidance, pain catastrophizing and anxiety which might further hamper the joint control and central sensitization (Roy JS et al., 2017). Cognitive behavioural therapy (CBT) as a primary intervention includes behavioural, cognitive and emotion-focused techniques. (Hofman et al.,2012). Prevalance of fibromyalgia in UK population summed up for a total of 5.4% (Jones JT et al.,2015).

Cognitive Behavioral Therapy for Fibromyalgia

Patients suffering from fibromyalgia underwent cognitive behavioural therapy approach, it not only helped them to cope up with the associated symptoms, but also changed their outlook towards the pain and improved their quality of life (QOL) as they became more acknowledging and less catastrophising. (Luciano JV et al.,2014). In a research-based study which was conducted in juvenile affected from fibromyalgia, it included CBT component (which consisted of relaxation and coping skill techniques, solving an issue and converting negative thoughts in concern with pain) along with neuromuscular exercises to gain a more evident approach and not just CBT alone (Kashikar-Zuck S et al.,2012).

Cognition such as expecting that an activity will lead to pain or pain may also trigger evasion behaviour (Philips HC.,1987; Sharp TJ.,2001). Physiological reactions to pain due to increase in the muscular tension and autonomic arousal causing an elevation in the pain and functional disability during the long term (Nortan Pj, Amsundson PJ.,2003) A misunderstanding of the autonomic arousal as an evidence to cause physical harm might show an avoidance behaviour(Nortan PJ, Amsundson PJ.,2003). Pilot studies have started to show evidence that non-pharmacological treatments which aligns their focus on dysfunctional attitude, sleep habits and lifestyle factors that may perpetuate sleep difficulties further minimising the effects of fibromyalgia (Singh BB et al.,1998; Edinger JD et al.,2005). However, why these effect in reducing pain or disability don’t sustain long is still unknown in fibromyalgia.

Using a combination of problem and emotion focused coping strategies didn't show a significant association with the health related QOL outcomes such as pain, fatigue and general health in fibromyalgia (Alice Theadom et al.,2006). Therefore, based on previous studies, it is imperative to explain how CBT shows a positive effect in fibromyalgia patients further improving their quality of life.

Research Question

The research question will be “What is the effect of CBT on pain and QOL in patients suffering from fibromyalgia?” I have based this question under the pragmatic paradigm, and I choose to be a pragmatist because in a mixed methods study, the literature is discussed in a sequential approach during each step in a manner with the process used (Creswell JW et al., 2010). For a pragmatist, the point of request is not to look for a fact that is autonomous from human experience, however to accomplish a superior, more extravagant experience regardless of whether through logical examination, imaginative investigation, social exchange, or any beneficial mix of these various methodologies (Maxcy.,2003). The special statement that truth is synonymous with the solution to a problem, this provides an assurance for why pragmatism should be used as a paradigm, as it shows that a pragmatist view ontology, epistemology and methodology uniquely in contrasts to other paradigms (Creswell and Plano clark.,2007).

Mixed Methods for Fibromyalgia Research

Both the quantitative and qualitative requests give us profound knowledge which would be hard to gain through either of an approach, further providing benefits in the study of health services (Johnson.,2004). Mixed method research also includes both the deductive and inductive logic in a very specific manner, hence it is termed as an inductive-deductive research cycle (Krathwohl.,2004). The biopsychosocial component draws light on both illness and sickness and not just either of it, considering the research question I want to explore includes all the factors from psychological, social along with the biological aspect (Gatchel et al., 2007; Shaw et al., 2010; Parylo.,2012). A study showed that researchers are urged to keep their research moulded in only one paradigm in order to ensure consistency and coherence regarding the knowledge (Holloway and Yodres.,2003). But the reconciliation of proof from both the qualitative and quantitative helps in empowering the research and further have a better approach in terms of treatment, as a pragmatist considers the practical nature of the real world and discovers truth in the solutions to issues and the outcome of objects and actions (Shaw et al.,2010). To assess pain as mentioned in the research question a Visual Analogue scale (VAS) can be utilised to get an outcome measure (Jull et al., 2002). Short form 36 (SF-36) can be used as an outcome measure to have an idea about the health status or QOL (Jenkinson C et al., 1992). Albeit, the quantitative approach shows a few restrictions due to its reductionism and determinism in the operationalization of pain and disability (Miller WL and Crabtree BF.,2005). Hence, a qualitative approach will help in comprehending the subjective truth of pain and disability by utilising the members point of view and sentiments (Miller WL and Crabtree BF.,2005).

Positivist however will hold a conviction that reality is fixed, hence summing up the findings and replication of studies would be considered dangerous because the people and their outlook towards the world are always evolving with time (Pamela J. Bettis and James A. Gregson). A positivist is the one in which the research classification and the hypothesis used may not reflect the nearby voting demographic understandings (Johnson RB, Onwuegbuzie AJ., 2007). Knowledge produced might not be comprehending and general for the direct applications to particular circumstances, settings and people (Johnson RB, Onwuegbuzie AJ.,2007). A purist believes that social science should be objective and free from the time and context speculations (Nagel.,1986). Hence, this way of thinking causes to remove the risk of bias and to be uninvolved emotionally with the objects of study (Johnson RB, Onwuegbuzie.,2007).

While an Interpretivist is worried about subjectivity, understandings and the manner in which an individual built their social world, give rise to complexities further involving the elements of uncertainty (Grix., 2010). The crucial bases of such tactics are that they propose multiple constructed realities, due to the fact that different people are likely to experience the world in differing ways (Lincoln and Guba.,2000). They would communicate with the patients in a spoken or written manner by talking to them and having a close watch on how they feel about their pain and what their beliefs and encounters are without focusing much on the numbers aspect (Braun and Clarke.,2013). A qualitative study doesn’t help in generalising the outcome of sample size on a more diverse and broader aspect of population, further which proves to be beneficial with quantitative study (Hesse-Biber, 2010).

It is immediately clear that a pragmatist shows a little amount of interest in any experimental phenomenon inquiry unless the ultimate goal is to increase human welfare (Pansiri.,2005). In the study of the similar phenomenon, triangulation is a combination of methodologies (Denzin.,1978). This includes incorporating complementary techniques in qualitative and quantitative approaches in order to neutralize limitations in each strategy (Denzin., 1978). Hence, pragmatism presents a holistic worldview which further enables the inclusion of both the quantitative and qualitative approach (Greence.,2008).

Conclusion

CBT is a widely used approach which includes both psychological and behavioural component. But it is imperative to develop research-based studies in order to incorporate the best form of treatments in fibromyalgia patients, which will help them in reducing their pain and mending their quality of life. Due to the multi-dimensional nature of the pain, a mixed method approach would be the most suitable one as it includes a combination of both the quantitative and qualitative methods. Further, it will help to form a cyclical process in which hypothesis are validated and criticised. A mixed method would help in evolving the health care system and as well proposition of better studies on improving the outcome measures. Hence, being a pragmatist give an opportunity to have a broad vision to acknowledge the best of both perspectives which I would have missed by taking only a single paradigm into the picture.

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