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This thesis considers recent advances in the conceptualisation of pain and in particular, the contribution of Neuromatrix theory (Melzack 1990, 1999,2005), which implicates threat processing biases in the aetiology and maintenance of chronic pain. Fibromyalgia is presented as a condition that can particularly benefit from this understanding. Guided by research into threat processing biases in anxiety, the literature on attentional bias to threat in chronic pain and fibromyalgia is reviewed, with special emphasis on the Stroop and visual probe paradigms. This highlights that a number of chronic pain conditions might be associated with attentional bias to pain. related threat; however the literature is inconsistent and there is a dearth of research using fibromyalgia samples. The limited research that has used pure fibromyalgia sample indicates that fibromyalgia might be associated with a generalised, rather than pain/disorder-specific, threat bias. Thus, an empirical study is also presented, that aims to establish whether fibromyalgia is associated with attentional bias to threat, as a method of gaining insight into possible, broader threat processing abnormalities. Visual probe methodology was used to test selective attention to generalised threat words in a sample of 34 fibromyalgia patients and healthy controls. Results showed a trend towards an interaction between group and the measures of attentional bias, with evidence that this related to hypervigilance to threat in the fibromyalgia group. This trend did not reach statistical significance (p = .090). There was no further evidence of attentional bias. Further research is needed in order to establish the reliability of these findings and address issues of low power, however the potential that results may be meaningful provides great scope for achieving new insight into fibromyalgia.

Purpose: To describe the experiences of individuals recently diagnosed with fibromyalgia syndrome (FMS) using Arthur Frank's narrative typologies. Relevance: Fibromyalgia syndrome (FMS) is a musculoskeletal condition of unknown aetiology characterised by chronic widespread pain and poor sleep. There is an absence of studies investigating the illness experience of those recently diagnosed. Participants: A theoretical sampling strategy was used to identify 23 individuals (22 female, 1 male) with a first diagnosis of FMS by a Consultant Rheumatologist. Methods: Qualitative in-depth semi-structured interviews (over a 24 month period) were used to identify the perceptions and experiences of individuals recently diagnosed with FMS. The methodological principles underpinning the study were drawn from pragmatism, critical reflection and feminism (data collection). The design was iterative and emergent. Analysis: Interviews were digitally recorded and transcribed verbatim. Narrative thematic analysis was used to analysis the textual data from the interviews. Results: The experience of being diagnosed and living with FMS is biographically disruptive, threatens Identity and challenges patients' understandings of their bodies and the lives they live. Consistent with Arthur Frank's narrative typologies 3 dominant themes of quest, chaos and restitution were identified within the illness experiences of individuals living with FMS. This thesis however challenges Frank's narrative of quest, and proposes the division of this narrative into sub-categories: active engagement and active dis-engagement. Each narrative preference is not uniform but contains common characteristics as it is told through the unique perceptions and experiences of the individual. Conclusions: It is not possible to homogenise the illness experience of individuals with FMS but their narratives contain unifying plotlines. By allowing individuals the opportunity to recount their stories clinicians might recognise these plotlines and understand how the illness experience of FMS is being interpreted.

La fibromyalgie (FM) touche 1,4 à 2,2 % de la population générale avec une nette prédominance féminine (80 % des sujets). Ce syndrome est caractérisé par des douleurs chroniques diffuses, des troubles du sommeil, des troubles cognitifs, des perturbations émotionnelles et une fatigue chronique. Les mécanismes physiopathologiques de la FM ne sont pas complètement élucidés. Cependant, la FM est considérée comme un syndrome lié au stress. Des déséquilibres du système nerveux autonome (SNA) et de l'axe hypothalamo-hypophyso-surrénalien (HHS) ont été mis en évidence dans la FM. Ce déficit de l’axe du stress (SNA et HHS) induirait secondairement des dysfonctionnements des contrôles endogènes de la douleur. A partir de cette hypothèse et en s’appuyant sur deux essais cliniques, notre objectif est d’évaluer l'efficacité d'un programme d’entraînement spécifique, sur les douleurs et les symptômes des patientes FM. Une première étude observationnelle de cinq ans, démontre qu’une prise en charge globale, associée à un entraînement physique spécifique [3 sessions de 45 minutes par semaine d’entraînement continue à intensité modérée (MICT), progressivement couplé à un entraînement fractionné à haute intensité (HIIT)] améliore considérablement les symptômes de la FM. Les premiers résultats d'une seconde étude, contrôlée et randomisée de 24 mois, confirment des dysfonctionnements des mécanismes de modulation centrale de la douleur, ainsi qu’un déficit de la régulation autonome, chez au moins une fraction des patientes FM. Ce programme d’entraînement spécifique, encadré et individualisé, dont l’intensité des exercices est définie pour rééquilibrer la balance neurovégétative (tonus parasympathique et réactivité sympathique), permettrait via des mécanismes de neuroplasticité centrale, associés aux effets périphériques tels que l'augmentation de la perfusion vasculaire au niveau musculaire, de soigner la fibromyalgie. / Fibromyalgia affects 1.4–2.2% of the general population, predominately women (more than 80% of subjects). This syndrome is characterised by chronic widespread pain, sleep disturbances, cognitive dysfunction, emotional disorders and chronic fatigue.Physiopathological mechanisms of FM are not fully elucidated but FM is considered a stress related syndrome. Studies on the stress axis in FM have demonstrated dysfunction of both the Autonomic Nervous System (ANS) and the Hypothalamic-Pituitary-Adrenal (HPA) axis. This stress axis deficit (ANS and HPA) could consequently induce dysregulation of pain modulation. According to this hypothesis and using two clinical trials, our main objective is to assess the efficacy of a specific training program on pain and symptoms in female fibromyalgia patients.Firstly, a 5-year observational study shows that overall care coupled with specific physical training [3 sessions of 45 minutes per week of Moderate Intensity Continuous Training (MICT) gradually associated with High Intensity Interval Training (HIIT)] may lead to dramatic improvement of FM symptoms. Secondly, the initial results of a 24-month, controlled, randomised trial (RCT) confirm dysregulation of central pain modulation and a deficit of the autonomic balance, at least in a percentage of FM patients. This specific, supervised, individualised training program with exercise intensity defined to rebalance the neurovegetative system (parasympathetic tone and sympathetic reactivity), associated by peripheric effects as the improvement of muscle perfusion, may allow FM to be treated through central neuroplasticity.