The present study examined differences between fibromyalgia patients and healthy controls on anger rumination, mental health and quality of life and tested anger rumination as a mediator of patient–control differences in mental health and quality of life. Participants were a propensity score‐matched sample of 58 fibromyalgia patients and 58 healthy controls. Participants completed measures of anger rumination, depression and anxiety and quality of life. Patients were higher than controls on all anger rumination scales and depression and anxiety and lower on quality of life. All anger rumination scales were related to poorer mental health and quality of life. Patient–control differences on mental health and quality of life were mediated by anger rumination. In multiple mediator models, the only subscale with unique mediating effects was anger memories. Anger rumination has potent associations with mental health and quality of life, and differences between patients and controls on mental health and quality of life are partially mediated by differences in anger rumination. Addressing tendencies to ruminate on anger experiences in the care of fibromyalgia patients may offer an important avenue to improved health and quality of life.

Fibromyalgia is a chronic illness characterized by pain and fatigue. Persons with fibromyalgia experience increased the risk for poor mental and physical health-related quality of life, which may be dependent on multiple factors, including health beliefs, such as confidence in physicians and the health-care system, and health behaviors, such as treatment adherence. Respondents with fibromyalgia (n = 409) were recruited nationally, via support organizations, and completed self-report measures: Multidimensional Health Profile – Health Functioning Index (MHP-H), Short-Form-36 Health Survey (SF-36v2), and Medical Outcomes Study (MOS) Measure of Patient Adherence – General Adherence Items. In mediation models, belief in the healthcare system and health-care personnel, and health efficacy exerted an indirect effect through treatment adherence on mental and physical quality of life. Adaptive health beliefs and attitudes were related to greater treatment adherence and, in turn, to a better quality of life. Maladaptive health beliefs and mistrusting attitudes about physician-level and systemic-level healthcare provision are negatively related to both treatment adherence and consequent physical and mental health-related quality of life in persons with fibromyalgia. Future randomized controlled trials are needed to determine if therapeutic strategies to alter health values might improve adherence and self-rated health.

Fibromyalgia (FM) is a musculoskeletal and neurological disorder that causes constant pain, cognitive problems with short term memory, and sleep disorders. There are more females diagnosed with FM than males, and research has therefore primarily been conducted with females. Because little is known about African American males with FM, biopsychosocial theory was used in this phenomenological study to examine how African American males with FM are affected biologically, psychologically, and socially. Eight African American males diagnosed with FM were recruited from Houston, Texas and were interviewed about their lived experiences with FM, including experiences with the healthcare system, and how they used the internet to seek information about FM. Individual interview transcripts, conduct open coding, and thematic analysis led to identification of the following themes: (a) lengthy multiple medical evaluations to receive a diagnosis and various symptoms; (b) physical challenges, physical limitations, emotional issues, and cognitive issues experienced with FM; (c) limited physical and emotional support from family and friends; (d) hopeful about work and plans; (e) trust and confidence in healthcare providers and medical information obtained by asking questions; (f) limited internet search and not involved in online FM forums. The study showed that African American males with FM may experience debilitating symptoms and may use faith-based beliefs as one way to cope with FM. These results may bring positive social changes by providing caretakers with a better understanding of how FM affects the quality of life of African American males with FM, and provide new data to assist healthcare providers in diagnosing, treating, and serving this population.

<p>Fibromyalgi är en sjukdom som involverar symtom såsom kronisk smärta, stelhet och sömnstörningar. Sjukdomens orsak är ännu inte klarlagd. Att leva med kronisk smärta, trötthet och rörelseinskränkningar kan inverka negativt på det dagliga livet. Syftet med studien var att belysa fysisk aktivitets inverkan på sjukdomssymtom samt livskvalité hos patienter med fibromyalgi. Metoden var en litteraturstudie baserad på 20 vetenskapliga artiklar. Artiklarna visade liknande resultat när det gällde fysisk aktivitets inverkan på symtom samt livskvalité hos personer med fibromyalgi. Det framkom att fysisk aktivitet gav god effekt när träning utfördes med låg- till medelintensitet samt utfördes under en längre tid. Det framkom även att symtomen påverkade förmågan och viljan att delta i någon form av fysisk aktivitet. Vidare forskning inom området behövs när det gäller att utforma och individanpassa motionsprogram för fibromyalgipatienter.</p>

<p><strong>Sammanfattning</strong></p><p>Fibromyalgi har betraktats ända framtill våra dagar som en ren psykosomatisk sjukdom som uppkom utan känd orsak. Sjukdomen innebar en ständig smärta och en oändlig trötthet/ utmattning. Det fanns ingen behandling för sjukdomen bara lindra symtomen. Syftet med denna litteraturstudie var att beskriva hur kvinnor med fibromyalgi upplevde sin livssituation. Metoden som användes var en litteraturstudie med beskrivande design. Artiklarna kvalitetsbedömdes, innehållet sammanställdes och resulterade i fyra kategorier. Resultatet som rörde dem fysiska aspekterna av livssituation visade att smärta, trötthet/utmattning och sömnlöshet var vanligt förekommande symtom i kvinnornas vardag som påverkade deras livskvalitet. Symtomen hindrade dem från att leva ett aktivt liv samt delta i sociala aktiviteter. De psykiska aspekterna inom livssituationen visade att kvinnorna med fibromyalgi gav uttryck för en längtan efter det liv de levt innan sjukdomen och den förlorade identiteten. De sociala aspekterna visade att kvinnorna med fibromyalgi hade en önska att få spendera mer tid tillsammans med familjen. Sjukdomen hade också en negativ inverkan på förhållande och separationer var inte ovanligt. Arbetet prioriterades högt och arbetslivet uppskattades som stimulerande. Bristen på synliga symtom vid sjukdomen  gjorde att kvinnorna blev ifrågasatta av personer i omgivningen och sjukvårdspersonal. Under de existentiella aspekterna föll de positiva sidorna med sjukdomen in. Kvinnorna började reflektera över alla måsten och plikter i livet samt lärde sig att prioritera på ett bättre sätt.</p><p> </p> / <p><strong>Abstract</strong></p><p><strong></strong><strong></strong>Fibromyalgia has considered until to day as a psychosomatic disease that emerged without any known cause.The main symptoms are constant pain and an abnormal feeling of fatigue or exhaustion. There are no treatment for the illness it just alleviated the symptoms. The aim of this study was the describe how women with fibromyalgi experienced their life-situation.The method used was a literature study with a descriptive design. The articles were quality-tested, the content put together/compiled and resulting in four categories as follows.The result involving the physical aspects of life-situation showed that pain, tiredness and sleeplessness was commonly occurring symptoms in women´s daily life which affected their quality of life.The symptoms prevented women from living an active life and actively taking part in social activites. The psychological aspects of life-situation showed that women with fibromyalgia expressed a longing for the life they lived before the illness and the lost identity. The social aspects showed that the women wished to spend more time with their families. The disease had negative effects on their relationships and separation was not unusual. Work was highly prioritised and estimated as stimulating. The deficiency on visible symptoms of the disease made that the women became questioned by persons in their environment and by health-personal. The positive sides of the disease was found in the existential aspects. The women started to reflect about their duties in life and learned how to prioritise on a better way.</p>

The overall aim of this thesis was to elucidate and investigate psychophysiological aspects and effects of acupuncture and needle stimulation. Within this framework emphasis was directed toward the effects of needle stimulation (acupuncture) on muscle blood flow in the tibialis anterior and trapezius muscles in healthy subjects and patients suffering from chronic muscle pain. This study also included evaluation of a new application of photoplethysmography in noninvasive monitoring of muscle blood flow. The evaluation was based on experiments known to provocate skin or muscle blood flow. The psychological aspects studied comprised the effects of manual acupuncture on pain in fibromyalgia patients and the effects of electro-acupuncture on psychological distress and vasomotor symptoms in postmenopausal women in the clinical context. The results showed that photoplethysmography have potential to noninvasively monitor muscle blood flow and to discriminate between blood flow in skin and muscle, although some considerations still have to be accounted for. It was further shown that muscle blood flow change in response to needle stimulation differed between healthy subjects and patients. Deep needle stimulation in the muscle of healthy subjects consistently increased muscle blood flow more than subcutaneous needle stimulation. In the painful trapezius muscle of FMS patients, however, subcutaneous needling was equal or even more effective in increasing muscle blood flow than deep intramuscular stimulation. Generally, needle stimuli had weak effect on blood flow in the trapezius muscle of the severely affected trapezius myalgia patients, possibly depending on older age and lesser number of patients included in the study. The different patterns of blood flow response to needle stimulation between healthy subjects and patients with chronic muscle pain might be a manifestation of altered somatosensory processing in the patients. The clinical studies showed that best pain relief of acupuncture in FMS patients was achieved in the neck-shoulder region, while the effect on the generalised symptoms was of short duration. Well-being and sleep was found to best predict treatment outcome. The results suggest that acupuncture treatment may be used for the alleviation of neck-shoulder pain, primarily, but it is not an alternative as the sole treatment. Electro-acupuncture, significantly decreased psychological distress and climacteric symptoms in postmenopausal women, but not better than a (near-) placebo control, implying pronounced non-specific effects. / Akupunktur ingår som en del i traditionell kinesisk medicin (TCM) och har använts i över 2000 år för att lindra sjukdom och symptom. I Sverige blev akupunktur godkänd som smärtlindringsmetod inom Hälso- och Sjukvården 1984. Sedan nästan 10 år är akupunktur jämställd med övrig behandling i sjukvården vilket innebär, att akupunktur kan användas även för behandling av annat än smärta. Förutsättningen är emellertid, att det finns tillräckligt med vetenskapliga belägg, s.k. evidens, för detta. I de allra flesta fall saknas det idag. För att säkerställa att evidens föreligger krävs omfattande forskning om effekter av akupunktur. Syftet med de olika studierna i avhandlingen var att belysa och studera psykologiska och fysiologiska aspekter och effekter av akupunktur och nålstimulering. Effekt på blodflöde i hud och muskel undersöktes på friska personer och på patienter med kronisk muskelsmärta. Normalt krävs ett mindre kirurgiskt ingrepp för att mäta blodflöde i muskel, men i dessa studier användes en mätmetod, som enkelt och utan ingrepp (icke-invasivt) i normala fall används för att mäta blodflöde i huden, s.k. fotopletysmografi (PPG, eng.). Med hjälp av ny teknik användes PPG i dessa studier för att mäta även muskelblodflöde. En studie för utvärdering av den nya PPG-tekniken ingick också i avhandlingen. Utvärderingen av mätmetoden visade goda möjligheter att mäta muskelblodflöde icke-invasivt med hjälp av PPG. Hos friska personer blev effekten på blodflödet störst vid djup stimulering i muskeln och där den s.k. DeQi-känslan framkallades (som vid klassisk akupunktur). Hos patienter med fibromyalgi var nålstimulering i huden lika, eller t.o.m. mer, effektiv att öka muskelblodflödet i skuldran än den djupa nålstimuleringen. De olika mönstren av blodflödesökning mellan de friska personerna och patienterna kan bero på ett förändrat reaktionssätt i nervsystemet som svar på smärtsam stimulering. I två kliniska studier studerades den smärtlindrande effekten av manuell akupunktur vid fibromyalgi och effekten av elektroakupunktur på stress och klimakteriebesvär hos kvinnor i övergångsåldern. Akupunktur vid fibromyalgi visade sig ha bäst smärtlindrande effekt i nack-skulderområdet, medan effekten på de generella symptomen var kortvarig. Patienter som mådde och sov relativt bra erhöll bäst effekt. Efter en behandlingsserie, bestående av elektroakupunktur, minskade stress och klimakteriebesvär påtagligt hos kvinnorna i övergångsåldern, men inte mer än hos en grupp kvinnor, som fick en kontrollbehandling bestående av mycket ytligt placerade nålar i huden. Detta tyder på att en betydlig del av behandlingsresultatet utgjordes av ospecifika effekter eller, s.k. eller placeboeffekter.

Aims: The overall aim of this thesis was to elucidate psychological processes and development, maintenance or recovery related to fibromyalgia based on in depth interviews. In a next step women with fibromyalgia, women without long-lasting pain and women with long-lasting pain were compared using psychometric instruments selected or developed based on qualitative results. Methods: Twenty-one women with fibromyalgia and 8 women recovered were interviewed. Their narrations were analysed using Grounded Theory. Tentative theory was built. The I Myself Scale (IMS) was constructed to mirror self-regulation prior to onset of symptoms and complemented with an instrument on current self-regulation: Structural Analysis of Social Behaviour (SASB) and SF-36 mirroring health related quality of life, regarding the two pain groups. The groups were compared using analysis of variance, principal components analysis paired with discriminant analysis and profile analysis. Results: Analyses of the interviews resulted in core concepts of an “unprotected self” (current fibromyalgia) or a “strong but not enough to be weak” self (recovery). Data patterns indicated that the women as children were unprotected in relation to stimuli and affects. Relationships with the parents were characterised by strain and low levels of support. The recovery group had as children simultaneously been able to develop obvious competence and capability to receive help. Psychological vulnerability was in adult life compensated for through pronounced helpfulness and dissociation/repression including intense activity. An increase in mental load such as localised pain or psychosocial crisis preceded onset of fibromyalgia accompanied by impaired cognitive functioning. The state of fibromyalgia meant maintained high levels of mental load such as difficulties of the selfstructures, impaired cognitive functioning and somatic symptoms. The recovery group experienced substantial social support and often used mastering strategies to ease symptoms. A decrease in strain as improved life conditions and cease of overexertion preceded recovery. Health was thereafter maintained through careful management as seeking low levels of strain and pacing of activity. Recovery ‘on parole’ also meant personal growth and use of efficacious defences. Psychometrical testing confirmed qualitative data patterns of self-regulation connected to fibromyalgia. Impaired selfreference/ understanding of health needs and others not being asked for help and advice was reported before onset of symptoms. Dissociation or repression including intense activity and self-loading were also employed. SASB and SF-36 indicated that women with fibromyalgia experienced higher levels of mental “load” than the other pain group. Conclusion: Qualitative data indicated that life prior to onset of fibromyalgia and current fibromyalgia held qualities of impaired self-regulation in relation to mental and physical load. The state of recovery relied on improved self-regulation allowed by conditions of life. Quantitative data patterns confirmed qualitative results on impaired self-protection before onset of fibromyalgia and a specifically high level of mental load during the state of fibromyalgia. Psychological disregulation is discussed and hypothesised to cause but also later in the process parallel alterations in somatic homeostatic functions. Recovery could mean that biological regulation regarding strain is replaced with more of “psycho-social” regulation as careful pacing of work. Implications for treatment are suggested.

Fibromyalgi är en sjukdom som involverar symtom såsom kronisk smärta, stelhet och sömnstörningar. Sjukdomens orsak är ännu inte klarlagd. Att leva med kronisk smärta, trötthet och rörelseinskränkningar kan inverka negativt på det dagliga livet. Syftet med studien var att belysa fysisk aktivitets inverkan på sjukdomssymtom samt livskvalité hos patienter med fibromyalgi. Metoden var en litteraturstudie baserad på 20 vetenskapliga artiklar. Artiklarna visade liknande resultat när det gällde fysisk aktivitets inverkan på symtom samt livskvalité hos personer med fibromyalgi. Det framkom att fysisk aktivitet gav god effekt när träning utfördes med låg- till medelintensitet samt utfördes under en längre tid. Det framkom även att symtomen påverkade förmågan och viljan att delta i någon form av fysisk aktivitet. Vidare forskning inom området behövs när det gäller att utforma och individanpassa motionsprogram för fibromyalgipatienter.

Sammanfattning Fibromyalgi har betraktats ända framtill våra dagar som en ren psykosomatisk sjukdom som uppkom utan känd orsak. Sjukdomen innebar en ständig smärta och en oändlig trötthet/ utmattning. Det fanns ingen behandling för sjukdomen bara lindra symtomen. Syftet med denna litteraturstudie var att beskriva hur kvinnor med fibromyalgi upplevde sin livssituation. Metoden som användes var en litteraturstudie med beskrivande design. Artiklarna kvalitetsbedömdes, innehållet sammanställdes och resulterade i fyra kategorier. Resultatet som rörde dem fysiska aspekterna av livssituation visade att smärta, trötthet/utmattning och sömnlöshet var vanligt förekommande symtom i kvinnornas vardag som påverkade deras livskvalitet. Symtomen hindrade dem från att leva ett aktivt liv samt delta i sociala aktiviteter. De psykiska aspekterna inom livssituationen visade att kvinnorna med fibromyalgi gav uttryck för en längtan efter det liv de levt innan sjukdomen och den förlorade identiteten. De sociala aspekterna visade att kvinnorna med fibromyalgi hade en önska att få spendera mer tid tillsammans med familjen. Sjukdomen hade också en negativ inverkan på förhållande och separationer var inte ovanligt. Arbetet prioriterades högt och arbetslivet uppskattades som stimulerande. Bristen på synliga symtom vid sjukdomen  gjorde att kvinnorna blev ifrågasatta av personer i omgivningen och sjukvårdspersonal. Under de existentiella aspekterna föll de positiva sidorna med sjukdomen in. Kvinnorna började reflektera över alla måsten och plikter i livet samt lärde sig att prioritera på ett bättre sätt. / Abstract Fibromyalgia has considered until to day as a psychosomatic disease that emerged without any known cause.The main symptoms are constant pain and an abnormal feeling of fatigue or exhaustion. There are no treatment for the illness it just alleviated the symptoms. The aim of this study was the describe how women with fibromyalgi experienced their life-situation.The method used was a literature study with a descriptive design. The articles were quality-tested, the content put together/compiled and resulting in four categories as follows.The result involving the physical aspects of life-situation showed that pain, tiredness and sleeplessness was commonly occurring symptoms in women´s daily life which affected their quality of life.The symptoms prevented women from living an active life and actively taking part in social activites. The psychological aspects of life-situation showed that women with fibromyalgia expressed a longing for the life they lived before the illness and the lost identity. The social aspects showed that the women wished to spend more time with their families. The disease had negative effects on their relationships and separation was not unusual. Work was highly prioritised and estimated as stimulating. The deficiency on visible symptoms of the disease made that the women became questioned by persons in their environment and by health-personal. The positive sides of the disease was found in the existential aspects. The women started to reflect about their duties in life and learned how to prioritise on a better way.

Aim Our aim is to highlight perceptions of fibromyalgia among health care personell. MethodsA systematic literature review conducted with a deductive approach. FindingsHealth care personell felt insecure because of a lack of understanding which lead to avoiding contact with these patients. Many felt that the fibromyalgia patient was categorised and that they would have been better served with another name of their disease. There was a great distrust against the diagnosis and its aetiology. The patient was perceived as troublesome, illness-fixated and draining the personell of energy. The paradox that the patient is looking so healthy but bearing so much pain was confusing for the health care personell. Conclusions Communication and an empathic encounter was identified as important elements for patient care. The health care personell should try to look past their own perceptions of fibromyalgia and meet the patient with affirmation and respect. Key wordsFibromyalgia, attitudes, perception, health care personell, communication.