This qualitative study sought to answer: How may I, as an artist, use art for my own transformation and healing? I am an artist and teacher living with chronic pain and fatigue and wanted to find healing through art and inspire others to do the same. During the three month study, I made artwork, reflected in my journal, and practiced guided imagery. The journal was used to reflect on my health, the creative process, and to record ideas generated through guided imagery. Findings showed that short term relief was provided during the act of creation, but no long-term relief was achieved. The primary conclusion was that I was able to use art for healing and transformation, but only after experimentation and reflection. By adapting the creative process to accommodate for my illness, I was able to include art making as part of a healthy life.

Individuals with non-apparent, physical disabilities face unique social challenges from those that are encountered by the more visibly disabled. The absence of visible cues indicating physical impairment causes ambiguity in social situations, leaving the sufferer vulnerable to moral judgments and social sanctions when they are unable to embody and perform to cultural norms. This dynamic generates a closeted status that the individual must learn to navigate. Using Eve Sedgwick's "The Epistemology of the Closet," this paper deploys auto-ethnography, traditional ethnographic techniques, and literature reviews to illuminate a third space of functioning between the outwardly 'healthy' and the visibly disabled.

Bakgrund: Det saknas biomedicinsk förklaring till varför fibromyalgi uppstår, vilket gör att patienter idag främst diagnostiseras genom symtombilden som ingår i sjukdomen. Att fibromyalgi består av både fysiska och psykiska besvär och att orsaken är oklar gör att sjukdomen är svårbehandlad. Vid bemötande av denna patientgrupp är det viktigt att ha ett holistiskt synsätt. Syfte: Att belysa aktuell forskning om kvinnors upplevelser av att leva med fibromyalgi. Metod: En litteraturöversikt baserad på tretton vetenskapliga artiklar som har analyserats. Resultat: De främsta huvudsymtomen för kvinnor med fibromyalgi är smärta, trötthet, utmattning, depression, sömnstörningar samt kognitiv nedsättning. Huvudteman som framkommit i studien är En sjukdom som påverkar livet och Att kämpa med sjukvården. Vidare framkom fyra underteman som grundas på sjukdomens begränsningar, som gör att kvinnor måste omstrukturera sin livssituation för att uppnå en livskvalitet. Slutsats: En ökad förståelse för hur kvinnor upplever att leva med fibromyalgi kan bidra till en förbättrad attityd mot denna patientgrupp. Detta kan leda till att kvinnors upplevelser av sjukdomen förbättras. / Background: There is no biomedical reason why fibromyalgia occurs. Today, the patients are diagnosed mainly by the symptoms that are part of fibromyalgia. The cause of fibromyalgia is unclear, and it consists of both physical and psychological problems that make the disease difficult to treat. It is important to have a holistic approach when treating patients with fibromyalgia. Aim: To create an overview of current research of women’s experiences of living with fibromyalgia. Method: The study is designed as a study based on thirteen scientific articles which have been analyzed. Results: The main symptoms for women with fibromyalgia were pain, fatigue, exhaustion, depression, sleep disorders and cognitive impairments. The main themes that have emerged are A disease that affects the daily life and To struggle with the healthcare. Furthermore, the results show four subthemes which were based on that the limitations of the disease demand the women to restructure their life situation achieve quality of life. Conclusion: Increased knowledge and understanding of the experiences of patients living with fibromyalgia, may contribute to a better attitude and a better care for this group of patients. This may lead to improvement of women’s experiences of the disease.

Syftet med denna litteraturstudie var att beskriva hur människor med fibromyalgi upplever att leva med långvarig smärta, hur denna hanteras i det dagliga livet samt vilka omvårdnadshandlingar som upplevs betydelsefulla av fibromyalgidrabbade. Litteratursökningen genomfördes via Högskolan Dalarnas databaser ELIN, Blackwell Synergy och EBSCO HOST med hjälp av sökord i olika kombinationer. Tre artiklar söktes manuellt. Inklusionskriterierna var att artiklarna skulle vara vetenskapliga och skrivna på engelska, svenska, norska eller danska samt vara publicerade mellan 1997-2007. Artiklarna (n=16) kvalitetsgranskades med hjälp av granskningsmallar och de artiklar som var av hög eller medelhög kvalitet inkluderades. I resultatet framkom att den långvariga smärtan vid fibromyalgi upplevdes dominera medvetandet vilket kunde leda till känslor av ilska, hjälplöshet, frustration, irritation, desperation och utmattning. Flera delar av, eller i vissa fall hela kroppen, engagerades av smärtan. Exempel på strategier för att hantera smärtan var att använda sig av fysiska aktiviteter, avslappningsövningar, självdistrahering, alternativmedicinska behandlingar och att ha en positiv attityd. Den viktigaste formen av psykologiskt stöd var att bli lyssnad till och att få uttrycka sig utan att känna sig dömd. Vidare var praktiskt stöd, såsom assistans med hushållssysslor av stor betydelse. Att erhålla adekvat information om sjukdomstillståndet och prognosen upplevdes vara viktigt av fibromyalgidrabbade.

Thesis (PhD) - Swinburne University of Technology, Faculty of Engineering and Industrial Sciences, 2009. / A thesis submitted for the degree of Doctor of Philosophy, Faculty of Engineering and Industrial Sciences, Swinburne University of Technology, 2009. Typescript. "February 2009". Includes bibliographical references (p. 291-313)

There is a paucity of research that explores how people with Fibromyalgia (FMS) relate to themselves and others, with a particular focus on childhood experiences, mentalization and attachment theory. Ten people with FMS participated in semi-structured interviews, which explored the following areas: Important current relationships, experiences with others and childhood experiences of relationships. Stress and coping were also explored. Interview transcriptions were investigated using Interpretative Phenomenological Analysis (Smith & Osborn, 2003). The following three superordinate themes were identified: “The power of painful childhood experiences”, “the connection between stress and relating to others” and “interpersonal stress is wedded to illness”. Among the participants, childhood was characterised by abuse, illness, bereavement or parental discord. These early events related to various adult consequences in terms of how others and the self were related to. Mirroring childhood experiences, adult relations were often described as destructive. Interpersonal stress was wedded to illness in that others were perceived as invalidating or as ignorant of the suffering experienced. Illness tended to be described as leading to isolation and increased vulnerability to abuse. Literature pertaining to FMS, attachment and mentalization theory was useful in informing the interpretation. Limitations, clinical implications and directions for future research are discussed.

Bakgrund: Dagens forskning visar på att det finns en oengihet om orsaken bakom fibromyalgi. Ålder, etnicitet eller social status spelar ingen roll, alla kan drabbas, dock finns det forskning som visar att kvinnor drabbas oftare än män.. De mest framträdanden symtomen är värk, stelhet och trötthet. Den behandling som erbjuds denna patientgrupp är oftas symtomlindrande behandling. Syfte: Att beskriva upplevelsen av mötet med vården för patienter med fibromyalgi. Metod: Författarna har valt att göra en litteraturöversikt av åtta vetenskapliga artiklar som har fokus på patienters upplevelse av att leva med fibromyalgi och mötet med vården. Författarna valde Joyce Travelbees omvårdnadsteori med fokus på kommunikation och mellanmänskliga relationer. Resultat: Resultatet visar att patienter med fibromyalgi upplever att sjukvårdspersonal ifrågasätter deras trovärdighet och inte tar deras problem på allvar. Vidare visar resultatet att sjukvårdspersonalen kategoriserar dessa patienter efter stereotypa rolluppfattningar och möter dem utifrån deras förförståelse om vad fibromyalgi är eller inte är. Diskussion: Denna studie visar att sjukvårdspersonal utgår från sin egen eller andras objektiva bedömning av patientens situation istället för patientens unika upplevelse i mötet med dessa. Författarna gör då tolkningen utifrån resultatet och utifrån Joyce Travelbees omvårdnadsteori att sjukvården brister i deras förmåga att lära känna och kartlägga patientens behov. / Background: The cause for fibromyalgia is not known. Age, ethnicity and social status doesn´t matter. The most prominent symptoms are pain, stiffness and fatigue. The treatment for fibromyalgia is limited, it is often a combination of pain relief, physical activity and lifestyle changes. Nurses working with fibromyalgia patients have an important role in education and informing patients about their disease. Aim: The aim of this study is to describe patient with fibromyalgia and their experience of the encounter with the health care. Method: A literature review of eight scientific articles, with the focus on patients’ experience of living with fibromyalgia and the encounter with the health care. The authors chose Joyce Travelbees theoretical framework for their literature review. Result: The result shows that patient with fibromyalgia experience that health care professionals question their credibility and that they don’t take their problems seriously. Furthermore the result showed that health care professionals categorized these patients by stereotypical role perceptions, and encounters these patients by their pre-understanding about what fibromyalgia is or is no. Discussion: This study shows that health care professionals meets these patients, based of their own and others objective assessment of the situation, instead of being based on the patient´s unique perception of their situation. The authors make the interpretation based on the result and Travelbees nursing theory that health care professionals lack in their ability to know and to identify the patient´s needs.

Previous work has suggested that chronic pain patients report psychological distress through higher endorsement of somatic rather than cognitive signs of anxiety and depression. The present study compared female Non-Pain (11=52), Orofacial Pain (n=3 17) and Fibromyalgia (n=50) groups. on SCL-90-R Somatization, Anxiety and Depression raw scores and cognitive-somatic symptom patterning of the Anxiety and Depression scales. Comparisons were also made amongst orofacial pain diagnostic subgroups and subgroups based on Multidimensional Pain Inventory (MPI) classification groups. The Somatization. Anxiety and Depression scores were higher in the OroFacial Pain and Fibromyalgia than Non-Pain group and higher in the Dysfunctional than Adaptive Coper MPI Profile group. No differences in somatic-cognitive symptom patterning existed among the diagnostic or the MPI groups/subgroups. OroFacial pain patients endorsing cognitive items stronger than somatic items on the Anxiety and/or Depression scales showed a tendency towards more psychopathology (higher SCL-90-R scale scores) than the participants endorsing somatic items more so than cognitive items. I n conclusion, study results indicate that differentiation of cognitive-somatic patterns does not contribute to increased understanding of chronic pain conditions.

Background: Fibromyalgia (FM) disorder commonly involves musculoskeletal widespread pain and other symptoms like fatigue, sleep disruption, depression and anxiety and is associated with disability, work disability and high health care utilization. An integrated approach combining pharmacological and non-pharmacological treatments is advised to manage the disorder. Among the non-pharmacological interventions exercise has been shown to help; however, details about effectiveness of different types of interventions remain unknown. Objectives: The objective of this dissertation was to synthesize the evidence on the effectiveness of: a) Aquatic exercise interventions for adults with FM as reported in randomized control trials (RCTs), and b) any physical activity interventions for adults with FM as reported in systematic reviews. This was done by conducting a Cochrane systematic review of an aquatic training intervention and second, synthesizing the effectiveness of a variety of exercise interventions. Methods: For the Cochrane systematic review, nine electronic databases were searched. Selection criteria included full text publication of a RCT including an aquatic exercise intervention (AQ) (exercise in water was >50% of the full intervention) and provision of between-group outcome data. Pairs of reviewers independently screened and selected articles, assessed risk of bias, and extracted data on 24 outcomes. Effects of the interventions were evaluated using mean, standardized mean differences and 95% confidence interval (MD/SMD [95% CI]). Specific computer software designed for meta-analysing and evaluating the quality of evidence were used (i.e RevMan, GradePro). The second review, the synthesis of a variety of exercise interventions or umbrella systematic review, inspected six electronic databases for the January 1st 2007 to March 31st 2012 period. We included systematic Cochrane and non-Cochrane reviews that reported on the effects of any physical activity intervention for adults with FM. Pairs of reviewers independently screened and selected articles, assessed quality of the reviews using a valid and reliable tool (AMSTAR tool), and extracted data on four outcomes. Effects of the interventions were evaluated using standardized mean differences and 95% confidence intervals (SMD [95% CI]). We planned to use RevMan software for meta-analysis but due to heterogeneity of the reviews this was not done. Results: The Cochrane review examined 16 aquatic exercise training studies (n = 881). Nine studies compared aquatic exercise to control, five studies compared aquatic exercise to land-based exercise, and two compared aquatic to a different aquatic program. The aquatic vs control studies provided low to moderate quality evidence suggesting that aquatic training is beneficial for wellness, symptoms and fitness in adults with FM. The aquatic vs land group results suggested very low to low quality evidence that there are no differences in benefits between aquatic and land-based exercise except in muscle strength (very low quality evidence favoring land). In examining aquatic vs aquatic meta-analyses was not possible and only one difference in a major outcome was found. The umbrella systematic review synthesis of information (n-= nine systematic reviews) found positive results for diverse exercise interventions on pain, multidimensional function, and self-reported physical function and no conclusive evidence for new (to FM) physical activity mode (i.e. qigong, tai chi). There are however, methodological weaknesses in some of the reviews which reduce applicability of the research to clinical practice. Adverse effects reported suggest there was no serious harm performing physical activity for individuals with FM. Conclusions: Exercise interventions have the potential to positively impact individuals with FM including several outcomes like quality of life, physical functioning and pain. While some interventions had statistically significant results, methodological limitations prevented us from arriving at conclusions regarding particular elements and modes of exercise that will help inform health professional’s clinical practice. On the other hand, some preliminary analysis showed that variables like age, disease duration, disease severity and pain intensity warrant further exploration. A rigorous scientific process (or quality research) as the precursor of quality evidence is crucial for validity and credibility of the information and our future understanding of the effectiveness of exercise interventions for individuals with FM.

Bakgrund: Fibromyalgi är ett syndrom och ett kroniskt tillstånd som orsakar smärta, ömhet och stelhet i rörelseorganen. Fibromyalgi karaktäriseras också av sömnstörningar, fatigue, ångest, depression och problem med tarmfunktionerna. Syfte: Att beskriva kvinnors upplevelser av att leva med fibromyalgi och vilka copingstrategier de använder för att hantera sin situation. Metod: Litteraturstudie med deskriptiv design. Resultat: Kvinnor med fibromyalgi upplevde en oförutsägbar fluktuerande och utbredd smärta, en ständigt närvarande fatigue, stelhet samt kognitiva svårigheter. De kognitiva svårigheterna visade sig som bland annat koncentrations- och minnessvårigheter.  Att leva med fibromyalgi ansågs av kvinnorna som emotionellt påfrestande. Frustration, ångest och depression var vanligt förekommande och många kvinnor upplevde en misstro och oförståelse från sin omgivning. Fibromyalgin hade en stor inverkan på kvinnornas sociala liv som arbetsliv och dagliga aktiviteter. För att hantera sin fibromyalgi använde kvinnorna sig av olika fysiska och mentala copingstrategier. Slutsats: En ökad kunskap hos omgivningen om hur det är att leva med fibromyalgi kan leda till ökad förståelse och därmed ett gott bemötande till dessa kvinnor. Detta kan generera en känsla av bekräftelse, främja hanteringen av fibromyalgin samt minska kvinnornas lidande. / Background: Fibromyalgia is a syndrome and a chronic condition which causes pain, soreness and stiffness in the musculoskeletal system. Fibromyalgia is additional characterized by sleep disorder, anxiety, depression and bowel functional problems.  Aim: Describe women’s experiences of living with fibromyalgia and which coping strategies they use for handling their situation. Method: A literature review with descriptive design. Result: Women with fibromyalgia experienced an unpredictable, fluctuating and widespread pain, an ever-present fatigue, stiffness and cognitive difficulties. The cognitive difficulties found to include concentration difficulties and memory problems. Living with fibromyalgia was considered by the women as emotionally stressful. Frustration, anxiety and depression were common. Many women experienced mistrust and incomprehension from the surroundings. Fibromyalgia had a great impact on women’s social life such as work life and daily activities. To manage their fibromyalgia, the women used various physical and mental coping strategies.   Conclusion: An increased knowledge from the surroundings about how it is to live with fibromyalgia could lead to increased understanding and good treatment for these women. That could generate confirmation, promote the management of fibromyalgia and decrease the suffering for these women.