Multicomponent self-management interventions for chronic widespread pain including fibromyalgia: A systematic review and meta-analysis

Talk Code: 
R.3
Presenter: 
Adam Geraghty
Twitter: 
Co-authors: 
Adam Geraghty, Emma Maund, Dave Newell, Cathy Price, Miriam Santer, Hazel Everitt, Tamar Pincus, Rachel West, Michael Moore, Paul Little, Beth Stuart.
Author institutions: 
University of Southampton, Solent NHS Trust, Royal Holloway University of London

Problem

Chronic widespread pain (CWP) has an estimated prevalence of 10-15%, and is associated with substantial disability, psychological distress and high health care usage. CWP is increasingly viewed as occurring on spectrum, with Fibromyalgia representing its more severe presentation. Guidelines advise moving away from specialist care, placing primary care at the centre of CWP management. Medical treatment options are limited; opiates and gabapentinoids are associated with substantial side-effect profiles and risk of dependence. Supporting those with CWP to effectively self-manage is a priority. Our aim is to determine the effectiveness multicomponent self-management interventions specifically targeting CWP (including fibromyalgia). This review will form the basis of research to develop novel primary care-centred, person-based self-management interventions for CWP.

Approach

A systematic review and meta-analysis of randomised controlled trials (RCTs) including adults with a diagnosis of CWP or Fibromyalgia, taking part in a multicomponent self-management intervention. We drew on an established definition of self-management as ‘a structured, taught, or self-taught course or intervention programme principally aimed at patients with the goal of improving the participants’ health status or quality of life by teaching them skills to apply to everyday’ (Miles CL, Pincus T, Carnes D et al. 2011). Multicomponent refers to the intervention containing at least two of the following components; psychological, mind–body therapies, physical activity, lifestyle and medical education. The following databases were searched from their inception to December 2017 (All searches are currently being updated): The Cochrane Central Register of Controlled Trials, MEDLINE, Embase, PsycINFO, and the WHO International Clinical Trials Registry. The Cochrane Risk of Bias tool was used to assess risk in all trials. The review was prospective registered (PROSPERO ID: CRD42018099212).

Findings

Thirty-eight RCTs met our inclusion criteria and will be included in our analysis (n= 4489). Eleven trials limited to trial registry only were identified and will be discussed. Data has been extracted and our analysis is on-going; full findings will be reported at the conference.

Consequences

This systematic review will provide the current state of the evidence for multicomponent self-management interventions for CWP. We will describe the format and components of successful interventions, and use the evidence to infer critical elements for a self-management approach targeting those with CWP cared for within a general practice context.

Submitted by: 
Adam Geraghty
Funding acknowledgement: 
This research was part funded by Research Capacity Funding from Solent NHS Trust.