Psychosocial Factors in Fibromyalgia: A Qualitative Study on Life Stories and Meanings of Living with Fibromyalgia

Fibromyalgia (FM) is defined by the American College of Rheumatology (ACR) 1990 classification criteria as a syndrome in which an individual is required to have both a history of chronic widespread pain and the presence of, at least, 11 of 18 tender points (Wolfe et al., 1990). However, additional symptoms such as sleep disorders, fatigue, and psychological distress are also common in clinical practice (Blotman & Branco, 2007; Wilke, 2009) which has contributed over time to questioning if tender points would be the most appropriate measure to capture the essence of FM (Wilke, 2009). In 2010, Wolfe et al., proposed the ACR preliminary diagnostic criteria for FM including two variables that best defined FM and its symptom spectrum: the widespread pain index (WPI) and the symptom severity scale (SS scale). The WPI is a measure of the number of painful body regions and the SS scale assesses cognitive problems, unrefreshed sleep, fatigue, and somatic symptoms. The authors combined the WPI and the SS scale in order to recommend a new case definition of FM: (WPI≥7 AND SS ≥5) OR (WPI 3-6 AND SS≥9); moreover, the symptoms have to be present at a similar level for at least 3 months and the patient does not have a disorder that explain the pain (Wolfe et al., 2010). In terms of gender prevalence, FM is more common among women between 20 and 50 years (Blotman & Branco, 2007). Although the exact etiology and pathogenesis of FM are still unknown there is evidence that psychosocial factors could play an important role. In fact, FM has been conceptualized within biopsychosocial perspectives, in which physiological, psychological, and social factors are considered as interacting in different ways and at different stages. In a review article, Eich et al. (2000) evaluated the role of psychosocial factors in the development of FM supporting that psychosocial factors can be relevant at different etiological levels and can be classified into predisposing, triggering, and stabilising/"chronifying". On the other hand, Van Houdenhove and Egle (2004) conceptualized stress as playing a key role in the pathogenesis of FM, placing emphasis on the relationships among adverse life experiences, stress regulation, and pain-processing mechanisms. One year later, the authors highlighted, from an etiologic point of view, studies concerning the role of adverse life events, personality and lifestyle factors, post-traumatic stress, and negative childhood experiences (Van Houdenhove et al., 2005). Thus, the proposed integrative biopsychosocial models