|dc.description.abstract||Background: Chronic pain conditions particularly fibromyalgia (FM) are an important
issue considering the demand that they place on health services and the negative impact
on an individual’s well-being. Research regarding what impact FM may have on the
various domains of health related quality of life is sparse. In addition, research identifying
predictors relating to a person’s self-concept on pain outcomes such as quality of life and
disability is scarce in a chronic pain population. Self-esteem has been linked to
psychological adjustment in various chronic diseases (Chong et al, 2009) and is suspected
to be a vulnerability factor in FM (Johnson et al., 1997; Michielsen et al., 2006). Research
on self-compassion found that it is a significant predictor of increased psychological
adjustment in people with chronic medical conditions (Wren, Somers, & Wright, 2011).
The majority of research on self-compassion has been conducted in non-clinical samples.
Identifying the predictive values of self-esteem and the self-compassion subscales (self-warmth
and self-coldness) in relation to pain outcomes are useful provided they can be
enhanced and utilised to inform intervention.
Aims: This research portfolio had two aims, to systematically review and carry out a
meta-analysis with the literature investigating the impact of FM on health related quality
of life using the Short Form-36 version one and to investigate whether self-warmth, self-coldness
and self-esteem act as predictors of quality of life and disability for individuals
with chronic pain.
Method: A systematic review and meta-analysis of studies which assessed the impact of
FM on health related quality of life was undertaken. Sensitivity and subgroup analyses
were conducted to address the level of heterogeneity in the studies. The empirical study
comprised of a cross-sectional design in which 60 individuals with chronic pain were
recruited from three NHS sites based in Fife and Lothian and a pain self-management
group in Fife to complete six validated psychometric questionnaires: Self Compassion
Scale (Neff, 2003), Rosenberg Self-Esteem Scale (Rosenberg, 1965), Brief Pain Inventory-
Short Form (Cleeland, 1991), Pain Disability Questionnaire (Anagnostis, Gatchel, &
Mayer, 2004), Hospital Anxiety and Depression Scale (Zigmond and Snaith, 1983) and
Quality of Life Scale (Burckhardt, Woods, Schultz, & Ziebarth, 2003).
Systematic Review Results: In total, 18 studies met the inclusion criteria of the systematic
review and demonstrated that the health related quality of life of individuals with FM
was lower compared to healthy controls on all eight subdomains of the SF-36 particularly
Physical Role. It was found that Social Functioning was the subdomain least affected
when comparing participants with FM to healthy controls.
Empirical Project Results: Quality of life was lower than previous research with females
reporting a higher level of quality of life than males. It was found that after controlling
for demographic and clinical variables, self-warmth was the only significant predictor for
quality of life but not on levels of disability. Neither self-coldness nor self-esteem were
significant predictors on scores of quality of life or disability.
Conclusion: The above studies expand literature on the nature of chronic pain and its
outcomes such as health related quality of life. The meta-analysis evidenced that HRQoL
was lower in individuals with FM than in healthy controls. The association between
symptom severity and quality of life requires further investigation in FM.
Psychological interventions targeting the development of self-warmth attributes and
skills may have a beneficial effect in improving quality of life for people with chronic pain.
While the systematic review highlighted that FM has a more significant impact physically
rather than mentally in relation to quality of life, both studies highlighted the need for
interventions to target the psychological adjustment of people with chronic pain