The 4 U’s Rule of Fibromyalgia: A Proposed Model for Fatigue in a Sample of Women with Fibromyalgia: A Qualitative Study

Abstract

Although fatigue usually goes unnoticed, it is a symptom that poses great challenges to patients with fibromyalgia and is a strong limitation. The aim of this study is to identify and describe the variables involved in fatigue in nine different situations of the Goal Pursuit Questionnaire (GPQ) that may occur in the daily lives of women with fibromyalgia, according to an ABC (Antecedents–Behaviors–Consequences) model. This study followed a qualitative descriptive research method and a deductive–inductive hybrid approach based on a phenomenological paradigm. Twenty-six women with fibromyalgia participated in focus group discussions between February and March of 2018. Thematic content analysis was carried out from transcribed verbatim interviews. We identified nine major themes that emerged from the participants’ conversations: self-imposed duties, muscle fatigue, overwhelming feeling of tiredness, difficulty thinking, difficulty concentrating, negative emotions, lifestyle changes, affected everyday activities, and lack of motivation for daily activities and social interactions. We conclude that the ABC model allowed certain elements to emerge regarding the fatigue experience, highlighting its importance as a symptom in fibromyalgia. This additional analysis of the ABC model showed that fatigue can be described through the 4 U’s Rule, which is integrated by these four adjectives: (1) Unpredictable, (2) Uncontrollable, (3) Unseen, and (4) Unintelligible. Identifying these characteristics can contribute to a better understanding of fibromyalgia in addition to better treatment for these patients.

Contextualizing goal preferences in fear-avoidance models. Looking at fatigue as a disabling symptom in fibromyalgia patients

“…The goal of this study has been to develop and validate the adaptation of the Spanish version of the GPQ [20] in relation to fatigue, an essential and forgotten symptom of FM [24]. The…”

“…The goal of this study has been to develop and validate the adaptation of the Spanish version of the GPQ [ 20 ] in relation to fatigue, an essential and forgotten symptom of FM [ 24 ]. The analyses concerning the internal structure of the GPQ-F showed that this version is consistent with the original scale and reaches comparable psychometric standards.…”

“…Despite some findings providing support for the validity of an affective-motivational approach to chronic pain, little research has examined how a goal-based motivational construct may influence fatigue symptoms in individuals with chronic illnesses. As we have pointed out, in spite of pain often being the main symptom in the diagnosis of fibromyalgia, fatigue has been shown to be highly prevalent and persistent in these patients [24][25][26][27][28][29]. Although more that 75% of FM patients report fatigue [30], conceptualizing it as one of their most concerning symptoms that impact on quality of life [31,32], little is known regarding the psychosocial variables involved in its maintenance.…”

Fibromyalgia as a Heterogeneous Condition: Subgroups of Patients Based on Physical Symptoms and Cognitive-Affective Variables Related to Pain

“…With a view to future research, it would be necessary to examine the consistency of the clusters identified in other samples of FM patients, the confirmation of the optimal number of clusters via complementary statistical methods (e.g., latent profile analysis), the replicability of findings using revised versions of the self-reports (e.g., FIQ-revised), as well as the stability along the time of the clusters. Likewise, and given the key role of fatigue in FM patients (Velasco-Furlong et al, 2020), it would be of great interest to examine whether the dimensionality of fatigue is also reflected in the establishment of clusters. It would also be of remarkable clinical utility to establish the predictive value of the classification generated by analyzing the differential response of each subgroup to CBT.…”

Perfectionism and Pain Intensity in Women with Fibromyalgia: Its Influence on Activity Avoidance from The Contextual Perspective

“…Fibromyalgia (FM) is a complex syndrome characterized by frequent chronic musculoskeletal pain and widespread sensitivity, which is often accompanied by symptoms such as extreme fatigue [ 1 ], cognitive decline [ 2 ], sleep disturbances [ 3 ], and psychological and affective disorders [ 4 ], among others [ 5 , 6 ]. These symptoms cause significant functional impairment [ 7 ] and higher levels of physical deterioration [ 8 ].…”