Mindfulness meditation alleviates depressive symptoms in women with fibromyalgia: results of a randomized clinical trial. An Online Mindfulness Intervention Targeting Socioemotional Regulation in Fibromyalgia: Results of a Randomized Controlled Trial Treating fibromyalgia with mindfulness-based stress reduction: Results from a 3-armed randomized controlled trial The efficacy of mindfulness meditation plus Qigong movement therapy in the treatment of fibromyalgia: a randomized controlled trial. Multidisciplinary treatment of fibromyalgia: does cognitive behavior therapy increase the response to treatment? A mind-body technique for symptoms related to fibromyalgia and chronic fatigue. Mindfulness Training as an Intervention for Fibromyalgia: Evidence of Postintervention and 3-Year Follow-Up Benefits in Well-Being Is brief psychodynamic psychotherapy in primary fibromyalgia syndrome with concurrent depression an effective treatment? A randomized controlled trial. Mindfulness Meditation Alleviates Fibromyalgia Symptoms in Women: Results of a Randomized Clinical Trial The impact of a meditation-based stress reduction program on fibromyalgia. Meditation awareness training for the treatment of fibromyalgia syndrome: A randomized controlled trial Integrating Virtual Reality With Activity Management for the Treatment of Fibromyalgia: Acceptability and Preliminary Efficacy Mindfulness-Based Intervention Does Not Influence Cardiac Autonomic Control or the Pattern of Physical Activity in Fibromyalgia During Daily Life: An Ambulatory, Multimeasure Randomized Controlled Trial A protocol and pilot study for managing fibromyalgia with yoga and meditation. Improving physical functional status in patients with fibromyalgia: a brief cognitive behavioral intervention. Internet-enhanced management of fibromyalgia: A randomized controlled trial A pilot randomized controlled trial of the Yoga of Awareness program in the management of fibromyalgia
OBJECTIVE Depressive symptoms are common among patients with fibromyalgia , and behavioral intervention has been recommended as a major treatment component for this illness . The objective of this study was to test the effects of the Mindfulness-Based Stress Reduction ( MBSR ) intervention on depressive symptoms in patients with fibromyalgia . METHODS This r and omized controlled trial examined effects of the 8-week MBSR intervention on depressive symptoms in 91 women with fibromyalgia who were r and omly assigned to treatment ( n = 51 ) or a waiting-list control group ( n = 40 ) . Eligible patients were at least 18 years old , willing to participate in a weekly group , and able to provide physician verification of a fibromyalgia diagnosis . Of 166 eligible participants who responded to local television news publicizing , 49 did not appear for a scheduled intake , 24 enrolled but did not provide baseline data , and 2 were excluded due to severe mental illness , leaving 91 participants . The sample averaged 48 years of age and had 14.7 years of education . The typical participant was white , married , and employed . Patients r and omly assigned to treatment received MBSR . Eight weekly 2.5-hour sessions were led by a licensed clinical psychologist with mindfulness training .  Somatic and cognitive symptoms of depression were assessed using the Beck Depression Inventory administered at baseline , immediately postprogram , and at followup 2 months after the conclusion of the intervention . RESULTS Change in depressive symptoms was assessed using slopes analyses of intervention effects over time . Depressive symptoms improved significantly in treatment versus control participants over the 3 assessment s. CONCLUSION This meditation-based intervention alleviated depressive symptoms among patients with fibromyalgia Background Patients with fibromyalgia ( FM ) experience pain as well as deficits in positive affect and social relations that are not explicitly addressed in most behavioral treatments . Purpose The purpose of this study is to compare the effects of a 12-module online intervention targeting socioemotional regulation via mindful awareness/acceptance ( MSER ) with those of an attention-control treatment , healthy lifestyle tips ( HT ) . Methods Seventy-nine FM patients were r and omly assigned to MSER or HT , with outcomes assessed via online diary reports of pain , coping efficacy , affect , and social relations . Multilevel analyses revealed greater improvements in social functioning , positive affect , and coping efficacy for pain and stress ( all ps < .05 ) in MSER versus HT across the 6-week trial . Conclusions FM patients experience increases in self-efficacy for coping with pain and positive engagement in relationships , marginal increases in positive affect , and decreases in relationship stress from an automated online intervention that targets socioemotional regulation skills . Findings highlight the potential utility of widely accessible , low-cost intervention methods for fibromyalgia ( Clinical trials.gov number NCT01748786 ) & NA ; Mindfulness‐based stress reduction ( MBSR ) is a structured 8‐week group program teaching mindfulness meditation and mindful yoga exercises . MBSR aims to help participants develop nonjudgmental awareness of moment‐to‐moment experience . Fibromyalgia is a clinical syndrome with chronic pain , fatigue , and insomnia as major symptoms . Efficacy of MBSR for enhanced well‐being of fibromyalgia patients was investigated in a 3‐armed trial , which was a follow‐up to an earlier quasi‐r and omized investigation . A total of 177 female patients were r and omized to one of the following : ( 1 ) MBSR , ( 2 ) an active control procedure controlling for nonspecific effects of MBSR , or ( 3 ) a  wait list  . The major outcome was health‐related quality of life ( HRQoL ) 2 months post‐treatment . Secondary outcomes were disorder‐specific quality of life , depression , pain , anxiety , somatic complaints , and a proposed index of mindfulness . Of the patients , 82 % completed the study . There were no significant differences between groups on primary outcome , but patients overall improved in HRQoL at short‐term follow‐up ( P = 0.004 ) . Post hoc analyses showed that only MBSR manifested a significant pre‐to‐post‐intervention improvement in HRQoL ( P = 0.02 ) . Furthermore , multivariate analysis of secondary measures indicated modest benefits for MBSR patients . MBSR yielded significant pre‐to‐post‐intervention improvements in 6 of 8 secondary outcome variables , the active control in 3 , and the wait list in 2 . In conclusion , primary outcome analyses did not support the efficacy of MBSR  in fibromyalgia , although patients in the MBSR arm appeared to benefit most . Effect sizes were small compared to the earlier , quasi‐r and omized investigation . Several method ological aspects are discussed , e.g. , patient burden , treatment preference and motivation , that may provide explanations for differences . In a 3‐armed r and omized controlled trial in female patients suffering from fibromyalgia , patients benefited modestly from a mindfulness‐based stress reduction intervention OBJECTIVE To test the short and longterm benefits of an 8 week mind-body intervention that combined training in mindfulness meditation with Qigong movement therapy for individuals with fibromyalgia syndrome ( FM ) . METHODS A total of 128 individuals with FM were r and omly assigned to the mind-body training program or an education support group that served as the control . Outcome measures were pain , disability ( Fibromyalgia Impact Question naire ) , depression , myalgic score ( number and severity of tender points ) , 6 minute walk time , and coping strategies , which were assessed at baseline and at 8 , 16 , and 24 weeks . RESULTS Both groups registered statistically significant improvements across time for the Fibromyalgia Impact Question naire , Total Myalgic Score , Pain , and Depression , and no improvement in the number of feet traversed in the 6 minute walk . However , there was no difference in either the rate or magnitude of these changes between the mind-body training group and the education control group . Salutary changes occurring by the eighth week ( which corresponded to the end of the mind-body and education control group sessions ) were largely maintained by both groups throughout the 6 month followup period . CONCLUSION While both groups showed improvement on a number of outcome variables , there was no evidence that the multimodal mind-body intervention for FM was superior to education and support as a treatment option . Additional r and omized controlled trials are needed before interventions of this kind can be recommended for treatment of FM OBJECTIVE Multidisciplinary treatments ( MTs ) are usually recommended for reducing fibromyalgia ( FM ) symptoms and include physical exercise , drug management , education , and cognitive behavior therapy ( CBT ) . However , there is no evidence that CBT adds efficacy to the other therapeutic components . This r and omized controlled trial analyzed the response of FM patients to two MTs , with and without CBT , according to the presence of concurrent symptoms . METHODS Eighty-three women with FM were r and omly assigned to MT or combined MT and CBT . The MT included medical intervention , physical training , education , and discussion of the syndrome . The CBT focused on coping with stress , modifying lifestyles , and changing pain behaviors . Demographic and clinical data , information regarding tender points , and question naire responses about functional capability [ Fibromyalgia Impact Question naire ( FIQ ) ] , health status [ 36-item Short Form Health Survey ( SF-36 ) ] , and mental health [ Symptom Checklist-90-Revised ( SCL-90-R ) ] were obtained at the beginning , at the end of the 15-week treatment , and at 6-month follow-up . Subgroups are identified in relation to treatment response . RESULTS Sixty-six women ( 80 % ) completed treatment . Although the variance of the total sample had changed at posttreatment ( F=2.67 , P=.031 ) , there was no significant effect for the TimexTreatment interaction ( F=1.65 , P=.16 ) . Univariate tests detected a significant fall in the FIQ score . The subgroup of patients with fatigue showed a better response with MT+CBT than with MT . At 6-month follow-up , the statistical differences had been maintained . Intention-to-treat analysis ratified these results . CONCLUSIONS MT improves functional capability and reduces symptom impact . CBT increases mildly the effect of MT in patients with fatigue CONTEXT A novel mind-body approach ( amygdala retraining ) is hypothesized to improve symptoms related to  fibromyalgia and chronic fatigue .  OBJECTIVE To examine the use of a mind-body approach for improving symptoms related to  fibromyalgia and chronic fatigue .  DESIGN This was a single-blind , r and omized controlled trial . SETTING The study was conducted in a tertiary-care fibromyalgia and chronic fatigue clinic . PATIENTS Patients with fibromyalgia , chronic fatigue , or both were included . INTERVENTIONS Patients were r and omly assigned to receive amygdala retraining along with st and ard care or st and ard care alone . St and ard care involved attending a 1.5-day multidisciplinary program . The amygdala retraining group received an additional 2.5-hour training course in which the key tools and techniques adapted from an existing program were taught to the patient . A home- study video course and associated text were provided to supplement the on-site program . Both groups received telephone calls twice a month to answer questions related to technique and to provide support . MAIN OUTCOME MEASURES Vali date d self-report question naires related to general health , well-being , and symptoms , including Short Form-36 , Measure Yourself Medical Outcome Profile , Multidimensional Fatigue Inventory , Epworth Sleepiness Scale , and Fibromyalgia Impact Question naire . RESULTS Of the 44 patients r and omly assigned who completed baseline assessment s , 21 patients completed the study ( 14 in the st and ard care group and 7 in the study group ) . Median age was 48 years ( range , 27 - 56 years ) , and female subjects comprised 91 % of the group . Analyses demonstrated statistically significant improvements in scores for physical health , energy , pain , symptom distress , and fatigue in patients who received the amygdala retraining compared with st and ard care Background : Mindfulness-based stress reduction ( MBSR ) proposes a systematic program for reduction of suffering associated with a wide range of medical conditions . Studies suggest improvements in general aspects of well-being , including quality of life ( QoL ) , coping and positive affect , as well as decreased anxiety and depression . Methods : A quasi-experimental study examined effects of an 8-week MBSR intervention among 58 female patients with fibromyalgia ( mean , 52 ± 8 years ) who underwent MBSR or an active social support procedure .  Participants were assigned to groups by date of entry , and 6 subjects dropped out during the study . Self-report measures were vali date d German inventories and included the following scales : visual analog pain , pain perception , coping with pain , a symptom checklist and QoL. Pre- and postintervention measurements were made . Additionally , a 3-year follow-up was carried out on a subgroup of 26 participants . Results : Pre- to postintervention analyses indicated MBSR to provide significantly greater benefits than the control intervention on most dimensions , including visual analog pain , QoL subscales , coping with pain , anxiety , depression and somatic complaints ( Cohen d effect size , 0.40–1.10 ) . Three-year follow-up analyses of MBSR participants indicated sustained benefits for these same measures ( effect size , 0.50–0.65 ) . Conclusions : Based upon a quasi-r and omized trial and long-term observational follow-up , results indicate mindfulness intervention to be of potential long-term benefit for female fibromyalgia patients OBJECTIVE There are no studies investigating the efficacy of short-term psychodynamic psychotherapy in primary fibromyalgia syndrome ( FMS ) . We conducted a r and omized controlled trial evaluating an adapted form of individual short-term psychodynamic psychotherapy ( ASTPP ) versus primary care management ( TAU ) . The study focused on FMS patients with psychiatric comorbidity . METHODS Forty-six female patients with FMS and an International Classification of Diseases , 10th Revision diagnosis of a comorbid depression or anxiety disorder were recruited in a hospital setting . Participants were r and omized to receive either ASTPP ( 25 sessions , 1 session/week ) or TAU ( 4 consultations/6 months ) . Outcome measures included the Fibromyalgia Impact Question naire ( FIQ ) , the Hospital Anxiety and Depression Scale ( HADS ) , the Pain Disability Index , the Symptom Checklist 27 and the health-related quality of life . Primary endpoints of the outcome assessment were the FIQ total score and the HADS depression scale at 12-month follow-up . RESULTS Both treatments were effective in reducing the FIQ total score ( ES=0.56 and ES=0.75 , respectively ) . Intent-to-treat analyses failed to provide evidence suggesting a marked superiority of individual psychodynamic psychotherapy as compared to TAU . CONCLUSIONS A high-st and ard routine treatment focusing on the improvement of health behavior and including antidepressant and analgesic medication is equally effective as a short-term individual psychodynamic psychotherapy in improving fibromyalgia-related symptoms Background Several recent review s have evaluated evidence on the efficacy of Mindfulness-Based Stress Reduction ( MBSR ) among fibromyalgia sufferers , and concluded that more research should test effects on both psychological and physiological functioning . Purpose We conducted a r and omized prospect i ve trial of MBSR among female fibromyalgia patients . Methods Effects on perceived stress , pain , sleep quality , fatigue , symptom severity , and salivary cortisol were tested in  treatment ( n = 51 ) versus wait-list control participants ( n = 40 ) using data at baseline , post-program , and 2-month follow-up . Results Analyses revealed that MBSR significantly reduced perceived stress , sleep disturbance , and symptom severity , with gains maintained at follow-up . Greater home practice at follow-up was associated with reduced symptom severity .  MBSR did not significantly alter pain , physical functioning , or cortisol profiles . Conclusion MBSR ameliorated some of the major symptoms of fibromyalgia and reduced subjective illness burden . Further exploration of MBSR effects on physiological stress responses is warranted . These results support use of MBSR as a complementary treatment for women with fibromyalgia ( IS RCT N : 34628811 ) Fibromyalgia is a chronic illness characterized by widespread pain , fatigue , sleep disturbance , and resistance to treatment . The purpose of this study was to evaluate the effectiveness of a meditation-based stress reduction program on fibromyalgia . Seventy-seven patients meeting the 1990 criteria of the American College of Rheumatology for fibromyalgia took part in a 10-week group outpatient program . Therapists followed a carefully defined treatment approach and met weekly to further promote uniformity . Patients were evaluated before and after the program . Initial evaluation included a psychiatric structured clinical interview ( SCID ) . Outcome measures included visual analog scales to measure global well-being , pain , sleep , fatigue , and feeling refreshed in the morning . Patients also completed a medical symptom checklist , SCL-90-R , Coping Strategies Question naire , Fibromyalgia Impact Question naire , and the Fibromyalgia Attitude Index . Although the mean scores of all the patients completing the program showed improvement , 51 % showed moderate to marked improvement and only they were counted as " responders . " These preliminary findings suggest that a meditation-based stress reduction program  is effective for patients with fibromyalgia OBJECTIVES The purpose of this study was to conduct the first r and omized controlled trial ( RCT ) to evaluate the effectiveness of a second-generation mindfulness-based intervention ( SG-MBI ) for treating fibromyalgia syndrome ( FMS ) . Compared to first-generation mindfulness-based interventions , SG-MBIs are more acknowledging of the spiritual aspect of mindfulness . DESIGN A RCT employing intent-to-treat analysis . METHODS Adults with FMS received an 8-week SG-MBI known as meditation awareness training ( MAT ; n = 74 ) or an  active control intervention known as cognitive behaviour theory for groups ( n = 74 ) . Assessment s were performed at pre- , post- , and 6-month follow-up phases . RESULTS Meditation awareness training participants demonstrated significant and sustained improvements over control group participants in FMS symptomatology , pain perception , sleep quality , psychological distress , non-attachment ( to self , symptoms , and environment ) , and civic engagement . A mediation analysis found that ( 1 ) civic engagement partially mediated treatment effects for all outcome variables , ( 2 ) non-attachment partially mediated treatment effects for psychological distress and sleep quality , and ( 3 ) non-attachment almost fully mediated treatment effects for FMS symptomatology and pain perception . Average daily time spent in meditation was found to be a significant predictor of changes in all outcome variables . CONCLUSIONS Meditation awareness training may be a suitable treatment for adults with FMS and appears to ameliorate FMS symptomatology and pain perception by reducing attachment to self . Statement of contribution What is already known on this subject ? Design ing interventions to treat fibromyalgia syndrome ( FMS ) continues to be a challenge . There is growing interest into the applications of mindfulness-based interventions for treating FMS . Second-generation mindfulness-based interventions ( SG-MBIs ) are a key new direction in mindfulness research . What does this study add ? Meditation awareness training - an SG-MBI - result ed in significant reductions in FMS symptomatology . SG-MBIs recognize the spiritual aspect of mindfulness and may have a role in the treatment of FMS Objectives : Cognitive-behavioral therapies ( CBT ) for fibromyalgia syndrome ( FMS ) are important interventions in the management of this condition . Empirical evidence reports that although the results are promising , further research is needed to respond more appropriately to these patients . This study focuses on exploring the use of Virtual Reality ( VR ) as an adjunct to the activity management component . The aim of this study is to present the results of a small-sized r and omized controlled trial to test the preliminary efficacy and acceptability of this component . Material s and Methods : The final sample was composed of 61 women diagnosed with FMS according to the American College of Rheumatology . The sample was r and omly allocated to 2 conditions : VR treatment and treatment as usual . Results : Participants in the VR condition achieved significant improvements in the primary outcome : disability measured with the FIQ . The improvement was also significant in secondary outcomes , such as perceived quality of life and some of the coping strategies included in the Chronic Pain Coping Inventory : task persistence and exercise . There were no differences in other secondary outcome measures like pain intensity and interference and depression . Participants reported high satisfaction with the VR component . Discussion : The effects were related to the psychological aspects targeted in the treatment . The component was well accepted by FMS patients referred from a public hospital . These findings show that the VR component could be useful in the CBT treatment of FMS and encourage us to continue exploring the use of integrating VR with CBT interventions for the treatment of FMS Objectives : Fibromyalgia ( FM ) is a syndrome characterized by severe pain , fatigue and sleep disturbance . There is evidence of central hyper-responsiveness to sensory stimulation and impaired cardiovascular autonomic control . Laboratory investigations suggest that mindfulness-based stress reduction ( MBSR ) may improve autonomic functioning in FM . However , these findings may not reflect what occurs during naturalistic conditions , and MBSR studies during real-life functioning are lacking . We conducted a r and omized controlled , 3-armed study with 168 female FM patients . This report describes cardiac , respiratory , and physical activity findings . Methods : Eight-week MBSR was compared with wait-list and active control intervention .  Ambulatory accelerometry and cardiorespiratory function were monitored over 24-h periods at 3 time points : preintervention , postintervention , and at the 8-week follow-up . Also , baseline levels were compared with an age-matched group of 33 healthy women . Findings : Activity heart rate , respiratory sinus arrhythmia , and ventilation were measured . Comparison with controls confirmed differences in cardiac autonomic tone and activity pattern among patients . Most measures also showed effects of time of day and point of measurement . Regarding the intervention study , there were no effects of treatment . In addition , there were no relations between patient-reported clinical improvement and objective physiological or accelerometry parameters . Intervention-related benefits in wellbeing were not associated with changes in daytime cardiorespiratory measures or pattern of physical activity . Conclusions : MBSR did not produce cardiac autonomic benefits or changes in daily activity in FM . Furthermore , the lack of an association between patient-experienced clinical improvement and objective physiological measures suggests that subjective changes in the wellbeing of FM patients over time are not related to alterations in the cardiorespiratory autonomic function or activity levels Fibromyalgia is a chronic syndrome characterized by widespread pain , sleep disturbance , stiffness , fatigue , headache , and mood disorders . Recent research has result ed in an improved underst and ing of fibromyalgia and its possible causes . This article highlights some of the current research , discusses a strategy for using yoga and meditation as a therapy for fibromyalgia sufferers , and presents the results of a preliminary 8-week study using yoga and meditation to help manage fibromyalgia symptoms . The study of 11 participants found significant improvement in the overall health status of the participants and in symptoms of stiffness , anxiety , and depression . Significant improvements were also seen in the reported number of days " felt good " and number of days " missed work " because of fibromyalgia . Nonsignificant improvements were seen in measures of pain , fatigue , and how one felt in the morning . Effect sizes were medium to large for most tested areas . This study supports the benefits of yoga and meditation for individuals with fibromyalgia and encourages further research to explore their use as st and ard therapies for fibromyalgia OBJECTIVE Sustained improvement in physical functional status was the primary goal of a brief , 6 session cognitive behavioral therapy ( CBT ) protocol for fibromyalgia ( FM ) . METHODS One hundred forty-five patients with FM were r and omly assigned to either ( 1 ) st and ard medical care that included pharmacological management of symptoms and suggestions for aerobic fitness , or ( 2 ) the same st and ard medical treatment plus 6 sessions of CBT aim ed at improving physical functioning . Outcome measures included the Medical Outcome Study Short Form-36 Physical Component Score and McGill ratings of pain . Outcomes were treated dichotomously using a preestablished criterion for clinical ly significant success based upon the reliability of change index from baseline to one year posttreatment . RESULTS Twenty-five percent of the patients receiving CBT were able to achieve clinical ly meaningful levels of longterm improvement in physical functioning , whereas only 12 % of the patients receiving st and ard care achieved the same level of improvement . There were no lasting differences on pain ratings between groups . CONCLUSION Lasting improvements in physical functioning have been among the most difficult outcomes to obtain in studies of FM . These data suggest that the inclusion of CBT to a st and ard medical regimen for FM can favorably influence physical functioning in a subset of patients & NA ; Both pharmacological and non‐pharmacological interventions have demonstrated efficacy in the management of fibromyalgia ( FM ) .  Non‐pharmacological interventions however are far less likely to be used in clinical setting s , in part due to limited access . This manuscript presents the findings of a r and omized controlled trail of an Internet‐based exercise and behavioral self‐management program for FM design ed for use in the context of a routine clinical care . 118 individuals with FM were r and omly assigned to either ( a ) st and ard care or ( b ) st and ard care plus access to a Web‐Enhanced Behavioral Self‐Management program ( WEB‐SM ) grounded in cognitive and behavioral pain management principles . Individuals were assessed at baseline and again at 6 months for primary endpoints : reduction of pain and an improvement in physical functioning . Secondary outcomes included fatigue , sleep , anxiety and depressive symptoms , and a patient global impression of improvement . Individuals assigned to the WEB‐SM condition reported significantly greater improvement in pain , physical functioning , and overall global improvement . Exercise and relaxation techniques were the most commonly used skills throughout the 6 month period . A no‐contact , Internet‐based , self‐management intervention demonstrated efficacy on key outcomes for FM . While not everyone is expected to benefit from this approach , this study demonstrated that non‐pharmacological interventions can be efficiently integrated into routine clinical practice with positive outcomes & NA ; A mounting body of literature recommends that treatment for fibromyalgia ( FM ) encompass medications , exercise and improvement of coping skills . However , there is a significant gap in determining an effective counterpart to pharmacotherapy that incorporates both exercise and coping . The aim of this r and omized controlled trial was to evaluate the effects of a comprehensive yoga intervention on FM symptoms and coping . A sample of 53 female FM patients were r and omized to the 8‐week Yoga of Awareness program ( gentle poses , meditation , breathing exercises , yoga‐based coping instructions , group discussion s ) or to wait‐listed st and ard care . Data were analyzed by intention to treat . At post‐treatment , women assigned to the yoga program showed significantly greater improvements on st and ardized measures of FM symptoms and functioning , including pain , fatigue , and mood , and in pain catastrophizing , acceptance , and other coping strategies . This pilot study provides promising support for the potential benefits of a yoga program for women with FM
No clinical or demographics explained as much variance in the FIQR total as any of the mindfulness subscales .
Fibromyalgia patients experience symptoms that may be alleviated by mindfulness interventions .
Baseline values for the observe subscale of the FFMQ were unexpectedly high .
CONTEXT AND OBJECTIVE A growing body of literature suggests that mindfulness techniques may be beneficial in fibromyalgia .
A recent systematic review and meta- analysis of six trials indicated improvement in depressive symptoms and quality of life , calling for increased rigor and use of st and ardized measures in future trials .
The purpose of the study was to examine the relationship between mindfulness [ as measured by the Five Facet Mindfulness Question naire ( FFMQ ) ] and fibromyalgia impact [ as measured by the Revised Fibromyalgia Impact Question naire ( FIQR ) ] .