Discussion
muscle or small group of muscles up, Pain, FM, pain, pains
FIBRO, CHRONIC PAIN, ADVERSE EVENT
Both the global and segmental groups presented a decrease in pain intensity, as evaluated by the visual analog scale and the McGill Pain Questionnaire; a decrease in the impact of FM on quality of life; an improvement in the pain threshold at tender points; and improvements in patients’ attitudes toward chronic pain and postural control at the end of treatment. There were no significant differences between the groups.These were two treatment protocols created specifically for individuals with FM. To our knowledge, this is the first randomized trial to investigate the global posture reeducation method for adults with FM. The duration of the interventions was 10 weeks; each session was approximately 60 to 80 min long, in accordance with a previous FM study [Loduca and Samuellan [Segmental exercises are static muscle stretching exercises that involve stretching a single muscle or small group of muscles up to a tolerable point and sustaining the position for a certain period, usually 30 s [FM patients present deficits in postural control, sensory organization, and balance self-efficacy associated with pain [In addition, the segmental group presented a higher mean value of flexibility than the global group at the end of the treatment. Myofascial tensions may have been distributed through the muscle chains [The most recent evidence- and consensus-based FM management guidelines recommend beginning with patient education and physical therapy [In Brazil, a very recent multidisciplinary educational health promotion program called “Fibro Friends” was validated for individuals with FM [Part of the educational approach is the ability to care for and be attentive to and welcoming of the patient. This certainly influenced the results of the current study. For example, the following adverse event was considered and prevented: “A possibility of slight discomfort during exercises, which is expected at the start of treatment and should decrease in a few days.” This adverse event was not observed. A welcoming reception is one of the most relevant suggestions included in the National Humanization Policy of the Brazilian National Health System. A welcoming reception expresses an action of approximation or “being with,” that is, an attitude of inclusion. This refers to a commitment to recognizing the other person, such as by showing an attitude of welcoming the patient in his or her pains, joys, ways of living, and feelings [In addition, learning positive feelings and understanding promote resilience [In chronic pain, the presence of dysfunctional beliefs and negative thoughts are common. Beliefs are culturally shared intimate conceptions or convictions about our perceptions of ourselves, others, and our environment [We decided to include the ACR 2011 criteria indexes as outcome measures because these criteria are indicated for clinical and epidemiological research [The two stretching exercise methods and learning processes could have modulated the generation of pain via the concept of nociplastic pain in FM [