Background: Chronic widespread pain is the cardinal symptom of Fibromyalgia (FM). Understanding how people with FM evaluate and response upon pain is essential for the development of biopsychosocial symptom management strategies. Aim: To synthesize qualitative descriptions on how people diagnosed with FM experience pain in terms of evaluation and response based on the Symptom Management Theory. Methods: This paper followed the ENTREQ declaration and Sandelowski and Barroso's meta-synthesis principles. Qualitative or Mixed Method studies published in English of Spanish between 1990 and 2018 were included. A pre-planned comprehensive search was carried out in PubMed, Scopus, ISI WebofScience and Cinahl Plus databases. A manual search was also implemented. The CASP Qualitative Checklist was used for methodological quality assessment. A thematic synthesis was employed to analyze and present the findings. The COVIDENCE and Nvivo12.Plus software were used for the process of studies selection and data analysis respectively.
Results: A total of 37 studies were included. Two themes emerged: 1) Cognitive, emotional and social factors related with pain and 2) Cognitive and behavioral factors related with the management of pain. Regarding the cognitive, emotional and social factors related with pain four sub-themes emerged: 1) Beliefs regarding the source and aggravating and modulating factors of pain: the biomedical paradigm wins, 2) Beliefs regarding the relationship between pain and the rest of FM symptoms: sleep fatigue and depression, 3) Meaning of pain: pain as an illness or an alarm, 4) Emotional and social aspects of pain: catastrophizing, depression, frustration and stigma. In relation with the cognitive and behavioral factors related with the management of pain six sub-themes emerged: 1) Pharmacological treatments: lights and shadows, 2) Physical activity: the cause of and solution to pain, 3) Psychology in the treatment of pain: CBT as the gold standard? 4) Natural and complementary therapies, 5) Problem and emotion focused self-coping, 6) Pain in society: from the necessity of being understood to social isolation.
Conclusions: The findings suggest that the biomedical model continue influencing the pain beliefs and behaviors among people diagnosed with FM.

COGNITIVE AND BEHAVIORAL FACTORS ASSOCIATED WITH PAIN IN PEOPLE DIAGNOSED WITH FIBROMYALGIA: A QUALITATIVE META-SYNTHESIS