Effect of a Nurse-Led Teaching Program on Sleep Disturbances and Pain Experiences Among Patients With Fibromyalgia

Abstract

Introduction

Fibromyalgia is a chronic condition causing widespread pain in the muscles and bones, frequently occurring alongside fatigue, sleep problems, cognitive difficulties, and mood disorders.

Objective

This study investigates the effectiveness of a nurse-led teaching program on sleep disturbances and pain experiences among patients with fibromyalgia.

Methods

A quasi-experimental with pretest and posttest measures was implemented in this study. Sixty patients with fibromyalgia were included in the sample, divided equally into a study group and a control group (30 patients each). The study took place at the rheumatology outpatient clinic of Mansoura University Hospital, Egypt from June 1, 2024, to December 31, 2024. The program consisted of 24 consecutive sessions, each lasting ∼20–30 min for 12 weeks. Researchers used three tools to collect data; Demographics Form, Visual Analogue Scale (VAS), and the Pittsburgh Sleep Quality Index (PSQI).

Results

The two groups exhibited no statistically significant differences. across all demographic characteristics (p > .05), except for place of residence (p = .0383). Prior to the program, independent samples t-tests revealed that there were no statistically significant differences in mean PSQI and VAS scores between the two groups. However, after the program, there was a statistically significant difference in mean PSQI scores (p = .009) and VAS scores (p = .05) between groups.

Conclusion

A nurse-led teaching program can be a valuable nonpharmacological intervention for managing sleep disturbances and pain in patients with fibromyalgia, highlighting the crucial role of nurses in empowering patients with self-management strategies.

Keywords

fibromyalgia sleep disturbances pain nurse-led intervention teaching program

Introduction/Background

Fibromyalgia is a chronic condition that causes widespread muscle pain and a range of other symptoms unrelated to the musculoskeletal system (Badaeva et al., 2024; Siracusa et al., 2021). These symptoms can include such as fatigue, cognitive alterations, poor sleep quality, and headaches. While pain is the most prominent symptom, sleep disturbances and depression are also common and significantly impact the life quality of patients with fibromyalgia (Tahir et al., 2022; Van Wilgen et al., 2024). Consequently, this persistent pain and associated symptoms significantly impair patients’ quality of life (Caumo et al., 2022).

Fibromyalgia is best managed through interdisciplinary treatment that integrates both pharmacological (medication-based) and nonpharmacological therapies. Crucially, this approach should empower patients through education and encourage their active role in controlling their symptoms (Denche-Zamorano et al., 2024; Zeid & Ibrahim, 2021). Therefore, educational strategies can lead to better treatment results, less pain and physical limitations, and lower healthcare costs associated with that disease. While pharmacological treatments exist, however, they often come with side effects and may not fully address all symptoms (García-Perea et al., 2022). This highlights the need for alternative or complementary approaches that empower patients in self-management (Antunes & Marques, 2022).

Nursing interventions play a vital role in this management. For instance, nurses can provide individualized education sessions covering topics such as understanding fibromyalgia pathophysiology, recognizing symptom triggers, and effective self-management techniques. They can also teach and guide patients in implementing pain management strategies like progressive muscle relaxation, guided imagery, and gentle stretching exercises tailored to their individual needs and limitations. Furthermore, nurses can facilitate the development of healthy coping mechanisms through stress management techniques and support group referrals (Hamama & Itzhaki, 2023; Sadr et al., 2023).

In the context of sleep disturbances, beyond educating on sleep hygiene (setting a regular sleep schedule, creating a relaxing bedtime routine, and avoiding caffeine and alcohol before sleep), nurses can instruct patients on specific relaxation techniques like deep breathing, meditation, and yoga to alleviate pain and enhance sleep quality (Tan & Dinçer, 2024). Nurses are often at the forefront of patient care, and their expertise in education and holistic care makes them well-positioned to deliver effective interventions for individuals with fibromyalgia.

Review of Literature

The exact causes and underlying processes of fibromyalgia remain unclear. However, several elements are believed to affect the central and peripheral nervous systems, which are responsible for pain processing. These factors can be genetic, psychological, inflammatory, immune, hormonal, social, emotional, and cognitive (Clauw et al., 2023; Creed, 2022). In addition, several biological factors (like being female or having a family history), psychological factors (such as trauma or stress), social factors (like lower socioeconomic status or limited education), and lifestyle factors (like obesity or unhealthy habits) can elevate the risk of developing fibromyalgia (Atzeni et al., 2022; Bazzichi et al., 2024; Zu et al., 2024).

Sleep disorders are a widespread and weakening characteristic of fibromyalgia, considerably affecting the daily lives of those who suffer from this long-lasting pain condition. These sleep issues are now understood to be more than just a side effect; they are increasingly seen as a fundamental part of the disorder itself, possibly playing a role in how it develops and making other symptoms worse (Ughreja et al., 2023). Research consistently shows that sleep problems are very common in people with fibromyalgia, with estimates ranging from 60% to 90%, which is much higher than what is seen in the general population (Bolukbas & Celik, 2021; Taş, 2022; Ughreja et al., 2023; Wilson et al., 2024).

Sleep problems and pain are closely intertwined (Reyes del Paso et al., 2021; Whale et al., 2022), often worsening the condition. On the other hand, improving sleep can lead to improvements in other health issues. Therefore, addressing sleep problems is a crucial aspect of managing fibromyalgia (Denche-Zamorano et al., 2024). While some studies acknowledge the role of nurses in teaching sleep hygiene and pain management to patients with fibromyalgia (García-Perea et al., 2022; Whale et al., 2022; Yuan et al., 2021), therefore, more robust research, like randomized controlled trials, is needed to assess how well structured nurse-led programs improve these specific outcomes. Further investigation is also required to identify the best elements, length, and delivery methods for nurse-led programs to achieve the greatest benefits in sleep and pain management for individuals with fibromyalgia. Additionally, research should explore the long-term impact of these interventions on sleep and pain.

Significance of Study

Fibromyalgia is a significant global health concern, affecting an estimated 2%–5% of the world's population. Studies indicate a higher prevalence in women compared to men, with some reporting a female predominance of 80%–90%. In Egypt, research on the prevalence of fibromyalgia is still evolving. Some studies focusing on specific populations have provided initial estimates. For instance, a study on university students in Egypt found a prevalence rate of 12.4% (Tharwat et al., 2023).

By providing comprehensive and individualized care, nurses assist patients with fibromyalgia manage their symptoms, improving their life quality, and live more fulfilling lives. Therefore, the purpose of this study was to investigate the effect of a nurse-led teaching program on sleep disturbances and pain experiences among patients with fibromyalgia. Nurse-led education programs offer a promising avenue for empowering patients with self-management strategies to improve their sleep quality and pain experience. This study has the potential to yield significant insights into the effectiveness of nursing interventions in managing fibromyalgia symptoms and potentially improve patient outcomes (Singh et al., 2024; Taş, 2022).

Furthermore, this research expands the current understanding of the role of nurses in chronic pain management and could underscore the capacity of nurse-led initiatives to positively affect patient results, decrease healthcare spending, and elevate the standard of care for individuals managing this chronic condition. Moreover, it can inform the development of evidence-based nursing interventions and guidelines for fibromyalgia management, ultimately leading to better care and support for those living with this challenging condition. Therefore, the purpose of this study was to investigate the effect of a nurse-led teaching program on sleep disturbances and pain experiences among patients with fibromyalgia.

The Study Aim

The aim of the current study was to evaluate the effectiveness of a nurse-led teaching program on sleep disturbances and pain experiences among patients with fibromyalgia.

To meet the goal of this study, the subsequent research hypotheses were developed.

H1:

There will be a statistical significant difference in the pain intensity mean score between the study and the control group after the educational program.

H2:

There will be a statistical significant difference in the sleep disturbances mean score between the study and the control group after the educational program.

Methods

Research Design

This study utilized a quasi-experimental with pretest and posttest measures to meet its objectives. This design concerns manipulating the independent variable to detect the effect on the dependent variable.

Setting

This study took place at the rheumatology outpatient clinic of Mansoura University Hospital, Egypt from June 1, 2024, to December 31, 2024.

Sample

Sixty patients, diagnosed with fibromyalgia by a specialist physician in accordance with the American Rheumatology Association criteria, constituted the study sample. The study had no participants’ attrition. The study included participants who satisfied the following criteria: they were adults ≥ 18 years old, being diagnosed with fibromyalgia for 3 months or more, being reachable, had pain severity ≥ 3 on VAS, had sleep disturbances with ≥10 points on PSQI scores, without comparable education on sleep disturbances and pain management.

This study excluded participants diagnosed with fibromyalgia for fewer than 3 months, those with a history of sleep medication use and with chronic illnesses (like COPD or asthma) that could disrupt sleep, night shift workers, and anyone with cognitive or mental disorders that would hinder their ability to follow the educational program's instructions. To ensure balance between groups, participants with similar PSQI scores were carefully assigned to either the study or control group. Participants were assigned using an alternating method following an initial random draw for the first participant. The participants were unaware of their assigned groups, but the researchers knew the allocations.

Calculation of Sample Size

Sample size calculation was based on a margin of error (α) of 0.05, a statistical power (1–β) of 0.80, and an effect size (d) of 0.80. For α = 0.05 (two-tailed), the Z-score (Z₁–α/₂) is ∼1.96, and for 1–β = 0.80, the Z-score (Z₁–β) is ∼0.84. Using the following sample size formula, the minimum sample size is 50. Sixty individuals were included (30 study group and 30 control group)

n = \frac{2 {(Z_{1} - α / 2 + Z_{1} - β)}^{2}}{d^{2}} .

Data Collection Tools

The following three tools were employed by the researchers to gather data:

Tool (I): Demographics Form

The researcher created it, drawing from existing literature. This form contained eight questions focused on participants’ sociodemographic and disease-related details, such as age, sex, and education level (Okul & Fertelli, 2024).

Tool (II): The Visual Analogue Scale (VAS) was used to assess pain intensity. In the current study, the segmented numerical version of the VAS was employed. The VAS is a measurement tool where individuals rate their pain on a continuum from 0 (“no pain”) to 10 (“worst possible pain”). Pain intensity is categorized as mild (below 3), moderate (3 to 6), and severe (above 6) based on these ratings. The VAS has demonstrated high reliability, with a Cronbach's alpha of 0.97 reported previously (Alghadir et al., 2018) and 0.92 found in the present study.

Tool (III): Pittsburgh Sleep Quality Index (PSQI), created by Buysse et al. (1989); its Arabic reliable version was adopted by researchers from Suleiman et al. (2010) and Al Maqbali et al. (2020). It consists of “19” self-assessed questions in addition to “5” questions assessed by the bed partner or roommate. However; only the self-assessed questions were included; the questions were then grouped to form seven “Sleep Domains” namely: subjective sleep quality (Q 9), latency of sleep (Q2 and 5a), duration of sleep (Q 4), efficiency of sleep (Q 1, Q 3, and Q 4), sleep disturbances (Q5b–Q5j), usage of sleep medication (Q 6), and daytime dysfunction (Q7 and Q 8).

Each question is scored through a 3-point Likert Scale ranging from (0) which means no difficulty to (3) which means severe difficulty. The seven component scores are then added together to give a global PSQI score ranging from zero to 21. Generally, score from 0 to 5; good sleep quality, score from 6 to 10; mild sleep problems, score 11 to 15; moderate sleep problems, and 16 to 21; severe sleep problems. As previously reported, Suleiman et al. (2012) found a Cronbach's alpha of 0.77 for the internal consistency of the Arabic PSQI in cancer patients, indicating acceptable homogeneity among the items. Our current study's Cronbach's alpha of 0.82 further supports the good internal consistency of the Arabic PSQI in our specific sample.

Ethical Considerations

Approval for this study was officially obtained from the Research Ethics Committee of the Faculty of Nursing at Mansoura University (IRB. 0724) before the study began. Participants received detailed information about the research goals, its importance, and how it would be conducted. They had the chance to ask questions and were given a guarantee that they might leave at any time without incurring any penalties. Participants provided written informed consent prior to the commencement of data collection. To protect participant privacy, all data were anonymized using codes. Additionally, the documents were stored securely in a locked location.

Statistical Analysis

Data were analyzed using SPSS (Version 25). Descriptive statistics, including means, standard deviations (SDs), and percentages, were calculated to summarize patient information. Baseline comparability between the intervention and control group in relation to demographic characteristics was assessed using a chi-square test. To determine the significant differences in sleep disturbance and pain experience between the study and control groups before and after the intervention, independent samples t-tests were performed. The significance level was set at p < .05 for all analyses.

Intervention

Following ethical approval, eligible participants were identified and recruited, provided with study information, and given written consent. Participants were alternately assigned to the study or control group (n = 30 per group). Baseline data were collected using the three study tools. The study group participated in a 12-week individualized online health education program via Zoom meeting, developed by the researchers based on relevant guidelines (Badaeva et al., 2024; Bazzichi et al., 2024; Creed, 2022). Each of the twice-weekly, 20–30-minute sessions covered specific topics within three main modules.

The fibromyalgia Education module included sessions on the definition of fibromyalgia, potential causes and contributing factors, common symptoms and their management, possible side effects of medications, identified risk factors, principles of rehabilitation (including physical therapy and exercise), and strategies for adapting to daily life with fibromyalgia. The Sleep Education module had sessions that focused on the importance of sleep for individuals with fibromyalgia, identifying factors affecting sleep quality, and practical improvement strategies such as sleep hygiene techniques, relaxation exercises, and establishing a consistent sleep schedule (Arfuch et al., 2022; Duhn et al., 2023).

The Pain Management (Nonpharmacological) module detailed various nonpharmacological approaches to pain relief, including but not limited to: gentle exercises and movement strategies, relaxation techniques (e.g., progressive muscle relaxation and deep breathing), thermal therapies (heat and cold application), and basic principles of pacing activities. Each session was delivered individually using a standardized approach. This involved a structured booklet of educational materials that covered the specific topics for that session, complemented by digital visual aids (e.g., short videos). Sessions incorporated interactive elements such as guided group discussions (when appropriate for the topic), opportunities for participants to ask questions and receive personalized answers, and practical demonstrations of techniques (e.g., breathing exercises) (Martínez-Navarro et al., 2023; Saracoglu et al., 2021).

To ensure consistency of intervention delivery, all education sessions were conducted by the same trained researcher following a detailed session-by-session protocol. This protocol outlined the specific content to be covered, the teaching methods to be employed, and key information to be emphasized in each session. Participants in the study group received weekly follow-up in the clinic or via Zoom for those unable to attend in person. These sessions allowed for feedback on fibromyalgia-related issues and adherence to the learned strategies. The posttest was administered after this follow-up phase. The control group received the standard of care provided to all patients with fibromyalgia at the rheumatology clinic throughout the study. This involved typical consultations with a rheumatologist, including assessment of disease activity, medication management according to established guidelines, and general patient education consistent with the clinic's usual protocol. The control group received this standard care, which remained consistent throughout the study period and they did not receive the educational intervention until after the posttest.

Results

Table 1 presents the characteristics of both the study and control groups, each consisting of 30 participants. In terms of age: the mean age was 41.15 ± 10.87 years in the study group, 53.3% of them were 40 < 50 years old, while, the mean age was 43.11 ± 10.87 years in the control group, 46.7% of them were 40 < 50 years old. Concerning gender: 80% of the study group were females and 93.3% of the control group were females. In relation to marital status: 70% and 76.7% of participants in both study and control groups were married, respectively. Regarding occupation: in the study group, 53.3% were housewives, and 70% were housewives in the control group. Concerning level of education: 46.7% and 56.7% of participants in both study and control groups had secondary educational levels correspondingly.

Table 1.

Frequency and Percentage Distribution and Statistical Differences of Demographic Characteristics Among Study and Control Groups (n = 60).

Participants’ characteristics	Study (30)		Control (30)		χ²	p value*
Participants’ characteristics	No	%	No	%
Age (years) 20 < 30 30 < 40 40 < 50 ≥ 50 Mean SD	2 8 16 4	6.7 26.7 53.3 13.3	3 6 14 7	10 20 46.7 23.3	0.663	.718
Age (years) 20 < 30 30 < 40 40 < 50 ≥ 50 Mean SD	41.15 ± 10.87		43.11 ± 10.87		0.663	.718
Gender Male Female	6 24	20 80	2 28	6.7 93.3	0.621	.431
Marital status Single Married	9 21	30.0 70.0	7 23	23.3 76.7	0.006	.936
Occupation House wife Employee	16 14	53.3 46.7	21 9	70.0 30.0	1.667	.046^a
Level of education Primary Secondary University	10 14 6	33.3 46.7 20	5 17 8	16.7 56.7 26.6	0.444	.801
Place of residence Rural Urban	7 23	23.3 76.7	12 18	40 60	2.613	. 383
Duration of symptoms < 1year 1–2 years ≥ 3 years	5 16 9	16.7 53.3 30	9 14 7	30 46.7 23.3	1.301	.297
Family history Yes No	3 27	10 90	5 25	16.7 83.3	1.789	.852
Other chronic illness^a Hypertension Diabetes mellitus Osteoarthritis Others	9 7 11 5	30 23.3 36.7 16.7	8 6 13 2	26.7 20 43.3 6.7	1.212	.765

Numbers are not mutually exclusive.

*Statistically significant at p ≤ .05.

Regarding place of residence: 76.7% of participants were urban in the study group, and 60% of them were urban in the control group. With respect to symptom duration: 53.3% and 46.7% of participants in the study and control groups, respectively, in that order are suffering from fibromyalgia symptoms for 1 to 2 years. For family history: the same table also presents 90% and 83.3% of participants in the study and control groups who did not have a family history of the disease, respectively. As for other chronic illnesses: 36.7% and 43.3% of participants in study and control groups sequentially are suffering from osteoarthritis. According to Table 1, the two groups were statistically comparable across the measured variables (p > .05). The only exception was place of residence, where a significant difference (p = .0383).

Table 2 shows a comparison of pain scale scores between the study group and the control group before and after an intervention. Before intervention: 23.3% of participants in the study group reported moderate pain and 76.6% of them reported severe pain. In the control group, 36.6% reported moderate pain and 63.3% reported severe pain. Participants in the two groups reported no mild pain according to inclusion criteria. The mean pain score before the intervention was 9.26 ± 0.94 for the study group and 8.93 ± 1.06 for the control group. The t-test yielded a p value of .081, there was no statistically significant difference in mean pain scores between the two groups, at baseline.

Table 2.

Frequency and Percentage Distribution of Pain Scores Among Study and Control Groups Before and After Program (n = 60).

Pain scale	Before				After
	Study (30)		Control (30)		Study (30)		Control (30)
	N	%	N	%	N	%	N	%
Mild (< 3)	–	–	–	–	8	26.7	3	10
Moderate (4–6)	7	23.3	11	36.6	17	56.7	11	36.7
Severe (> 6)	23	76.7	19	63.3	5	16.7	16	53.3
Mean ± SD	9.26 ± 0.94		8.93 ± 1.06		2.60 ± 2.59		3.76 ± 1.88
t test	2.598				1.992
p value	.081				.05*

*Statistically significant at p ≤ .05.

Following the intervention, the study group showed a higher proportion of participants reporting mild (26.7%) and moderate (56.7%) pain compared to the control group (10% and 36.7%, respectively). Conversely, severe pain was less prevalent in the study group (16.7%) than in the control group (53.3%). This difference was reflected in the mean pain scores, which were significantly lower in the study group (2.60 ± 2.59) compared to the control group (3.76 ± 1.88), a statistically significant finding (p = .05).

Table 3 presents a comparison of total PSQI scores between a study group and a control group. Before intervention: in the study group, 26.7% of participants had moderately difficult sleep, and 73.3% experienced severely difficult sleep. In the control group, 33.3% experienced moderately difficult sleep, and 66.7% experienced severely difficult sleep and no participants in the two groups reported mild sleep problems according to the inclusion criteria. The mean PSQI score before the intervention was 17.16 ± 1.72 for the study group and 16.66 ± 3.36 for the control group.

Table 3.

Frequency and Percentage Distribution and Mean Differences of Total Pittsburgh Sleep Quality Index (PSQI) Scores Among Study and Control Groups Before and After Program (n = 60).

Total PSQI scores
	Before				After
	Study (30)		Control (30)		Study (30)		Control (30)
	N	%	N	%	N	%	N	%
Mild sleep problems (6–10)	–	–	–	–	11	36.7	5	16.7
Mild sleep problems (6–10)	–	–	–	–	11	36.7	5
Moderate sleep problems (11–15)	8	26.7	10	33.3	16	53.3	19	63.3
Severe sleep problems (16–21)	22	73.3	20	66.7	3	10	6	20
Mean ± SD	17.16 ± 1.72		16.66 ± 3.36		9.80 ± 2.60		11.20 ± 5.23
t	0.724				0.375
Significant	.472				.009*

*Statistically significant at p ≤ .05.

The t test yielded a p value of .472, there was no statistically significant difference in the average PSQI scores of the two groups prior to the intervention. After Intervention: In the study group, 36.7%, 53.3%, and 10% reported mild, moderate, and severe sleep problems in that order, respectively. In the control group, 16.7%, 63.3%, and 20% of participants experienced mild, moderate, and severe sleep problems, respectively. The mean PSQI score after the intervention was 9.80 ± 2.60 for the study group and 11.20 ± 5.23 for the control group. The t-test revealed a p value of .009, a statistically significant difference in mean PSQI scores between the two groups after the intervention.

Table 4 compares the PSQI domain scores of a study group and a control group. Initially, no significant differences existed between the groups across any sleep domains. Following the intervention, the study group demonstrated significant improvements in subjective sleep quality, sleep efficiency, daytime dysfunction, and sleep disturbances compared to the control group (p < .05). However, no significant differences were observed between the groups postintervention in sleep latency (p = .618), sleep duration (p = .589), or use of sleep medication (p = .344).

Table 4.

Mean and Standard Deviation and Differences Among Pittsburgh Sleep Quality Index (PSQI) Domains Among Study and Control Groups Pre and Postprogram (n = 60).

PSQI domains	Study (X ± SD)	Control (X ± SD)	t (p)
Sleep latency Pretest Posttest	2.3 ± 0.441.30 ± 0.70	2.1 ± 0.451.34 ± 0.80	t = 0.857(.395) t = .501 (.618)
Subjective sleep quality Pretest Posttest	1.56 ± 0.500.86 ± 0.85	1.76 ± 0.431.13 ± 0.97	t = 1.653(.104) t = .589 (.032)*
Sleep duration Pretest Posttest	1.76 ± 0.431.03 ± 1.14	1.96 ± 0.901.53 ± 1.09	t = 4.313(.469) t = .729 (.589)
Sleep efficiency Pretest Posttest	1.96 ± 0.181.43 ± 1.28	2.1 ± 1.371. 23 ± 1.19	t = 3.930(.570) t = 2.076 (.042*)
Use of sleep medication Pretest Posttest	0.63 ± 0.830.00 ± 00	0.56 ± 0.640.20 ± 0.04	t = 0.103(.892) t = 0.063 (.344)
Day time dysfunction Pretest Posttest	1.30 ± 0.831.14 ± 0.97	1.16 ± 0.621.63 ± 0.73	t = .508(.614) t = 2.359 (.021)*
Sleep disturbance Pretest Posttest	1.53 ± 0.621.11 ± 0.53	1.83 ± 0.781.63 ± 0.049	t = 0.463(.645) t = 2.576 (.010)*

*Statistically significant at p ≤ .05.

Discussion

The effect of a nurse-led teaching program on sleep disturbances and pain experiences among patients with fibromyalgia was investigated in this study. Regarding the characteristics of participants, the current study results indicated that most participants were between 40 and 49 years old, were female, married, housewives, and had a secondary educational level. This coincides with previous studies found in the literature (Bolukbas & Celik, 2021; Cetingok et al., 2022; García-Perea et al., 2022; Külekçioğlu & Çetin, 2021).

As for place of residence, most of them were from urban areas. This result was not in harmony with Sauch Valmaña et al. (2022) who reported that most cases in their study of fibromyalgia were detected in rural areas. With respect to symptom duration, about half of them had been suffering from fibromyalgia symptoms for 1 to 2 years. For family history, the majority of participants did not have a family history of fibromyalgia; this finding was in the same line with Tharwat et al. (2023). Regarding the presence of other chronic illnesses, more than a third of participants were suffering from osteoarthritis. This result was similar to Jiao et al. (2021) who reported that the most frequent comorbidities among their participants were cardiovascular diseases (25.0%). The next most frequent were osteoarthritis or osteoporosis, present in 18.5% (18.5%).

The study demonstrated that a nurse-led teaching program effectively reduced pain and improved sleep quality. Participants in both the intervention and control groups initially reported moderate to severe pain, and their average pain levels were not significantly different at the start. However, following the educational program, the intervention group experienced a significant decrease in pain compared to their initial levels and the control group's postintervention pain. These results are similar to other studies conducted by Climent-Sanz et al. (2021) and Serpas et al. (2022) who demonstrated that an educational program had a powerful impact on pain reduction among patients with fibromyalgia. This finding supports the broader emphasis in the literature (García-Perea et al., 2022) on the need for nonpharmacological approaches to pain management in fibromyalgia. Furthermore, it specifically highlights the potential of nurse-led interventions, as suggested by Yuan et al. (2021) in delivering effective pain management education.

This study confirmed that a nurse-led teaching program effectively enhanced sleep quality among fibromyalgia patients and reinforced the importance of sleep education as shown in prior comparative studies conducted by Okul and Fertelli (2024). This result also aligns with Reyes del Paso et al. (2021) and Ughreja et al. (2023). Regarding the crucial interplay between sleep and pain in fibromyalgia, our findings provide empirical support for a previous study conducted by Whale et al. (2022) who recommended further research into effective interventions targeting sleep disturbances in this population.

The observed improvement in sleep quality following our nurse-led program corroborates the importance of sleep education noted by Okul and Fertelli (2024). While Whale et al. (2022) also emphasized the link between sleep and pain, our study provides further evidence for the effectiveness of a structured nurse-delivered intervention in improving sleep outcomes, an area where García-Perea et al. (2022) called for more robust research.

A study showed that education was the most popular component of a self-management program among fibromyalgia patients (Pearson et al., 2022). The interconnectedness of pain and insomnia is well-established, with studies suggesting a greater impact of sleep disorders on chronic pain (Castelo-Branco et al., 2024; Climent-Sanz et al., 2021). This implies that interventions designed to address sleep problems and enhance the restorative aspects of sleep may be an effective strategy for alleviating primary fibromyalgia symptoms, including pain.

Study Strengths and Limitations

The findings of this study suggest that nurse-led interventions can positively impact sleep disturbances and pain experiences. Several factors contributed to the robustness of these findings. Notably, the lack of participant attrition throughout the study period is a significant strength, indicating a high level of participant engagement and commitment to the intervention. This complete retention minimizes the potential for bias due to drop-out and strengthens the internal validity of our results. However, this study had some limitations. Firstly, it involved a small number of patients from a single healthcare facility, meaning the findings might only apply to similar patient groups and not to everyone with fibromyalgia. Secondly, sleep quality and pain were assessed using self-reported measures and thirdly, quasi-experimental design cannot definitively establish a causal relationship between a nurse-led teaching program and sleep disturbances and pain experiences.

Implication for Practice

A nurse-led teaching program offers valuable evidence that can significantly enhance the standard of care for individuals with fibromyalgia. By equipping patients with knowledge about their condition, effective self-management strategies for pain and sleep, and coping mechanisms, nurses can empower them to take a more active role in their care. This patient-centered approach can lead to increased self-efficacy, improved adherence to treatment plans, and a greater sense of control over their symptoms, ultimately enhancing their overall well-being and quality of life.

Compared to more intensive or drug-based treatments, nurse-led programs can be a more affordable and accessible option, potentially reaching a wider range of patients, including those in underserved areas or with limited financial resources. This nonpharmacological approach also offers a valuable alternative or complementary strategy, especially considering the potential side effects and limitations of pharmacological treatments for fibromyalgia. Integrating these programs into routine nursing practice, whether through individual counseling sessions, group workshops, or telehealth platforms, can provide consistent and accessible support for patients. Furthermore, this approach fosters interdisciplinary collaboration, as nurses can work alongside physicians, physical therapists, and psychologists to provide holistic and coordinated care.

Recommendations

Future research should aim to strengthen the evidence base and optimize the implementation of nurse-led teaching programs for fibromyalgia. Longitudinal studies are needed to evaluate the long-term sustainability of the observed benefits on pain and sleep quality. Investigations comparing the effectiveness of different program components (e.g., specific educational modules and relaxation techniques) and varying delivery methods (e.g., individual vs. group, in-person vs. telehealth) are crucial to identifying the optimal program structure. Furthermore, rigorous randomized controlled trials are warranted to confirm the causal effects of these programs and minimize potential biases.

Conclusion and Recommendations

In conclusion, this study findings documented that a nurse-led teaching program had a significant impact on improving sleep disturbances and pain experiences among patients with fibromyalgia. The findings indicated that patients who participated in the program reported lower pain intensity scores and improved sleep quality compared to the control group. These results highlight the potential value of incorporating nurse-led education and support as an effective component in the management of fibromyalgia symptoms. Further research that could utilize randomized controlled trials with larger sample sizes and longer follow-up periods are warranted to further investigate the relationship between a nurse-led teaching program and sleep disturbances and pain experiences

Footnotes

Acknowledgements

The authors extend their thanks to the participants for their participation and to the research team for their assistance.

ORCID iDs

Nermen Abdelftah Mohamed

Aziza Ibrahim Abd El Kader

Ethical Considerations

Approval for this study was officially obtained from the Research Ethics Committee of the Faculty of Nursing at Mansoura University (IRB. 0724) before the study began, participants received detailed information about the research goals, its importance, and how it would be conducted. They had the chance to ask questions and were given a guarantee that they might leave at any time without incurring any penalties. Participants provided written informed consent prior to the commencement of data collection. To protect participant privacy, all data was anonymized using codes. Additionally, the documents were stored securely in a locked location.

Author Contributions

All authors actively participated in all phases of this research, from initial ideas to the final manuscript. They have all reviewed and endorsed it and are accountable for the work's integrity.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Data Availability Statement

The data generated and analyzed for this research are available from the corresponding author under reasonable terms.

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