La fibromyalgie se caractérise par une douleur chronique au long cours, un retentissement fonctionnel important et une détresse émotionnelle fréquente. Dans le cadre du modèle du sens commun de l’autorégulation, cette étude examine les liens entre représentation de la fibromyalgie, croyances associées à la douleur, processus d’adaptation cognitifs et émotionnels et douleur, et identifie des profils de patients fondés sur leurs représentations. Un questionnaire en ligne a été proposé à cent soixante-dix adultes atteints de fibromyalgie, recrutés par trois associations de patients. Des instruments validés ont évalué les représentations de la fibromyalgie et de la douleur, les stratégies d’adaptation à la douleur chronique, l’acceptation de la douleur, la dramatisation, l’anxiété, la dépression, l’intensité et l’interférence de la douleur ainsi que l’impact de la fibromyalgie sur la vie quotidienne. Les participants rapportent une douleur intense, un impact fonctionnel sévère et une prévalence élevée de symptômes anxieux et dépressifs. Les représentations marquées par l’importance des conséquences et une forte charge émotionnelle sont associées à une perception de la douleur comme constante et mystérieuse, à une utilisation accrue de stratégies centrées sur la maladie (repos, protection) et à une dramatisation élevée, elle-même liée à un handicap plus important. L’analyse en classes révèle deux profils de représentation, dont un profil de forte menace représentationnelle cumulant douleur plus intense, impact plus sévère et détresse émotionnelle accrue. Ces résultats soulignent le rôle central des représentations de la fibromyalgie et de la douleur dans l’adaptation et plaident pour des interventions ciblant explicitement ces dimensions.

Fibromyalgia is a chronic pain syndrome characterised by widespread musculoskeletal pain, profound fatigue, sleep disturbances, and cognitive impairments, often referred to as ‘fibrofog’. Beyond its physical manifestations, it is frequently associated with significant psychological distress, including anxiety and depression. Given the absence of a clear organic lesion, fibromyalgia is increasingly understood through the lens of ‘nociplastic pain’, involving central sensitisation. This study investigates the psychological adjustment of patients within the framework of the Common-Sense Model (CSM) of self-regulation. The CSM suggests that individuals create ‘lay’ representations of their illness—structured around dimensions such as identity, cause, timeline, consequences, and controllability—which, in turn, guide their coping strategies and influence health outcomes. The primary aim of this research was to examine the relationships between illness representations, pain beliefs, cognitive and emotional coping strategies, and the overall impact of the disease in a French population. Furthermore, the study sought to identify distinct patient profiles based on their illness representations to better understand the heterogeneity of adjustment patterns in fibromyalgia. A cross-sectional study was conducted using a secured online survey. The sample consisted of 170 adults (predominantly women) diagnosed with fibromyalgia, recruited through three national patient associations. Participants completed a battery of validated psychometric instruments: (1) The Revised Illness Perception Questionnaire (IPQ-R) to assess fibromyalgia representations; (2) The Pain Beliefs and Perceptions Inventory (PBPI) to evaluate beliefs regarding the mystery, constancy, and duration of pain; (3) The Chronic Pain Coping Inventory (CPCI) for specific coping strategies (e.g. resting, guarding, task persistence); (4) The Chronic Pain Acceptance Questionnaire (CPAQ) and the Pain Catastrophizing Scale (PCS) for psychological processes associated with pain; (5) The Hospital Anxiety and Depression Scale (HADS) and the Fibromyalgia Impact Questionnaire (FIQ) to measure clinical and functional outcomes. The participants reported high levels of pain intensity and a severe functional impact on daily life. Prevalence rates for clinically significant anxiety and depressive symptoms were notably high. Correlation analyses revealed that illness representations characterised by severe perceived consequences and high emotional burden were strongly associated with viewing pain as ‘mysterious’ and ‘constant’. Such beliefs were linked to maladaptive coping strategies, such as excessive resting and guarding, and a higher tendency toward catastrophising. A cluster analysis identified two distinct patient profiles: (i) Cluster 1 (High-Threat Profile): This group exhibited a ‘maladaptive’ pattern, characterised by low illness coherence (lack of understanding), low perceived control, and high emotional distress. These patients reported higher levels of pain, greater functional impairment, and more severe psychological distress; (ii) Cluster 2 (Coherence and Control Profile): this group displayed better adjustment. Despite experiencing significant pain, these participants reported a clearer understanding of their condition and a stronger belief in their ability to control symptoms. They showed higher levels of activity persistence and lower levels of catastrophising and emotional distress compared to Cluster 1. The findings underscore the pivotal role of illness coherence and perceived control in the adjustment process. A lack of understanding of the condition (high mystery) often leads to a sense of helplessness, which fuels catastrophising and functional decline. Interestingly, while pain acceptance is generally beneficial, the study suggests that for some patients, ‘coping’ may actually represent an exhausting struggle rather than true psychological flexibility. The results confirm that fibromyalgia is a heterogeneous condition, where the subjective interpretation of the illness is as critical as the physical symptoms themselves. This study highlights the necessity of a multidisciplinary approach in treating fibromyalgia. Beyond pharmacological management, clinical interventions should specifically target illness representations. Enhancing ‘illness coherence’ through patient education is essential to reduce the sense of mystery surrounding the symptoms. Cognitive-behavioural interventions should focus on reducing catastrophising and fostering a sense of personal control. By identifying patient clusters, clinicians can tailor therapeutic strategies—moving from a ‘one-size-fits-all’ model to personalised care that addresses the specific cognitive and emotional needs of the patient. Future research using longitudinal designs or Ecological Momentary Assessment (EMA) would further clarify the dynamic nature of these representations in daily life.