Original Article
Biodanza Reduces Acute
From the *Department of Physical
Education, Faculty of Education
Sciences, University of C

adiz, C

adiz,
Spain; †Department of Physical
Education and Sport, Faculty of Sport
Sciences, University of Granada,
Granada, Spain; ‡Department of
Physiology, Faculty of Pharmacy and
Institute of Nutrition and Food
Technology, University of Granada,
Granada, Spain.
Address correspondence to V
ıctor
Segura-Jim
enez, PhD, Department of
Physical Education, Faculty of
Education Sciences, University of
C
adiz, Avenida Rep
ublica Saharaui,
s/n, 11519, C
adiz, Spain. E-mail:
victor.segura@uca.es
Received April 26, 2015;
Revised March 11, 2017;
Accepted March 29, 2017.
Conflict of interests: None declared.
Funding: Instituto Andaluz del De-
porte (IAD), the Center of Initiatives
and Cooperation to the Develop-
ment (CICODE, University of Gran-
ada), and the Spanish Ministry of
Education [AP2010-0963].
1524-9042/$36.00
Ó 2017 by the American Society for
Pain Management Nursing
http://dx.doi.org/10.1016/
j.pmn.2017.03.007
Pain Severity in Women
with Fibromyalgia
enez, PhD,*,†
V
ıctor Segura-Jim

---
Claudia M. Gatto-Cardia, BSc,†
elia M. Martins-Pereira, BSc,†
Cl

Manuel Delgado-Fern
andez, PhD,†
Virginia A. Aparicio, PhD,‡ and Ana Carbonell-Baeza, PhD*
- ABSTRACT:
Biodanza is a useful therapy for the fibromyalgia management; how-
ever, there is no evidence of its effectiveness on acute pain. The objec-
tives of the present study were: to determine the changes of a 3-month
Biodanza program on acute pain severity (before vs. after session) and
cumulative pain severity in women with fibromyalgia; and to check the
associations of acute pain severity reduction with presession pain
severity, body fat percentage, and satisfaction with the session. This was
a 3-month low-moderate intensity (rate of perceived exertion around
12, based on a 6-20 point scale) Biodanza intervention study (1 session/
week). Twenty-seven women with fibromyalgia (54.2 ± 6.2 years)
participated. Pain severity was assessed before and after each single
session with a visual analog scale. There were immediate changes in all
sessions (p ¼ .001-.028), except in the first, second, and fourth sessions.
An overall 16% decrease of acute pain severity before and after each
session was noted (mean presession pain vs. postsession pain, 5.8 ± 2.1
vs. 4.9 ± 2.4; respectively). There was an independent association of
pain severity reduction (presession–postsession) with presession pain
severity (unstandardized coefficient B ¼ .21 ± .05; standardized coeffi-
cient b ¼ .25; p < .001), body fat percentage (B ¼ L.05 ± .02; b ¼ L.18;
p ¼ .003), and satisfaction with the session (B ¼ .40 ± .15; b ¼ .16;
p ¼ .007). There was a significant cumulative effect decrease in post-
session pain severity (p < .001; 95% confidence interval [CI] ¼ L.14,
L.05) and presession–postsession pain severity (p ¼ .007; 95% CI ¼ .02,
.12) along the 3-month intervention. No significant cumulative effect in
presession pain severity was identified (p > .05). In conclusion, Bio-
danza is an alternative therapy that reduced acute pain severity in
women with fibromyalgia. The intervention also yielded cumulative
pain severity reduction, which were higher in those women with fi-
bromyalgia presenting higher presession pain severity and lower body
fat percentage. The satisfaction with the session was also a key factor
positively associated with pain reduction.
Ó 2017 by the American Society for Pain Management Nursing
Pain Management Nursing, Vol -, No - (--), 2017: pp 1-10
2 Segura-Jim
enez et al.
INTRODUCTION
Fibromyalgia has been recently defined as a multisymp-
tom disorder (Segura-Jim
enez, A
lvarez-Gallardo, et al.,
2015; Wolfe, Br€ahler, Hinz, & H€auser, 2013; Wolfe
et al., 2011). Although several physical and
psychological non–pain-related symptoms are
characteristics of this disease (Salaffi & Sarzi-Puttini,
2012; Segura-Jim
enez et al., 2015; Segura-Jim
enez,
Aparicio, et al., 2014; Wolfe et al., 2013), pain
remains the most prominent symptom (Segura-
Jim
enez, A
lvarez-Gallardo, et al., 2015; Wolfe et al.,
2011). Such is the impact of pain that it seems to
limit voluntary physical activities in this population
(Nijs et al., 2013). As a result, patients with fibromyal-
gia usually refrain from any type of physical activity
with the idea that it will aggravate their symptoms
(Bj€ornsd
ottir, J

onsson, & Valdimarsd
ottir, 2013). None-
theless, such behavior, contrary to what they think,
significantly worsens their overall symptomatology
(Busch et al., 2011; Ellingson, Shields, Stegner, &
Cook, 2012).
Available evidence recommends patients with fi-
bromyalgia to be physically active to reduce their
pain, improve their overall symptomatology, enhance
their physical and emotional functioning and their
health-related quality of life (Rahman, Underwood, &
Carnes, 2014). Patients with fibromyalgia who are
physically active seem to modulate pain better than
those who are less active (Ellingson, Colbert, &
Cook, 2012; Ellingson, Shields, et al., 2012). This
highlights the importance of physical exercise to
manage the levels of pain in this population (Daenen,
Varkey, Kellmann, & Nijs, 2015). Because of the phys-
ical and psychological nature of fibromyalgia (Carville
et al., 2008; Segura-Jim
enez, A
lvarez-Gallardo, et al.,
2015), mind-body therapies have also had some effec-
tiveness as target treatments (Terhorst, Schneider,
Kim, Goozdich, & Stilley, 2011). In fact, diverse types
of complementary and alternative medicine therapies
such as acupuncture, Tai-Chi, balneotherapy, and Bio-
danza have been found to produce beneficial effects
on tenderness, long-term pain, fatigue, physical func-
tion, depression, and other symptoms in fibromyalgia
patients (Carbonell-Baeza et al., 2012; L
opez-
Rodr
ıguez, Castro-S
anchez, Fern
andez-Mart
ınez,
Matar
an-Pe~ narrocha, & Rodr
ıguez-Ferrer, 2012; L
opez-
Rodr
ıguez et al., 2013; Terhorst et al., 2011; Wang
et al., 2010).
Biodanza is a therapeutic strategy that combines
music, movement, and emotions to induce integrative
living experiences or vivencias (vivid, intensely felt
moment in the ‘‘here and now’’) in group participants
(Toro, 1991). Connections and interactions with self,
partners, and the group are also encouraged to
improve participants’ health, well-being, vitality, and
joy (D’Alencar, Mendes, Jorge, & Guimar~aes, 2008).
This technique is a novel complementary and alterna-
tive therapy that is still in the ongoing process of being
scientifically evaluated. In a previous study, the prac-
tice of Biodanza was useful by decreasing tenderness,
body fat percentage, and the overall impact of the dis-
ease in women with fibromyalgia (Carbonell-Baeza
et al., 2010). Furthermore, the combination of warm
water and Biodanza led to benefits in pain, physical
function, and depression in patients with fibromyalgia
(L
opez-Rodr
ıguez et al., 2012, 2013). However, it is
unknown whether this complementary and
alternative therapy is adequate to yield benefits on
pain after each individual session. Given the positive
effect of tai chi on acute pain in patients with
fibromyalgia (Segura-Jim
enez, Romero-Zurita, et al.,
2014), it can be hypothesized that other complemen-
tary and alternative therapies such as Biodanza might
also lead to acute pain reduction in this population.
Therefore, the aim of the present study was to
determine the changes of a 3-month (1 session/week)
Biodanza intervention on acute pain severity, as well
as on cumulative pain severity, in women with fibromy-
algia; and to check the associations of acute pain
severity reduction with presession pain severity,
body fat percentage, and satisfaction with the session.
MATERIAL AND METHODS
Participants
This study was part of a previous study developed by
our group (Carbonell-Baeza et al., 2010). A total of
255 Spanish female members from a local association
of patients with fibromyalgia (Granada, Spain) were
contacted. Seventy-nine potentially eligible patients re-
sponded. The inclusion criteria were (1) meeting the
1990 American College of Rheumatology (ACR)
criteria for fibromyalgia; (2) not having other severe so-
matic or psychiatric disorders or other diseases that
prevent physical activity; (3) not be attending another
type of physical or psychological therapy at the same
time; (4) not be engaged in regular physical activity
>20 minutes on >3 days/week. Seven patients did
not meet the criteria and one patient declined to
participate because of incompatibility with job
schedule. A final sample of 71 women with fibromyal-
gia met all the criteria. Because of a limitation of re-
sources, a convenience sample of 37 women with
fibromyalgia were assigned to the present study. The
rest of participants were assigned to a waiting list
and were offered a Biodanza program at the end of
the study period.
 Biodanza for Acute Pain Severity in Fibromyalgia
Design
There was an ethical obligation to provide treatment to
all patients willing to participate in the study, but a lim-
itation of resources allowed intervention in a particular
schedule only. The protocol has been previously re-
ported elsewhere (Carbonell-Baeza et al., 2010).
Because of the design of the present study, where
pain severity was assessed before and after each indi-
vidual session, a control group was not set up. There-
fore, for the present study, a quasi-experimental
design was stablished. Participant bias was controlled,
because the same individual was used at each testing
time point. Study participants provided their written
informed consent. The study was carried out between
January 2008 and June 2009. The Ethics Committee of
the Virgen de las Nieves Hospital (Granada, Spain) re-
viewed and approved the research protocol. The
ethical guidelines of the Declaration of Helsinki, last
modified in 2000, were followed.
Biodanza Intervention. The program consisted of
12 sessions (1 session/week), which were performed
in the facilities of the Faculty of Sport Sciences (Gran-
ada, Spain). Each session lasted 120 minutes and was
divided into two parts: (1) a verbal phase of 35–45 mi-
nutes where participants (seated in circle) were
encouraged to express their feelings. They also shared
with the group their experiences from the previous
sessions. In the first two sessions theoretical informa-
tion about the program was provided; and (2) the vi-
vencia itself (75-80 minutes), consisting of moving
and dancing by expressing the emotions elicited by
the songs, the other peers’ presence, proximity, and
feedback. The facilitator gave constant suggestions. Pa-
tients performed the dances individually, in pairs, and
with the whole group. The exercises proposed in
each living experience were fit according to the objec-
tive of the session and belonged to five main groups:
vitality, sexuality, creativity, affectivity, and transcen-
dence. To assess training intensity, the rate of
perceived exertion (RPE) based on Borg’s conventional
(6-20 point) scale (Borg, 1998) was used. The RPE
intervention mean value was 11.5 points, which corre-
sponded to low-moderate intensity. Participants were
asked not to change their activity levels and medication
during the 3-month intervention period. Only those
women attending at least 70% of the complete Bio-
danza intervention were included in the final analyses.
Instruments
Primary Study Outcomes.
Acute pain severity. A pain visual analog scale (VAS)
was administered immediately before (pre) and after
(post) each Biodanza session. The VAS is a simple
3
assessment tool consisting of a 10-cm line with 0 on
one end, representing no pain, and 10 on the other,
representing the worst pain ever experienced. Patients
marked the severity of their pain just before and after
each Biodanza individual session. The validity of the
VAS has previously been reported (Price, McGrath,
Rafii, & Buckingham, 1983). This instrument has
been recommended to measure pain severity in pa-
tients with fibromyalgia (Price, Patel, Robinson, &
Staud, 2008).
Cumulative pain severity. The VAS-pain was also
used to build an operational variable in the present
study. This represented how pain severity developed
throughout the intervention. For that purpose, the pre-
session pain variables (i.e., VAS-pain1, VAS-pain2, VAS-
pain3.VAS-pain12) were introduced in a linear mixed
model analysis to determine changes in presession
pain severity in the long term during the 3-month inter-
vention program. This procedure was repeated for
postsession and presession–postsession pain severity
(see statistical analyses section).
Secondary Study Outcomes.
Body composition. Bioelectrical impedance analysis
was performed at preintervention with an eight-polar
tactile-electrode system (InBody R20, Biospace, Seoul,
Korea) whose validity and reliability has been
described elsewhere (Lim et al., 2009; Segura-
Jim
enez, Aparicio, et al., 2015). Weight (in kilograms)
and body fat percentage were measured. Height (in
centimeters) was measured with a stadiometer (Seca
22, Hamburg, Germany). Body mass index was
calculated as weight divided by height squared (kg/
m2).
Satisfaction with the session. Patients marked their
satisfaction with the session after each individual Bio-
danza session, using a 6-point Likert scale following this
scoring: 1 ¼ completely unsatisfied, 2 ¼ unsatisfied,
3 ¼ somewhat unsatisfied, 4 ¼ somewhat satisfied,
5 ¼ satisfied, 6 ¼ completely satisfied.
Tender points. A standard pressure algometer (EF-
FEGI, FPK 20, Italy) was used for diagnosis confirma-
tion purpose at preintervention, according to the
1990 ACR criteria for classification of fibromyalgia
(Wolfe et al., 1990). Two successive measurements at
each tender point were assessed and the mean value
was used for the analysis. A pressure of 4 kg/cm2 or
less was set as a positive tender point. The total count
of positive tender points was recorded for each
participant.
Statistical Analyses
Descriptive analysis (i.e., mean, standard deviation, and
frequency) was used to display sociodemographic and
clinical (tender points count and body composition
4 Segura-Jim
enez et al.
parameters) variables. Pain severity variables were not
normally distributed; therefore, nonparametric tests
were used. To assess pain severity differences (pre vs.
post) before and after each session, the Wilcoxon test
was used. The Cohen’s d statistic assessed the effect
size of the pain severity differences. Cohen’s d values
of .25, .5, and .8 or greater were interpreted as
small, medium and large, respectively (Nakagawa &
Cuthill, 2007). Multiple linear regression analysis was
performed to examine the association between preses-
sion pain, body fat percentage, age, and satisfaction
with the session (independent variables) and preses-
sion–postsession pain severity difference (dependent
variable) by using the ‘‘enter’’ method. To study the cu-
mulative changes in presession and postsession pain
severity and presession–postsession changes in acute
pain, linear mixed models adjusting for age, body fat
percentage, attendance (number of real sessions),
and baseline pain severity (first session) were conduct-
ed. The statistical significance level was set at p < .05.
The Statistical Package for Social Sciences (SPSS
Version 20.0 for Windows, IBM Corp., Armonk, NY,
USA) was used for analyses purposes.
RESULTS
Nine women discontinued the program. This was
because of family commitments (n ¼ 1), beginning
other massage therapy (n ¼ 1), personal and health
problems (n ¼ 3), work commitments (n ¼ 1), and un-
known reasons (n ¼ 3). Additionally, one woman at-
tended less than 70% (minimum required) of the
program (attendance: 58%). A total sample of 27
women (73% of the original sample who agreed to
FIGURE 1. - Flow chart of participants. ACR ¼ American College of Rheumatology.
participate) was included in the final analyses. The pa-
tients’ flow is presented in Figure 1. The Biodanza pro-
gram patient’s adherence was 86% (range 70%-100%).
Compliers and noncompliers had no statistical differ-
ences in the primary study outcomes (all, p > .05). Ses-
sions were given in two different schedules, so two
Biodanza groups were established. Baseline participant
characteristics (age, weight, height, body mass index,
body fat percentage, tender points count, and VAS-
pain scores) and sociodemographic characteristics
(marital status, educational level, occupational status,
years since clinical diagnosis, and income) did not
have any statistical difference between the diverse Bio-
danza groups (all, p > .05).
Table 1 displays the sociodemographic character-
istics of study sample. The group had significant imme-
diate changes on pain in all sessions (p ¼ .001-.028),
except in the first, second, and fourth sessions
(Table 2). An overall 16% decrease of acute pain
severity in the comparison of VAS values before and af-
ter each session was identified (mean presession vs.
postsession pain, 5.8  2.1 vs. 4.9  2.4, respectively).
The effect size of the differences between presession
and postsession pain severity presented values be-
tween .32 and .80.
A positive association between pain severity dif-
ference (presession–postsession) with presession
pain severity (B ¼ .21  .05; b ¼ .25; p < .001) and
satisfaction with the session (B ¼ .40  .15; b ¼ .16;
p ¼ .007), and a negative association with body fat per-
centage (b ¼ .05  .02; b ¼ .18; p ¼ .003) was
found (Fig. 2). Pain severity differences (presession–
postsession) were not associated with age. There
were significant cumulative differences in postsession
 Biodanza for Acute Pain Severity in Fibromyalgia 5

improvements were greater in those women with

TABLE 1. higher presession pain severity and lower body fat per-
Clinical and Sociodemographic Characteristics centage. Moreover, this study highlighted the impor-
of the Population Studied (n ¼ 27) tance of the satisfaction with the session, because
those women with greater satisfaction were more suc-
Variable Mean (SD)
cessful at improving acute pain. This was the first
Age (yr) 54.2 (6.2) population-based study investigating the effects of Bio-
Weight (kg) 68.4 (10.2) danza on acute pain severity in every session and cu-
Height (cm) 156.7 (4.4) mulative pain severity along the intervention in
Body mass index (kg/cm2) 27.8 (4.3) women with fibromyalgia.
Body fat (%) 37.6 (5.8)
Positive tender points (no.) 17 (2)
Regarding pain, the little existing evidence sug-
gests that Biodanza can be a useful therapy to reduce
n (%) pain severity in patients with fibromyalgia in the long
term (Carbonell-Baeza et al., 2010, 2012). The
Marital status same conclusions have been reached by studies
Married 17 (63.0)
Single 5 (18.5) combining Biodanza and warm water, finding
Separate/divorced/widowed 5 (18.5) reduction of pain levels by means of different tests
Educational level* used at the end of the program (L
opez-Rodr
ıguez
Unfinished studies 2 (8.0) et al., 2012, 2013). Previously, a 3-month warm water
Primary school 5 (20.0) pool-based exercise program (Segura-Jim
enez et al.,
Secondary school 8 (32.0)
University degree 10 (40.0) 2013) and 3- and 6-month Tai-Chi (Segura-Jim
enez,
Occupational status* Romero-Zurita, et al., 2014) interventions proved to
Homemaker 15 (65.2) be effective by decreasing acute pain severity in pa-
Working 5 (21.7) tients with fibromyalgia. In the present study, all the
Unemployed 1 (4.3) sessions resulted in acute pain severity reduction,
Retired 2 (8.7)
Years since clinical diagnosis except for the first, second, and fourth sessions. The
#5 12 (44.4) environmental conditions were similar in all sessions
>5 15 (55.6) and the same procedures were followed, except for
Incomes (V) the first and second sessions, where expression of
#1,200 10 (37.0) feelings and experiences sharing with the group
1,201-1,800 4 (14.8)
>1,800 13 (48.1) were replaced by theoretical information about the
program, which might be causing the lack of pain
SD ¼ standard deviation. severity improvements. In the fourth session,
*Missing data.
although there was an overall pain severity reduction
of .5 points in the VAS scale, this change was not sta-
pain severity (p < .001; 95% confidence interval tistically significant. Of note, participants hardly knew
[CI] ¼ .14, .05) and presession–postsession about this complementary and alternative medicine
changes (p ¼ .007; 95% CI ¼ .02, .12) along the and, although the RPE was similar throughout all the
3-month intervention. No significant cumulative differ- sessions, they confirmed to the facilitator that they
ences in presession pain severity were identified felt overwhelmed by the psychological effort. There-
(p > .05) (Fig. 3). fore, the lack of statistically significant reduction in
acute pain severity at the beginning of the interven-
tion program might be linked to this initial learning
process.
DISCUSSION Previous studies have confirmed that exercise
The present study aimed at elucidating the changes of a alone and multidisciplinary and complementary and
3-month Biodanza intervention program on acute pain alternative therapy interventions are effective at
severity (before vs. after session) and cumulative pain reducing pain assessed by means of several instru-
severity in women with fibromyalgia. The results indi- ments (Baptista, Villela, Jones, & Natour, 2012;
cated that Biodanza was an appropriate physical ther- Bidonde et al., 2014; Carbonell-Baeza et al., 2011,
apy that reduced acute pain severity in women with 2012; Hooten, Qu, Townsend, & Judd, 2012).
fibromyalgia. Furthermore, Biodanza was also effective However, all these previous studies focused on pain
at reducing cumulative postsession pain severity for severity before and after the program but did not
the duration of the program. It is of interest that assess pain severity before and after each individual
6 Segura-Jim
enez et al.

TABLE 2.
Acute Pain Severity Through the 3-month Biodanza Intervention in Women with Fibromyalgia

Presession Pain Severity Postsession Pain Severity

Sessions n Mean (SD) p Cohen’s d

1 22 6.0 (1.9) 5.5 (2.2) .276

2 23 6.1 (2.1) 6.0 (2.4) .981
3 24 5.5 (2.1) 4.5 (2.6) .007 .40
4 21 5.5 (2.4) 5.0 (2.5) .173
5 25 5.6 (2.1) 4.6 (2.0) .013 .50
6 26 5.5 (2.2) 4.8 (2.5) .028 .32
7 20 6.4 (2.1) 5.4 (2.5) .005 .43
8 20 6.2 (1.7) 4.6 (2.4) .003 .80
9 24 5.5 (2.0) 4.4 (2.4) .005 .49
10 23 6.1 (1.6) 4.8 (2.1) .001 .72
11 22 6.1 (1.9) 4.7 (2.4) .002 .65
12 25 5.4 (2.4) 4.4 (2.6) .002 .40
SD ¼ standard deviation; CI ¼ confidence interval.

session. Only two studies have followed a presession
and postsession pain register design during the
complete intervention program (Segura-Jim
enez
et al., 2013; Segura-Jim
enez, Romero-Zurita, et al.,
2014). These previous studies found that a 3-month
period of warm water pool-based exercise (Segura-
Jim
enez et al., 2013) and Tai-Chi (Segura-Jim
enez,
Romero-Zurita, et al., 2014) intervention was not
enough to produce cumulative pain severity (evolution
of acute pain severity throughout the intervention)
reduction in patients with fibromyalgia. This might
be due to the fact that pain relief is related to a higher
length and frequency of intervention programs (Gusi,
Tomas-Carus, H€akkinen, H€akkinen, & Ortega-Alonso,
2006). In fact, when the Tai-Chi intervention was car-
ried out for a longer period (i.e., 6 months), significant
cumulative pain severity reduction were identified in
both presession and postsession pain severity
(Segura-Jim
enez, Romero-Zurita, et al., 2014).
In the present study, a 3-month Biodanza inter-
vention consisting of 1 session/week was long enough
to produce a postsession pain severity decrease dur-
ing the intervention program. This fact might assume
that other factors, which would not be present in 3-
month warm water exercise or 3-month Tai-Chi pro-
grams, might be involved in this postsession pain
severity cumulative decline. It is known that fibromy-
algia is a physical and psychological entity (Carville
et al., 2008; Segura-Jim
enez, A
lvarez-Gallardo, et al.,
2015). Working with music positively affects
disinhibition and social interaction (Baptista et al.,
2012). In fact, Biodanza has an intense affective-
emotional charge that might be a clue to promoting
improvements in psychological factors such as coping
strategies, anxiety, and depression (L
opez-Rodr
ıguez
et al., 2012, 2013), which in turn could help to
reduce pain severity in this population. Despite the
benefits on cumulative postsession pain severity, no
cumulative reduction of presession pain severity
during the intervention was identified. This means
that acute pain severity values returned to the initial
settings before the start of the next session. In this
context, Biodanza interventions of longer duration
and higher frequency might perhaps achieve the
desired results regarding cumulative presession pain
severity.
The results of the present study also indicated that
women who suffered more severe pain obtained greater
benefits from the Biodanza intervention. This is some-
what rational, because patients with higher presession
pain severity levels had greater chance of pain severity
improvement after the session than those with low pre-
session pain severity levels. Anyway, this finding high-
lighted that patients should be encouraged to attend
intervention sessions on those days when they suffer
more intense pain, because they will obtain greater ben-
efits. Overall, patients should become more conscious
of their needs and should try not to miss sessions so
that the effects could be better felt and perceived. In a
similar way, body fat percentage was associated with
acute pain severity improvements, so that the advice
of keeping a normal weight in this population agreed
with previous studies (Aparicio et al., 2013, 2014).
Furthermore, this study reinforced the idea of exercise
enjoyment in fibromyalgia population (Umeda,
Marino, Lee, & Hilliard, 2014), because those who en-
joyed the sessions the most achieved the greatest bene-
fits in acute pain. Therefore, facilitators should be
 Biodanza for Acute Pain Severity in Fibromyalgia
FIGURE 2. - Relationship of pain severity differences (pre-
session–postsession) with presession pain severity, body
fat percentage, and satisfaction with the session in women
with fibromyalgia. The linear least square and confidence
bands for average pain severity difference (95% confidence
interval [CI]) are shown. There was an independent associa-
tion of pain severity difference with presession pain severity
(B ¼ .21  .05; b ¼ .25; p < .001), body mass index (b ¼ .05
 .02; b ¼ 0.18; p ¼ .003), and satisfaction with the session
(B ¼ .40  .15; b ¼ .16; p ¼ .007). B ¼ unstandardized coef-
ficient  standard error. b ¼ standardized coefficient.
7
FIGURE 3. - Pain severity evolution throughout the
3-month Biodanza intervention in women with fibromyal-
gia. Significant cumulative differences identified in
postsession pain severity (p < .001; 95% confidence inter-
val [CI] ¼ .14, .04) and pain severity difference (preses-
sion–postsession) (p ¼ .007; 95% CI ¼ .02, .12). No
cumulative reduction in presession pain severity was
noted.
encouraged to make great efforts to ensure motivational
sessions, because acute pain severity improvement will
depend on the satisfaction of the session.
Because fibromyalgia constitutes the upper end of
a continuous spectrum of polysymptomatic distress
within the population (Segura-Jim
enez, A
lvarez-
Gallardo, et al., 2015; Segura-Jim
enez, Aparicio, et al.,
2014; Wolfe et al., 2011), full understanding of the
disease requires comprehensive assessment of pain,
physical function, and psychosocial factors (Carville
et al., 2008). Nonetheless, the goal of the treatment in
patients with fibromyalgia is relief of pain, which is still
considered the main symptom (Segura-Jim
enez,

lvarez-Gallardo, et al., 2015; Segura-Jim

A enez,
Aparicio, et al., 2014; Wolfe et al., 2011). In this
context, the present study identified the effectiveness
of Biodanza in treating acute pain severity in
fibromyalgia women. Furthermore, it can be
considered that acute pain severity reduction induced
by the Biodanza intervention was clinically relevant,
because a minimally important clinical change of 15%
in VAS-pain severity scores has been reported by a pre-
vious study of chronic musculoskeletal pain (Salaffi,
Stancati, Silvestri, Ciapetti, & Grassi, 2004).
Limitations and Strengths
Data regarding effects 24-48 hours postexercise was
not collected; this information might be useful in
8 Segura-Jim
enez et al.
future studies to ascertain how long beneficial effects
of Biodanza on acute pain severity remain active in
this population. Another limitation of the present
study was the relatively low sample size. It cannot be
affirmed that these results also apply to men with fibro-
myalgia. It would be helpful to test whether programs
of higher length and/or frequency might induce
greater acute pain severity benefits in this population.
Nonetheless, the intervention was carried out once a
week to allow participants to assimilate and integrate
the intense vivencias.
Implications for Nursing Education, Practice,
and Research
Biodanza has been found to elucidate beneficial effects
on key symptoms in fibromyalgia. The findings of the
present study provided greater support to the inclu-
sion of this therapeutic therapy to reduce acute pain
severity in women with fibromyalgia. It is important
for health professionals to encourage patients to be
physically active. In this context, Biodanza can be im-
plemented as a nursing intervention to help patients
to cope with their disease. This therapy does not
require specific facilities or specific equipment, which
means it can be easily implemented in nursing settings.
Furthermore, pain management nurses should advise
women with fibromyalgia to engage in Biodanza
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