A 2-day interdisciplinary treatment program including cognitive behavioral therapy (CBT), exercise, and education about fibromyalgia (FM) reduced pain and improved health status as effectively as a 10-week program, researcher report in an article published online April 7 in Rheumatology International. However, the shorter program may not have been as effective at reducing fatigue and improving physical function.
Ilknur Saral, MD, from the Department of Physical Medicine and Rehabilitation, Istanbul University, Turkey, and colleagues suggest that the specific elements included in the CBT might be a key factor in the program’s success.
The researchers conducted a 6-month, prospective, randomized controlled trial to compare effects on symptoms, health-related quality of life (HRQoL), and physical functions of long- and short-term treatment approaches in 66 women with FM. All the study subjects had previously been treated with at least one pharmacological agent (tricyclic antidepressants, nonsteroidal anti-inflammatory drugs, serotonin-norepinephrine reuptake inhibitors, selective serotonin reuptake inhibitors, gabapentin, or pregabalin) and/or nonpharmacological therapies such as exercise, massage, or acupuncture.
The long-term intervention (LG; n = 22) included ten 3-hour weekly sessions of CBT plus 2 full days of exercise training (including aerobic, stretching, and strengthening exercises), a home exercise prescription, and FM-related education. Participants were prescribed home exercise programs to be carried out during the study period, including 3 days per week of aerobic exercise, strengthening, and stretching, and 5 days per week of relaxation techniques.
The short-term intervention (SG; n = 22) included 2 full days of exercise training, education, and CBT. These patients also received a home exercise program similar to those in LG group. The control group (CG; n = 22) patients did not participate in any program and were advised to continue their previous treatments.
The researchers evaluated each patient at baseline and 6 months after treatment, using the visual analog scale, Fibromyalgia Impact Questionnaire, Beck Depression Inventory, Short Form-36, tender point numbers, and pressure algometry.
Compared with the control group, both the LG and the SG groups had significant improvements in pain intensity (P < .001), fatigue severity (P = .048), number of tender points (P = .002), and pressure pain threshold (P = .012). Patients in the intervention groups also had significant improvements in physical function and physical components of the HRQoL compared with controls.
A pairwise comparison for pain showed that the long-term intervention was significantly more effective than the shorter program in decreasing pain.
Moreover, in comparison to CG, the LG intervention significantly decreased fatigue and improved physical components of the HRQoL, whereas the SG group showed no significant improvement.
Neither the LG nor the SG intervention significantly improved quality of sleep, severity of depressive symptoms, or mental components of the HRQoL.
The authors note that FM-associated chronic pain and disability result from both somatic pathology and psychological or social factors. CBT is incorporated into FM treatment regimens in an effort to alter cognitive processes, and relaxation techniques are used in an attempt to reduce muscle tension. The researchers suggest that some of the differences in outcomes of multidisciplinary FM interventions are a result of differences in the content of the CBT programs used.
They write, “We believe that the CBT program in our study aiming to enhance awareness of the relationship between stressful life events, emotions/thoughts/behaviors, and symptomatic patterns, to develop skills to cope with stressful life events and pain, and to increase the ability to express emotions and opinions was the important determinant of reduction in both pain intensity and point tenderness in the long-term.”
They conclude that the short-term program generally meets the needs of women with FM, but that a long-term program may be more effective for reducing fatigue and improving physical function.