Improving physical functional status in patients with fibromyalgia: a brief cognitive behavioral intervention

• Published in: Journal of rheumatology Vol. 29; no. 6; pp. 1280 - 1286
• Main Authors: WILLIAMS, David A, CARY, Meredith A, GRONER, Kimberly H, CHAPLIN, William, GLAZER, Lara J, RODRIGUEZ, Alyssa M, CLAUW, Daniel J
• Format: Journal Article
• Language: English
• Published: Toronto, ON The Journal of Rheumatology 01-06-2002; Journal of Rheumatology Publishing
• Subjects: Adult; Aged; Analgesics - administration & dosage; Antidepressive Agents - administration & dosage; Behavior Therapy - methods; Behavior therapy. Cognitive therapy; Biological and medical sciences; Chronic Disease; Cognitive Therapy - methods; Combined Modality Therapy; Diseases of the osteoarticular system; Drug Therapy, Combination; Exercise; Female; Fibromyalgia - diagnosis; Fibromyalgia - drug therapy; Fibromyalgia - rehabilitation; Humans; Male; Medical sciences; Middle Aged; Miscellaneous. Osteoarticular involvement in other diseases; Odds Ratio; Patient Compliance; Physical Fitness - physiology; Physical Fitness - psychology; Probability; Prognosis; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Reference Values; Sensitivity and Specificity; Severity of Illness Index; Treatment Outcome; Treatments; Human; Cognitive therapy; Prognosis; Diseases of the osteoarticular system; Fibromyalgia; Fatigue; Striated muscle disease; Improvement; Chronic; Pain; Treatment; Clinical trial; Behavior therapy; Technique
• ISSN: 0315-162X; 1499-2752

OBJECTIVE: Sustained improvement in physical functional status was the primary goal of a brief, 6 session cognitive behavioral
therapy (CBT) protocol for fibromyalgia (FM). METHODS: One hundred forty-five patients with FM were randomly assigned to either
(1) standard medical care that included pharmacological management of symptoms and suggestions for aerobic fitness, or (2)
the same standard medical treatment plus 6 sessions of CBT aimed at improving physical functioning. Outcome measures included
the Medical Outcome Study Short Form-36 Physical Component Score and McGill ratings of pain. Outcomes were treated dichotomously
using a preestablished criterion for clinically significant success based upon the reliability of change index from baseline
to one year posttreatment. RESULTS: Twenty-five percent of the patients receiving CBT were able to achieve clinically meaningful
levels of longterm improvement in physical functioning, whereas only 12% of the patients receiving standard care achieved
the same level of improvement. There were no lasting differences on pain ratings between groups. CONCLUSION: Lasting improvements
in physical functioning have been among the most difficult outcomes to obtain in studies of FM. These data suggest that the
inclusion of CBT to a standard medical regimen for FM can favorably influence physical functioning in a subset of patients.