Internet-enhanced management of fibromyalgia: A randomized controlled trial

Abstract

Both pharmacological and non-pharmacological interventions have demonstrated efficacy in the management of fibromyalgia (FM). Non-pharmacological interventions however are far less likely to be used in clinical settings, in part due to limited access. This manuscript presents the findings of a randomized controlled trail of an Internet-based exercise and behavioral self-management program for FM designed for use in the context of a routine clinical care. 118 individuals with FM were randomly assigned to either (a) standard care or (b) standard care plus access to a Web-Enhanced Behavioral Self-Management program (WEB-SM) grounded in cognitive and behavioral pain management principles. Individuals were assessed at baseline and again at 6 months for primary endpoints: reduction of pain and an improvement in physical functioning. Secondary outcomes included fatigue, sleep, anxiety and depressive symptoms, and a patient global impression of improvement. Individuals assigned to the WEB-SM condition reported significantly greater improvement in pain, physical functioning, and overall global improvement. Exercise and relaxation techniques were the most commonly used skills throughout the 6 month period. A no-contact, Internet-based, self-management intervention demonstrated efficacy on key outcomes for FM. While not everyone is expected to benefit from this approach, this study demonstrated that non-pharmacological interventions can be efficiently integrated into routine clinical practice with positive outcomes.

Efficacy, acceptability and safety of cognitive behavioural therapies in fibromyalgia syndrome – A systematic review and meta‐analysis of randomized controlled trials

“…We excluded two studies because CBTs were delivered by Internet without any contact with a psychotherapist (Williams et al, 2010;Menga et al, 2014). One of these studies was included in the first version of the review (Williams et al, 2010). We included seven new studies (Williams et al, 2002;Parra-Delgado and Latorre-Postigo, 2013;Wicksell et al, 2013;Luciano et al, 2014;Martınez et al, 2014;Garcia-Palacios et al, 2015;Karlsson et al, 2015).One study (Williams et al, 2002) was not included in the first version of this review.…”

A Framework for Fibromyalgia Management for Primary Care Providers

“…For example, community resources, such as the YMCA or similar health clubs, may be available for exercise, and Web-based CBT may be an alternative to face-to-face therapist counseling. 29 Through knowing their team, PCPs are ideally positioned to coordinate care across specialties and to encourage and reinforce the importance of ongoing self-management.…”

“…• Improved knowledge about fibromyalgia and how to cope with pain 37 • Significant improvement in physical (pain, fatigue, and functional disability) and psychological (negative mood and anxiety) functioning and in impact of fibromyalgia in patients treated with CBT combined with exercise vs no CBT 41 • Significantly greater improvement in pain, physical functioning, and overall global improvement reported by patients randomized to standard care plus access to an Internet-enhanced behavioral self-management program designed for use in routine clinical care compared with patients receiving standard care alone 29 • Improvements often sustained for months after CBT stopped 38 Sleep hygiene Make sleep routine a priority. Optimize relaxing sleep environment.…”

“…15,17,29,[37][38][39][40][41] Furthermore, other nonpharmacological approaches, such as yoga, massage, and other types of physical therapy, may also be considered, 42 although more study is needed to assess their efficacy in fibromyalgia. An integrated approach is key, and the importance of self-management should be highlighted.…”

Analyzing Change Processes Resulting from a Smartphone Maintenance Intervention Based on Acceptance and Commitment Therapy for Women with Chronic Widespread Pain

“…Although the short-term effects (up to 1 year) of such treatments are well demonstrated, interventions to support the maintenance of effects and avoiding relapses are needed [3]. For treatment and/or maintenance treatment of CWP an alternative may be internet CBT and smartphone interventions [6,7]. Such technology-supported interventions are increasingly used to support people with health problems including chronic pain in self-management, and show effects similar to that of face-to-face CBT [8][9][10][11][12][13][14][15].…”