Tailored cognitive–behavioral therapy and exercise training for high‐risk patients with fibromyalgia

Abstract

Objective. The treatment of patients with fibromyalgia (FM), a high-prevalence chronic pain condition with a high impact on both patients and society, poses a great challenge to clinicians due to a lack of effective treatments. In view of the large individual variability in outcome, selecting patients at risk of long-term dysfunction and offering tailored treatment may be promising for beneficial treatment effects. Methods. High-risk patients were selected and classified into 2 groups (pain-persistence and pain-avoidance groups) and subsequently randomized in groups to either a treatment condition (TC) or a waiting list control condition (WLC). Treatment consisted of 16 sessions of cognitive-behavioral therapy (CBT) and exercise training in groups, tailored to the patient's specific cognitive-behavioral pattern, delivered within 10 weeks. Physical and psychological functioning and impact of FM were assessed at baseline, posttreatment, and 6-month followup. Treatment effects were evaluated using a linear mixed model. Results. The treatment effects were significant for all primary outcomes, showing significant differences in physical (pain, fatigue, and functional disability) and psychological (negative mood and anxiety) functioning, and impact of FM for the TC in comparison with the WLC. Effect sizes in the TC were overall large, and reliable change indices indicated a clinically relevant improvement among the TC. Conclusion. The presented results demonstrate for the first time that tailored CBT and exercise training for high-risk patients with FM is effective in improving short-and long-term physical and psychological functioning, indicating that tailoring treatment is likely to promote beneficial outcomes in FM and reduce the burden for patients and society.

A Framework for Fibromyalgia Management for Primary Care Providers

“…• 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.…”

The role of psychological factors in inflammatory rheumatic diseases: From burden to tailored treatment

“…In case of moderate adjustment problems, self-management interventions could sufficiently improve functioning by combining education with some cognitive-behavioral principles such as relaxation, problem solving, and goal setting [2]. For more severe adjustment problems, different evidence-based personalized therapist-guided treatments have become available for diverse patient groups and also include disease-generic approaches that encompass a broad variety of treatment modules of the most relevant areas of functioning across diseases and different cognitive-behavioral techniques and assignments that can be flexibly applied [68,89,90]. Within such tailored treatments, the content of the treatment (e.g., choice of modules to work on and specific topics or assignments within each module) is based on the elaborate screening in combination with the patient priorities and judgment of the therapist.…”

Tailored treatment: It's not what you think it is. Comment on the article by van Koulil et al

“…Indeed, one version of the pain-persistence model posits that persistence may be a form of active avoidance of other unwanted non-pain-associated outcomes, such as social disapproval (11). Also of interest is that both the painavoidance and pain-persistence treatments were aimed at increasing daily activities and physical condition, which is at odds with the authors' assumption that some patients "tend to persist in their activities in spite of the pain, which can lead to overuse and more symptoms in the long run" (6). If the authors in fact adhere to this idea, then one would expect a treatment that is aimed at flexible adjustment of personal goals, and self-regulation or decrease of activities, rather than an increase of activities.…”