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.

Early Experience with a Brief, Multimodal, Multidisciplinary Treatment Program for Fibromyalgia

“…Patients who travel long distances for specialty care are more willing to participate in shorter compared to lengthier treatment programs. We also observed wide individual variability in outcome (Oh et al, 2010) as reported by others (van Koulil, van Lankveld, Kraaimaat, van Helmond, Vedder, van Hoorn, Donders, de Jong, Haverman, Korff, van Riel, Cats, & Evers, 2010) and it was apparent that some of our patients needed different tailored treatment. It was also important to provide these patients with a pragmatic treatment that was both patient-friendly and high quality.…”

Transcutaneous Electrical Nerve Stimulation and Pain With Movement in People With Fibromyalgia

“…More recently, in individuals with fibromyalgia, lower disease impact (FIQR) was observed following tai chi when used clinically as a mind-body intervention, and lower pain interference was observed after transcutaneous direct current stimulation ( d = 0.73) when combined with education and exercise. These studies support the use of activity-based interventions in treatment of fibromyalgia and suggest that combining interventions may improve effect sizes.…”

Cognitive–behavioral mechanisms in a pain‐avoidance and a pain‐persistence treatment for high‐risk fibromyalgia patients

“…Mediation was examined with regard to the primary outcomes of physical and psychological functioning by the joint significance test (37). In an earlier report of this study it was shown that both the pain‐avoidance and pain‐persistence treatments were effective in improving the primary outcomes of physical and psychological functioning (12, 13). For the pain‐avoidance group, we analyzed the mediating effect of pain‐avoidance behavior on functioning.…”

“…In sum, identifying high‐risk patients in an early stage and offering them timely CBT and exercise training tailored to their specific pain‐avoidance or pain‐persistence pattern is likely to promote treatment outcomes in FM. In two previous reports, we indeed showed this approach to be effective in improving self‐reported physical and psychological functioning, the impact of FM, as well as the level of physical fitness (13, Van Koulil S, et al: unpublished observations). These studies, however, did not address the cognitive–behavioral mechanisms responsible for the obtained effects.…”