Abstract
OBJECTIVE: To evaluate a cognitive-behavioural out-patient program for patients with fibromyalgia syndrome.PATIENTS AND METHODS: A quasi-experimental design was used to evaluate 101 patients who participated in a four-week program that included psychological, family educational, occupational therapy and physiotherapy interventions. After discharge, patients were seen four times over one year for day-long review sessions. Five pain response scales from the Multidimensional Pain Inventory (MPI) and the Fibromyalgia Impact Questionnaire (FIQ) were used to assess treatment effects. Data were analyzed using multivariate ANOVAs followed by multiple comparisons using Tukey's honestly significant difference test.RESULTS: The overall multivariate effect for the MPI was significant (P<0.0001). Subsequent multiple comparisons indicated consistent improvement in pain severity, life interference, life control, emotional distress and activity level scores at discharge, but no change during a no-treatment waiting list control interval. These effects were maintained at a 12-month follow-up with the exception of activity level. The multivariate effect across the FIQ scales was significant (P<0.01). Multiple comparisons indicated that all variables except physical impairment improved at discharge. Impairment (P<0.05), anxiety and well-being (P<0.01) improved at follow-up compared with scores at admission.CONCLUSIONS: Pain response and health status improve following intensive cognitive-behavioural treatment. These effects persist at one year but are generally weaker than at discharge. The largest effects were on indexes that reflect emotional status and general well-being. Implications of these findings for fibromyalgia treatment programs are discussed.
Highlights
Interventions used to treat fibromyalgia syndrome (FS) include tricyclic drugs, muscle relaxants, nonsteroidal anti-inflammatory agents [1,2], electromyography (EMG) biofeedback training [3], aerobic exercise [4], hypnotherapy [5], education plus exercise [6], multimodal group therapy [7] and cognitive-behavioural therapy (CBT) [8,9]. Some of these approaches are only effective for short periods of time whereas others, the two latter programs, appear to promise long term effects
CBT has been recommended as a useful therapeutic measure in the treatment of FS [10], and preliminary data [8,9] from a CBT in-patient program have been encouraging
Pain response Multivariate ANOVA indicated an overall change across time for the Multidimensional Pain Inventory (MPI) variables (Pillai’s V[15,894]=7.76, P
Summary
College of Rheumatology criteria for FS [14] were admitted if they continued to function poorly after receiving basic education about FS and appropriate medications. Exclusion criteria included major psychological or medical illness, unwillingness to discontinue narcotic analgesics and lack of fluency in English. Of 127 consecutive patients admitted, five dropped out or were asked to leave and 21 had missing data on one of the assessment instruments (see below) for at least one of the follow-up sessions. Sixty-seven completed an additional assessment instrument (Fibromyalgia Impact Questionnaire [FIQ]). Average age of participants was 44.9 years (SD 8.1, range 20 to 60); 93 (92.1%) were female, 53.5% were currently working and 87 (86.1%) were living with a significant other (including children)
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