1
|
Hedman-Lagerlöf M, Buhrman M, Hedman-Lagerlöf E, Ljótsson B, Axelsson E. Shared and distinct effect mediators in exposure-based and traditional cognitive behavior therapy for fibromyalgia: Secondary analysis of a randomized controlled trial. Behav Res Ther 2024; 178:104546. [PMID: 38685153 DOI: 10.1016/j.brat.2024.104546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2024] [Revised: 04/19/2024] [Accepted: 04/19/2024] [Indexed: 05/02/2024]
Abstract
Fibromyalgia is a chronic pain condition associated with substantial suffering and societal costs. Traditional cognitive behavior therapy (T-CBT) is the most evaluated psychological treatment, but exposure therapy (Exp-CBT) has shown promise with a pronounced focus on the reduction of pain-related avoidance behaviors. In a recent randomized controlled trial (N = 274), we found that Exp-CBT was not superior to T-CBT (d = -0.10) in reducing overall fibromyalgia severity. This study investigated pain-related avoidance behaviors, pain catastrophizing, hypervigilance, pacing, overdoing and physical activity as potential mediators of the treatment effect. Mediation analyses were based on parallel process growth models fitted on 11 weekly measurement points, and week-by-week time-lagged effects were tested using random intercepts cross-lagged panel models. Results indicated that a reduction in avoidance behaviors, pain catastrophizing, and hypervigilance were significant mediators of change in both treatments. An increase in pacing and a reduction in overdoing were significant mediators in T-CBT only. Physical activity was not a mediator. In the time-lagged analyses, an unequivocal effect on subsequent fibromyalgia severity was seen of avoidance and catastrophizing in Exp-CBT, and of overdoing in T-CBT. Exposure-based and traditional CBT for fibromyalgia appear to share common treatment mediators, namely pain-related avoidance behavior, catastrophizing and hypervigilance.
Collapse
Affiliation(s)
- Maria Hedman-Lagerlöf
- Center for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet & Stockholm Health Care Services, Stockholm, Region Stockholm, Sweden.
| | - Monica Buhrman
- Division of Clinical Psychology, Department of Psychology, Uppsala University, Uppsala, Sweden
| | - Erik Hedman-Lagerlöf
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Gustavsberg University Primary Health Care Center, Academic Primary Health Care Center, Stockholm, Region Stockholm, Sweden
| | - Brjánn Ljótsson
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Erland Axelsson
- Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden; Liljeholmen University Primary Health Care Center, Academic Primary Health Care Center, Stockholm, Region Stockholm, Sweden
| |
Collapse
|
2
|
Murillo C, Vo TT, Vansteelandt S, Harrison LE, Cagnie B, Coppieters I, Chys M, Timmers I, Meeus M. How do psychologically based interventions for chronic musculoskeletal pain work? A systematic review and meta-analysis of specific moderators and mediators of treatment. Clin Psychol Rev 2022; 94:102160. [PMID: 35561510 PMCID: PMC11146991 DOI: 10.1016/j.cpr.2022.102160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 03/18/2022] [Accepted: 04/27/2022] [Indexed: 11/25/2022]
Abstract
Psychologically based interventions aim to improve pain-related functioning by targeting pain-related fears, cognitions and behaviors. Mediation and moderation analyses permit further examination of the effect of treatment on an outcome. This systematic review and meta-analysis aims to synthetize the evidence of specific mediators and moderators (i.e., treatment targets) of psychologically based treatment effects on pain and disability. A total of 28 mediation and 11 moderation analyses were included. Thirteen mediation studies were included in a meta-analysis, and the rest was narratively synthetized. Reductions in pain-related fear (indirect effect [IE]: -0.07; 95% confidence interval [CI]: -0.11, -0.04) and catastrophizing (IE: -0.07; 95%CI: -0.14, -0.00), as well as increases in self-efficacy (IE: -0.07; 95%CI: -0.11, -0.04), mediated effects of cognitive behavioral therapy on disability but not on pain intensity, when compared to control treatments. Enhancing pain acceptance (IE: -0.17; 95%CI: -0.31, -0.03) and psychological flexibility (IE: -0.30; 95%CI: -0.41, -0.18) mediated acceptance and commitment therapy effects on disability. The narrative synthesis showed conflicting evidence, which did not support a robust moderated effect for any of the examined constructs. Overall, the methodological quality regarding mediation was low, and some key pitfalls are highlighted alongside recommendations to provide a platform for future research.
Collapse
Affiliation(s)
- Carlos Murillo
- Department of Rehabilitation Sciences, Faculty of Health Sciences and Medicine, Ghent University, Belgium; Pain in Motion international research group, www.paininmotion.be, University of Antwerp, Campus Drie EikenUniversiteitsplein 12610 Wilrijk, Belgium
| | - Tat-Thang Vo
- Department of Statistics, The Wharton School, University of Pennsylvania, Pennsylvania, United States; Department of Applied Mathematics, Computer Science and Statistics, Ghent University, Belgium
| | - Stijn Vansteelandt
- Department of Applied Mathematics, Computer Science and Statistics, Ghent University, Belgium; Department of Medical Statistics, London School of Hygiene and Tropical Medicine, United Kingdom
| | - Lauren E Harrison
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University, California, United States
| | - Barbara Cagnie
- Department of Rehabilitation Sciences, Faculty of Health Sciences and Medicine, Ghent University, Belgium
| | - Iris Coppieters
- Department of Rehabilitation Sciences, Faculty of Health Sciences and Medicine, Ghent University, Belgium; Pain in Motion international research group, www.paininmotion.be, University of Antwerp, Campus Drie EikenUniversiteitsplein 12610 Wilrijk, Belgium; Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Belgium
| | - Marjolein Chys
- Department of Rehabilitation Sciences, Faculty of Health Sciences and Medicine, Ghent University, Belgium
| | - Inge Timmers
- Department of Rehabilitation Sciences, Faculty of Health Sciences and Medicine, Ghent University, Belgium; Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University, California, United States; Department of Rehabilitation Medicine, Maastricht University, Netherlands
| | - Mira Meeus
- Department of Rehabilitation Sciences, Faculty of Health Sciences and Medicine, Ghent University, Belgium; Pain in Motion international research group, www.paininmotion.be, University of Antwerp, Campus Drie EikenUniversiteitsplein 12610 Wilrijk, Belgium; MOVANT research group, Department of Rehabilitation Sciences and Physiotherapy, Faculty of Health Sciences and Medicine, University of Antwerp, Belgium.
| |
Collapse
|
3
|
López-Roig S, Peñacoba C, Martínez-Zaragoza F, Abad E, Catalá P, Suso-Ribera C, Pastor-Mira MÁ. The Activity Patterns Scale: An Analysis of its Construct Validity in Women With Fibromyalgia. Clin J Pain 2021; 37:887-897. [PMID: 34483231 DOI: 10.1097/ajp.0000000000000980] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 08/24/2021] [Indexed: 02/07/2023]
Abstract
OBJECTIVES Avoidance, persistence, and pacing are activity patterns that have different adaptive effects in chronic pain patients. Some inconsistent findings have been explained from a contextual perspective that underlines the purpose of the activity. In this way, avoidance, persistence, and pacing are multidimensional constructs, nuanced by their goals. This multidimensionality has been supported with a new instrument, the Activity Patterns Scale, in heterogeneous chronic pain samples. Owing to the clinical implications of this conceptualization, the complexity of the activity patterns and their relationships with health outcomes in fibromyalgia (FM), our aim was to explore the construct validity of this scale in this pain problem, testing its internal structure and the relationships with other constructs. MATERIALS AND METHODS The sample included 702 women with diagnosis of FM from tertiary (53.3%) and community settings (46.7%). Confirmatory factor analysis was conducted to test different factor structures of the activity patterns and Pearson correlation to explore the relationships with health outcomes and psychosocial variables. RESULTS A 6-factor structure showed acceptable fit indices (standardized root mean square residual=0.062; root mean-square error of approximation=0.066; comparative fit index=0.908). The highest significant relationships for health outcomes was between activity avoidance and FM impact (r=0.36) and excessive persistence and negative affect (r=0.41). DISCUSSION Avoidance and persistence activity patterns are shown as multidimensional constructs but not pacing. The ongoing pain in these women may make it difficult to regulate their activity taking into account other goals not contingent on pain fluctuations.
Collapse
Affiliation(s)
- Sofía López-Roig
- Department of Behavioral Sciences and Health, Miguel Hernández University, Elche
| | | | | | - Esther Abad
- Fibromyalgia Unit, Hospital of San Vicente del Raspeig, Alicante
| | - Patricia Catalá
- Department of Psychology, Rey Juan Carlos University, Madrid
| | - Carlos Suso-Ribera
- Department of Basic and Clinical Psychology and Psychobiology, Jaume I, University, Castellon, Spain
| | | |
Collapse
|
4
|
Is Irritable Bowel Syndrome Considered as Comorbidity in Clinical Trials of Physical Therapy Interventions in Fibromyalgia? A Scoping Review. J Clin Med 2021; 10:jcm10204776. [PMID: 34682899 PMCID: PMC8541581 DOI: 10.3390/jcm10204776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 10/13/2021] [Accepted: 10/15/2021] [Indexed: 11/17/2022] Open
Abstract
Evidence supports the presence of comorbid conditions, e.g., irritable bowel syndrome (IBS), in individuals with fibromyalgia (FM). Physical therapy plays an essential role in the treatment of FM; however, it is not currently known whether the IBS comorbidity is considered in the selection criteria for clinical trials evaluating physiotherapy in FM. Thus, the aim of the review was to identify whether the presence of IBS was considered in the selection criteria for study subjects for those clinical trials that have been highly cited or published in the high-impact journals investigating the effects of physical therapy in FM. A literature search in the Web of Science database for clinical trials that were highly cited or published in high-impact journals, i.e., first second quartile (Q1) of any category of the Journal Citation Report (JCR), investigating the effects of physical therapy in FM was conducted. The methodological quality of the selected trials was assessed with the Physiotherapy Evidence Database (PEDro) scale. Authors, affiliations, number of citations, objectives, sex/gender, age, and eligibility criteria of each article were extracted and analyzed independently by two authors. From a total of the 412 identified articles, 20 and 61 clinical trials were included according to the citation criterion or JCR criterion, respectively. The PEDro score ranged from 2 to 8 (mean: 5.9, SD: 0.1). The comorbidity between FM and IBS was not considered within the eligibility criteria of the participants in any of the clinical trials. The improvement of the eligibility criteria is required in clinical trials on physical therapy that include FM patients to avoid selection bias.
Collapse
|
5
|
Martinez-Calderon J, Flores-Cortes M, Morales-Asencio JM, Luque-Suarez A. Intervention Therapies to Reduce Pain-Related Fear in Fibromyalgia Syndrome: A Systematic Review of Randomized Clinical Trials. PAIN MEDICINE 2021; 22:481-498. [PMID: 32989450 DOI: 10.1093/pm/pnaa331] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVE This systematic review aimed to evaluate the effectiveness of different interventions at reducing pain-related fear in people with fibromyalgia and to analyze whether the included trials reported their interventions in full detail. DESIGN Systematic review. SETTING No restrictions. METHODS The Cochrane Library, CINAHL, EMBASE, PsycINFO, PubMed, and Scopus were searched from their inception to April 2020, along with manual searches and a gray literature search. Randomized clinical trials were included if they assessed pain-related fear constructs as the primary or secondary outcome in adults with fibromyalgia. Two reviewers independently performed the study selection, data extraction, risk-of-bias assessment, Template for Intervention Description and Replication (TIDieR) checklist assessment, and grading the quality of evidence. RESULTS Twelve randomized clinical trials satisfied the eligibility criteria, including 11 cohorts with a total sample of 1,441 participants. Exercise, multicomponent, and psychological interventions were more effective than controls were in reducing kinesiophobia. However, there were no differences in decreasing kinesiophobia when self-management and electrotherapy were used. There were also no differences between groups with regard to the rest of the interventions and pain-related constructs (fear-avoidance beliefs, fear of pain, and pain-related anxiety). However, a serious risk of bias and a very serious risk of imprecision were detected across the included trials. This caused the overall certainty of the judged evidence to be low and very low. Additionally, the included trials reported insufficient details to allow the full replication of their interventions. CONCLUSIONS This systematic review shows that there are promising interventions, such as exercise, multicomponent, and psychological therapies, that may decrease one specific type of fear in people with fibromyalgia, i.e., kinesiophobia. However, because of the low-very low certainty of the evidence found, a call for action is needed to improve the quality of randomized clinical trials, which will lead to more definitive information about the clinical efficacy of interventions in this field.
Collapse
Affiliation(s)
- Javier Martinez-Calderon
- Department of Physiotherapy, Faculty of Health Sciences, Universidad de Malaga, Malaga, Spain.,Instituto de Investigación Biomédica de Málaga (IBIMA), Malaga, Spain
| | - Mar Flores-Cortes
- Department of Physiotherapy, Faculty of Health Sciences, Universidad de Malaga, Malaga, Spain
| | - Jose Miguel Morales-Asencio
- Instituto de Investigación Biomédica de Málaga (IBIMA), Malaga, Spain.,Department of Nursing, Faculty of Health Sciences, Universidad de Malaga, Malaga, Spain
| | - Alejandro Luque-Suarez
- Department of Physiotherapy, Faculty of Health Sciences, Universidad de Malaga, Malaga, Spain.,Instituto de Investigación Biomédica de Málaga (IBIMA), Malaga, Spain
| |
Collapse
|
6
|
Masquelier E, D'haeyere J. Physical activity in the treatment of fibromyalgia. Joint Bone Spine 2021; 88:105202. [PMID: 33962033 DOI: 10.1016/j.jbspin.2021.105202] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/04/2021] [Indexed: 01/03/2023]
Abstract
International treatment recommendations for fibromyalgia (FM) highlight the importance of adapted physical activity (APA) combined with patient education. Cognitive and behavioral therapies as well as an interdisciplinary approach can be proposed for more complex or severe clinical situations, with a biopsychosocial vision of rehabilitation. To personalize the rehabilitation's therapeutic approach, a clinician can use simple and validated instruments for measuring physical performance that will highlight levels of physical conditioning, which range from low to very low in FM patients. Several systematic reviews and meta-analyses have found strong evidence that supervised aerobic and resistance-training programs reduce the pain intensity and significantly improve the quality of life and the physical and psychological functioning of female FM subjects. These therapeutic approaches appear safe and promising in terms of cost-effectiveness and should be the subject of more randomized controlled trials among male FM subjects and adolescents.
Collapse
Affiliation(s)
- Etienne Masquelier
- Centre Multidisciplinaire de Douleur Chronique, CHU UCL Namur, site Godinne, Avenue Dr G. Thérasse, 1, 5530 Yvoir, Belgium; Institute of NeuroScience (IoNS), Université catholique de Louvain, Louvain, Belgium.
| | - Jacques D'haeyere
- Centre Multidisciplinaire de Douleur Chronique, CHU UCL Namur, site Godinne, Avenue Dr G. Thérasse, 1, 5530 Yvoir, Belgium
| |
Collapse
|
7
|
Racine M, Sánchez-Rodríguez E, de la Vega R, Galán S, Solé E, Jensen MP, Miró J, Moulin DE, Nielson WR. Pain-Related Activity Management Patterns as Predictors of Treatment Outcomes in Patients with Fibromyalgia Syndrome. PAIN MEDICINE 2021; 21:e191-e200. [PMID: 31626301 DOI: 10.1093/pm/pnz259] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVES This study sought to determine if pre- to post-treatment changes in pain-related activity patterns (i.e., overdoing, avoidance, and pacing) were associated with pre- to post-treatment changes in function (i.e., pain interference, psychological function, and physical function) in patients with fibromyalgia syndrome who participated in either an operant learning- or an energy conservation-based training in activity management. METHODS Sixty-nine patients with fibromyalgia syndrome participated in an activity management treatment (32 in an operant learning group and 37 in an energy conservation group). Outcomes were assessed at pre- and post-treatment, and patients provided demographic information and completed measures assessing pain intensity, pain interference, psychological function, physical function, and pain management activity patterns. Three linear hierarchical regression analyses predicting changes in pain outcomes from changes in pacing, overdoing, and avoidant activity patterns were performed. RESULTS Changes in pain-related activity patterns made significant contributions to the prediction of changes in patients' function. Specifically: (a) increases in overdoing predicted reductions in pain interference; (b) decreases in avoidance predicted improvements in psychological function; and (c) increases in pacing predicted improvements in physical function. CONCLUSIONS This study provides support for a role of activity management treatments in improved adjustment to chronic pain. Research is needed to replicate and extend these findings in order to build an empirical basis for developing more effective chronic pain treatments for facilitating improved physical and psychological function in individuals with chronic pain.
Collapse
Affiliation(s)
- Mélanie Racine
- Department of Clinical Neurological Sciences, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Elisabet Sánchez-Rodríguez
- Unit for the Study and Treatment of Pain-ALGOS, Universitat Rovira i Virgili, Catalonia, Spain
- Research Center for Behavior Assessment (CRAMC), Department of Psychology, Universitat Rovira i Virgili, Catalonia, Spain
- Institut d'Investigación Sanitària Pere Virgili, Universitat Rovira i Virgili, Catalonia, Spain
| | - Rocío de la Vega
- Unit for the Study and Treatment of Pain-ALGOS, Universitat Rovira i Virgili, Catalonia, Spain
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington, USA
| | - Santiago Galán
- Unit for the Study and Treatment of Pain-ALGOS, Universitat Rovira i Virgili, Catalonia, Spain
- Research Center for Behavior Assessment (CRAMC), Department of Psychology, Universitat Rovira i Virgili, Catalonia, Spain
- Institut d'Investigación Sanitària Pere Virgili, Universitat Rovira i Virgili, Catalonia, Spain
| | - Ester Solé
- Unit for the Study and Treatment of Pain-ALGOS, Universitat Rovira i Virgili, Catalonia, Spain
- Research Center for Behavior Assessment (CRAMC), Department of Psychology, Universitat Rovira i Virgili, Catalonia, Spain
- Institut d'Investigación Sanitària Pere Virgili, Universitat Rovira i Virgili, Catalonia, Spain
| | - Mark P Jensen
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington, USA
| | - Jordi Miró
- Unit for the Study and Treatment of Pain-ALGOS, Universitat Rovira i Virgili, Catalonia, Spain
- Research Center for Behavior Assessment (CRAMC), Department of Psychology, Universitat Rovira i Virgili, Catalonia, Spain
- Institut d'Investigación Sanitària Pere Virgili, Universitat Rovira i Virgili, Catalonia, Spain
| | - Dwight E Moulin
- Department of Clinical Neurological Sciences, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Warren R Nielson
- Department of Psychology, Western University and Lawson Health Research Institute, London, Ontario, Canada
| |
Collapse
|
8
|
Sheila B, Octavio LR, Patricia C, Dolores B, Lilian V, Cecilia P. Perfectionism and Pain Intensity in Women with Fibromyalgia: Its Influence on Activity Avoidance from The Contextual Perspective. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17228442. [PMID: 33202698 PMCID: PMC7698249 DOI: 10.3390/ijerph17228442] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 11/06/2020] [Accepted: 11/11/2020] [Indexed: 12/25/2022]
Abstract
Given the scarcity of studies regarding perfectionism from a contextual perspective, this study aims to analyze its role in the relationship between pain and activity avoidance and its differential effect among patients with different fibromyalgia severity. A cross-sectional study with 228 women with fibromyalgia classified into two disease severity groups (low/moderate vs. high) was carried out. Moderation analyses were conducted; perfectionism was used as moderator, pain (in high and low pain situations) as independent variable, and activity avoidance as the outcome. Among the high disease severity group, analyses showed direct contributions of perfectionism (p < 0.001) but not of pain (p > 0.05); moderation effects were found in high pain situations (p = 0.002) (for low levels of perfectionism, a positive association was found between pain intensity and avoidance). Among the low severity group, direct effects of perfectionism (p < 0.05) and pain intensity (p = 0.04) were found (although the latter only for high pain situations); moderation effects were found in high pain situations (p = 0.018) (for high levels of perfectionism a positive and significant association was found between pain intensity and avoidance). Perfectionism has been found to be a key variable in the differential relationship between pain intensity (in high pain situations) and activity avoidance in groups with high and low disease severity.
Collapse
Affiliation(s)
- Blanco Sheila
- Department of Psychology, Universidad Rey Juan Carlos, 28933 Madrid, Spain; (B.S.); (L.-R.O.); (C.P.); (V.L.)
| | - Luque-Reca Octavio
- Department of Psychology, Universidad Rey Juan Carlos, 28933 Madrid, Spain; (B.S.); (L.-R.O.); (C.P.); (V.L.)
| | - Catala Patricia
- Department of Psychology, Universidad Rey Juan Carlos, 28933 Madrid, Spain; (B.S.); (L.-R.O.); (C.P.); (V.L.)
| | - Bedmar Dolores
- Pain Unit, Hospital Universitario de Fuenlabrada, 28944 Fuenlabrada, Madrid, Spain;
| | - Velasco Lilian
- Department of Psychology, Universidad Rey Juan Carlos, 28933 Madrid, Spain; (B.S.); (L.-R.O.); (C.P.); (V.L.)
| | - Peñacoba Cecilia
- Department of Psychology, Universidad Rey Juan Carlos, 28933 Madrid, Spain; (B.S.); (L.-R.O.); (C.P.); (V.L.)
- Correspondence: ; Tel.: +34-91-488-88-64
| |
Collapse
|
9
|
Hedman-Lagerlöf M, Andersson E, Hedman-Lagerlöf E, Wicksell RK, Flink I, Ljótsson B. Approach as a key for success: Reduced avoidance behaviour mediates the effect of exposure therapy for fibromyalgia. Behav Res Ther 2019; 122:103478. [PMID: 31585343 DOI: 10.1016/j.brat.2019.103478] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 06/09/2019] [Accepted: 09/09/2019] [Indexed: 01/10/2023]
Abstract
Fibromyalgia (FM) is a prevalent chronic pain disorder associated with large suffering and substantial societal costs. Pain-related avoidance behaviour and hypervigilance to bodily symptoms are common in FM and contribute in maintaining and exacerbating the disorder. Exposure therapy targeting avoidance behaviours and hypervigilance has shown promise in the treatment of FM. The present study investigated mediators of treatment outcome in exposure therapy for FM. We used data from a randomised trial, where 140 participants were allocated to 10-week internet-delivered exposure therapy or to a waiting-list control condition. The main outcome variable (FM symptoms) and the hypothesized mediators (FM-related avoidance behaviour, mindful non-reactivity and FM-related worry) were measured weekly throughout treatment. Mediation analyses were conducted using linear mixed effects models with bootstrap replication and time-lagged analysis. Results indicated that all three process variables were significant mediators of FM severity. However, in the time-lagged analyses, only FM-related avoidance behaviour displayed a unidirectional relationship over time with FM symptoms, suggesting a causal effect. Thus, results illustrate that changes in avoidance behaviour mediate the outcome of exposure on FM symptoms, which implies that avoidance behaviour is an important treatment target in exposure therapy.
Collapse
Affiliation(s)
- Maria Hedman-Lagerlöf
- Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden.
| | - Erik Andersson
- Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden
| | - Erik Hedman-Lagerlöf
- Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden
| | - Rikard K Wicksell
- Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden; Functional Area Medical Psychology, Karolinska University Hospital Solna, Stockholm, Sweden
| | - Ida Flink
- Örebro University, Center for Health and Medical Psychology (CHAMP), Örebro, Sweden
| | - Brjánn Ljótsson
- Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden; Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
10
|
Operant Learning Versus Energy Conservation Activity Pacing Treatments in a Sample of Patients With Fibromyalgia Syndrome: A Pilot Randomized Controlled Trial. THE JOURNAL OF PAIN 2018; 20:420-439. [PMID: 30326271 DOI: 10.1016/j.jpain.2018.09.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Revised: 07/23/2018] [Accepted: 09/07/2018] [Indexed: 12/26/2022]
Abstract
This study's aim was to assess the efficacy of 2 forms of activity pacing in patients with fibromyalgia syndrome (FMS). Treatment-related changes in activity management patterns were also examined. Patients with FMS (n = 178) were randomly assigned to an operant learning (OL; delayed [n = 36] or immediate [n = 54] groups) or an energy conservation (EC; delayed [n = 35] or immediate [n = 53] groups) treatment condition. Of these, 32 OL and 37 EC patients completed treatment. Forty-three patients were allocated to the delayed treatment condition (control group). Repeated measures analyses of variance were used to examine the effects of OL and EC treatments on primary (average pain and usual fatigue), secondary (pain and fatigue interference, physical and psychological function, sleep quality, depressive symptoms, and anxiety symptoms), and tertiary (pain-related activity patterns) outcomes. Neither treatment was effective in reducing average pain or usual fatigue symptoms. Relative to EC, OL patients showed greater improvements in depressive symptoms, whereas nonsignificant trends (P values ranging between .05 and .06) were observed for pain interference, fatigue interference, and psychological function. Both treatments were associated with improvements in sleep quality and physical function, increases in pacing, and decreases in overdoing activity patterns. Reductions in activity avoidance were only found in OL. These findings suggest that OL may be more beneficial than EC and that it could potentially be viewed as an effective stand-alone activity pacing treatment for patients with FMS. Research to determine the extent to which these preliminary findings replicate is warranted. PERSPECTIVE: This article examines the efficacy of 2 forms of activity pacing in patients with fibromyalgia syndrome. The results suggest the possibility that operant learning may be more beneficial than energy conservation and could potentially be viewed as an effective stand-alone activity pacing treatment for patients with fibromyalgia syndrome.
Collapse
|
11
|
Bäckryd E, Persson EB, Larsson AI, Fischer MR, Gerdle B. Chronic pain patients can be classified into four groups: Clustering-based discriminant analysis of psychometric data from 4665 patients referred to a multidisciplinary pain centre (a SQRP study). PLoS One 2018; 13:e0192623. [PMID: 29420607 PMCID: PMC5805304 DOI: 10.1371/journal.pone.0192623] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Accepted: 01/26/2018] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE To subgroup chronic pain patients using psychometric data and regress the variables most responsible for subgroup discrimination. DESIGN Cross-sectional, registry-based study. SETTING AND SUBJECTS Chronic pain patients assessed at a multidisciplinary pain centre between 2008 and 2015. METHODS Data from the Swedish quality registry for pain rehabilitation (SQRP) were retrieved and analysed by principal component analysis, hierarchical clustering analysis, and partial least squares-discriminant analysis. RESULTS Four subgroups were identified. Group 1 was characterized by low "psychological strain", the best relative situation concerning pain characteristics (intensity and spreading), the lowest frequency of fibromyalgia, as well as by a slightly older age. Group 2 was characterized by high "psychological strain" and by the most negative situation with respect to pain characteristics (intensity and spreading). Group 3 was characterized by high "social distress", the longest pain durations, and a statistically higher frequency of females. The frequency of three neuropathic pain conditions was generally lower in this group. Group 4 was characterized by high psychological strain, low "social distress", and high pain intensity. CONCLUSIONS The identification of these four clusters of chronic pain patients could be useful for the development of personalized rehabilitation programs. For example, the identification of a subgroup characterized mainly by high perceived "social distress" raises the question of how to best design interventions for such patients. Differentiating between clinically important subgroups and comparing how these subgroups respond to interventions is arguably an important area for further research.
Collapse
Affiliation(s)
- Emmanuel Bäckryd
- Pain and Rehabilitation Centre, and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Elisabeth B. Persson
- Lund University, Department of Health Sciences, Lund, Sweden
- Department of Pain Rehabilitation Medicine, Skåne University Hospital, Lund, Sweden
| | | | - Marcelo Rivano Fischer
- Lund University, Department of Health Sciences, Lund, Sweden
- Department of Pain Rehabilitation Medicine, Skåne University Hospital, Lund, Sweden
| | - Björn Gerdle
- Pain and Rehabilitation Centre, and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| |
Collapse
|
12
|
Harrison AM, McCracken LM, Jones K, Norton S, Moss-Morris R. Using mixed methods case-series evaluation in the development of a guided self-management hybrid CBT and ACT intervention for multiple sclerosis pain. Disabil Rehabil 2017; 39:1785-1798. [PMID: 27557625 DOI: 10.1080/09638288.2016.1209580] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE Two-thirds of the people with multiple sclerosis (pwMS) experience pain. Medications provide minimal relief, and current non-pharmacological interventions lack a clear conceptualization of MS pain. This study explored the potential efficacy of a telephone-supported hybrid cognitive behavior therapy and acceptance and commitment therapy self-management intervention for pwMS based on an empirically supported model of MS pain using a replicated single-case series design. METHODS Seven pwMS with varied demographic and disease characteristics completed the 8-week home-based program alongside 3 hours of telephone support. Online questionnaires were completed every four days for 16 weeks (4-weeks baseline, 8-weeks treatment, 4-weeks follow-up). The primary outcomes were pain severity and pain interference. Psychological process variables drawn from the MS pain model were also completed, and post-treatment qualitative interviews conducted. RESULTS Simulation modeling analysis (SMA) showed three patients had large improvements in pain outcomes, two showed no change and two worsened. Five participants showed significant change on various psychological process variables. Change in pain catastrophizing was the most consistent finding. CONCLUSIONS The findings suggest a self-management program for MS pain with minimal therapy support may be effective for some pwMS, but not those with more complex comorbidities. The participants suggested web-based delivery may simplify the approach, and therapist telephone contact was highly valued. Implications for Rehabilitation This case series suggests a hybrid CBT/ACT self-management workbook program for MS pain improves severity and impact of pain in some pwMS. Pain-related catastrophizing reduced in most pwMS, whilst change in other ACT and CBT process variables varied across the individuals. PwMS feedback suggests a tailored web-based delivery of the program with therapist telephone support may be optimal. PwMS with serious co-morbid depression and very advanced disease may not respond well to this self-management approach.
Collapse
Affiliation(s)
- Anthony M Harrison
- a Health Psychology Section, Institute of Psychiatry, Psychology and Neuroscience, King's College London , London , UK
| | - Lance M McCracken
- a Health Psychology Section, Institute of Psychiatry, Psychology and Neuroscience, King's College London , London , UK
| | - Katherine Jones
- a Health Psychology Section, Institute of Psychiatry, Psychology and Neuroscience, King's College London , London , UK
| | - Sam Norton
- a Health Psychology Section, Institute of Psychiatry, Psychology and Neuroscience, King's College London , London , UK
| | - Rona Moss-Morris
- a Health Psychology Section, Institute of Psychiatry, Psychology and Neuroscience, King's College London , London , UK
| |
Collapse
|
13
|
Van Den Houte M, Luyckx K, Van Oudenhove L, Bogaerts K, Van Diest I, De Bie J, Van den Bergh O. Differentiating progress in a clinical group of fibromyalgia patients during and following a multicomponent treatment program. J Psychosom Res 2017; 98:47-54. [PMID: 28554372 DOI: 10.1016/j.jpsychores.2017.05.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 04/28/2017] [Accepted: 05/03/2017] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Treatments including multiple nonpharmacological components have beneficial effects on the key symptoms of fibromyalgia, although effects are limited and often do not persist. In this study, we examined different patterns of clinical progress and the dynamic interplay between predictors and outcomes over time. METHODS Fibromyalgia patients (N=153; 135 women) followed a multidisciplinary group program spanning 12weeks, aimed at "regaining control over daily functioning". Anxiety, depression, pain coping and kinesiophobia were used as predictor variables. Outcome variables were pain severity, pain-related disability, physical functioning and functional interference. All variables were assessed at 3 moments: on the first and last day of treatment, and 12weeks after the last day of treatment. Overall treatment effects were analyzed using mixed model analyses. Latent class growth analysis identifying different treatment trajectory classes was used to investigate individual differences in treatment effects. Finally, cross-lagged structural equation models were used to investigate the dynamic interplay between predictors and outcomes over time. RESULTS Only a fourth to a third of the total group showed improvement on the outcome variables. These patients had lower baseline anxiety, depression and kinesiophobia, and improved more on anxiety, depression and kinesiophobia. Physical well-being had a stronger effect on anxiety and depression than vice versa. Physical functioning predicted relative changes in kinesiophobia, while kinesiophobia predicted relative changes in pain-related disability. CONCLUSION The results emphasize the importance of tailoring treatments to individual needs in order to improve overall effectiveness of treatment programs.
Collapse
Affiliation(s)
| | - Koen Luyckx
- School Psychology and Development in Context, University of Leuven, Leuven, Belgium
| | - Lukas Van Oudenhove
- Translational Research Centre for Gastrointestinal Disorders (TARGID), Department of Clinical & Experimental Medicine, University of Leuven, Leuven, Belgium
| | | | - Ilse Van Diest
- Health Psychology, University of Leuven, Leuven, Belgium
| | - Jozef De Bie
- Department of Psychiatry, Hospital ZOL Limburg, Genk, Belgium
| | | |
Collapse
|
14
|
Piedimonte A, Guerra G, Vighetti S, Carlino E. Measuring expectation of pain: Contingent negative variation in placebo and nocebo effects. Eur J Pain 2017; 21:874-885. [PMID: 28106308 DOI: 10.1002/ejp.990] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/08/2016] [Indexed: 02/05/2023]
Abstract
BACKGROUND Expectation is an important mechanism underlying placebo response. Here, we analysed expectation of placebo hypoalgesia and nocebo hyperalgesia by using, for the first time, the contingent negative variation (CNV), also known as expectancy wave. METHODS Subjects were presented a green or red cue followed by a train of either non painful or painful electrical stimuli, and expected hypoalgesia after the green and hyperalgesia after the red cue. In experiment 1, expectation was reinforced using a conditioning procedure whereby the green and red cues were paired with non painful and painful stimuli, respectively (acquisition). In a second session (test) the intensity of the stimuli was kept constant, regardless of cue. In experiment 2 no conditioning was performed and participants expected an altered pain perception indicated by the visual cues. CNV mean amplitude, time necessary to stop the train of stimuli (reaction time) and pain ratings were measured. RESULTS A difference in pain perception occurred when electrical stimuli followed the presentation of the green cue compared to the red in the test session, whereas reaction times showed no changes. The same difference occurred in the early CNV component, related to cognitive stimulus anticipation, whereas the late CNV component, related to motor preparation, did not change. Moreover, these differences in pain perception and CNV amplitude were less robust in the experiment 2. CONCLUSION Placebo hypoalgesia and nocebo hyperalgesia differently affect sensory (pain perception) and motor components (pain avoidance) of pain. Furthermore, CNV is an electrophysiological objective measure capable of dissecting these components. SIGNIFICANCE Dissection of placebo hypoalgesia, differentiating the sensory component (pain perception) from the motor component (pain avoidance). Study of these components using the contingent negative variation (CNV) as an electrophysiological objective measure.
Collapse
Affiliation(s)
- A Piedimonte
- Department of Neuroscience, University of Turin Medical School, and National Institute of Neuroscience, Italy
| | - G Guerra
- Department of Neuroscience, University of Turin Medical School, and National Institute of Neuroscience, Italy
| | - S Vighetti
- Department of Neuroscience, University of Turin Medical School, and National Institute of Neuroscience, Italy
| | - E Carlino
- Department of Neuroscience, University of Turin Medical School, and National Institute of Neuroscience, Italy
| |
Collapse
|
15
|
Palstam A, Larsson A, Löfgren M, Ernberg M, Bjersing J, Bileviciute-Ljungar I, Gerdle B, Kosek E, Mannerkorpi K. Decrease of fear avoidance beliefs following person-centered progressive resistance exercise contributes to reduced pain disability in women with fibromyalgia: secondary exploratory analyses from a randomized controlled trial. Arthritis Res Ther 2016; 18:116. [PMID: 27209068 PMCID: PMC4875714 DOI: 10.1186/s13075-016-1007-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Accepted: 04/28/2016] [Indexed: 01/24/2023] Open
Abstract
Background Fibromyalgia (FM) is characterized by persistent widespread pain, increased pain sensitivity and tenderness. Women with FM also report disability, in terms of negative consequences on activities of daily living. Our recent randomized controlled trial (RCT) is the first study of resistance exercise to show positive effects on pain disability. The resistance exercise program of our RCT emphasized active involvement of participants in planning and progression of the exercise, using the principles of person-centeredness, to support each participant’s ability to manage the exercise and the progress of it. The aim of this sub-study was to investigate explanatory factors for reduced pain disability in women with FM participating in a 15-week person-centered progressive resistance exercise program. Methods A total of 67 women with FM were included in this sub-study of an RCT examining the effects of person-centered progressive resistance exercise performed twice a week for 15 weeks. Tests of physical capacity and health-related questionnaires were assessed at baseline and after the intervention period. Multivariable stepwise regression was used to analyze explanatory factors for improvements in pain disability. Results Reduced pain disability was explained by higher pain disability at baseline together with decreased fear avoidance beliefs about physical activity (R2 = 28, p = 0.005). The improvements in the disability domains of recreation and social activity were explained by decreased fear avoidance beliefs about physical activity together with higher baseline values of each disability domain respectively (R2 = 32, p = 0.025 and R2 = 30, p = 0.017). The improvement in occupational disability was explained by higher baseline values of occupational disability (R2 = 19, p = 0.001). Conclusion The person-centered resistance exercise intervention, based on principles of self-efficacy, had a positive effect on recreational, social and occupational disability. The reduced pain disability seemed to be mediated by decreased fear avoidance beliefs. Age, symptom duration, pain intensity, and muscle strength at baseline had no explanatory value for reduced pain disability, indicating that the person-centered resistance exercise program has the potential to work for anyone with FM who has interest in physical exercise. The trial was registered on October 21, 2010 with ClinicalTrials.gov identification number: NCT01226784.
Collapse
Affiliation(s)
- Annie Palstam
- Institute of neuroscience and physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| | - Anette Larsson
- Institute of neuroscience and physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,University of Gothenburg Centre for Person Centered Care (GPCC), Gothenburg, Sweden
| | - Monika Löfgren
- Dep of Clinical Sciences, Karolinska Institutet and Dep of Rehabilitation Medicine, Danderyd Hospital, Stockholm, Sweden
| | - Malin Ernberg
- Department of Dental Medicine, Karolinska Institutet, and Scandinavian Center for Orofacial Neurosciences (SCON), Huddinge, SE-141 04, Sweden
| | - Jan Bjersing
- Sahlgrenska University Hospital, Rheumatology, Göteborg, Sweden
| | - Indre Bileviciute-Ljungar
- Dep of Clinical Sciences, Karolinska Institutet and Dep of Rehabilitation Medicine, Danderyd Hospital, Stockholm, Sweden
| | - Björn Gerdle
- Department of Medical and Health Sciences, Faculty of Medicine and Health Sciences, Linköping University, Pain and Rehabilitation Centre, Linköping, Sweden.,Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Eva Kosek
- Department of Clinical Neuroscience, Karolinska Institutet and Stockholm Spine Center, Stockholm, Sweden
| | - Kaisa Mannerkorpi
- Institute of neuroscience and physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,University of Gothenburg Centre for Person Centered Care (GPCC), Gothenburg, Sweden
| |
Collapse
|
16
|
Hasenbring MI, Chehadi O, Titze C, Kreddig N. Fear and anxiety in the transition from acute to chronic pain: there is evidence for endurance besides avoidance. Pain Manag 2015; 4:363-74. [PMID: 25350076 DOI: 10.2217/pmt.14.36] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Substantial evidence reveals that the fear of pain and pain anxiety play a significant role in the development of chronic pain and disability, although underlying mechanisms remain widely unknown. Recent studies indicate that endurance pain responses are important besides avoidance. The purpose of this brief narrative review is to provide an overview of research that argues for the integration of the mechanisms of associative learning, motivation and emotion regulation in order to understand the questions of how and why individuals respond with pain responses, which lead to long-term suffering. By using the avoidance-endurance model of pain, we provide a concept that elucidates a range of responses to pain, fear and anxiety that mediate the transition from acute to chronic pain.
Collapse
Affiliation(s)
- Monika I Hasenbring
- Department of Medical Psychology & Medical Sociology, Faculty of Medicine, Ruhr-University of Bochum, Germany
| | | | | | | |
Collapse
|
17
|
Bernik M, Sampaio TPA, Gandarela L. Fibromyalgia comorbid with anxiety disorders and depression: combined medical and psychological treatment. Curr Pain Headache Rep 2014; 17:358. [PMID: 23904203 DOI: 10.1007/s11916-013-0358-3] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Fibromyalgia is associated with high level of pain and suffering. Lack of diagnosis leads to onerous indirect economic costs. Recent data indicate that fibromyalgia; anxiety disorders, and depression tend to occur as comorbid conditions. They also share some common neurochemical dysfunctions and central nervous system alterations such as hypofunctional serotonergic system and altered reactivity of the hypothalamic-pituitary-adrenal axis. Conversely, functional neuroimaging findings point to different patterns of altered pain processing mechanisms between fibromyalgia and depression. There is no cure for fibromyalgia, and treatment response effect size is usually small to moderate. Treatment should be based on drugs that also target the comorbid psychiatric condition. Combined pharmacotherapy and cognitive-behavior therapy should ideally be offered to all patients. Lifestyle changes, such as physical exercise should be encouraged. The message to patients should be that all forms of pain are true medical conditions and deserve proper care.
Collapse
Affiliation(s)
- Marcio Bernik
- Anxiety Disorders Program, Institute of Psychiatry FMUSP, R. Dr. Ovidio Pires de Campos, 785, Caixa Postal 3671, CEP 01060-970, Sao Paulo, SP, Brazil.
| | | | | |
Collapse
|
18
|
Abstract
BACKGROUND Activity pacing (AP) is a concept that is central to many chronic pain theories and treatments, yet there remains confusion regarding its definition and effects. OBJECTIVE To review the current knowledge concerning AP and integrate this knowledge in a manner that allows for a clear definition and useful directions for future research. METHODS A narrative review of the major theoretical approaches to AP and of the empirical evidence regarding the effects of AP interventions, followed by an integrative discussion. RESULTS The concept of AP is derived from 2 main traditions: operant and energy conservation. Although there are common elements across these traditions, significant conceptual and practical differences exist, which has led to confusion. Little empirical evidence exists concerning the efficacy of AP as a treatment for chronic pain. DISCUSSION Future research on AP should be based on a clear theoretical foundation, consider the context in which the AP behavior occurs and the type of pacing problem ("underactivity" vs. "overactivity"), and should examine the impact of AP treatment on multiple clinical outcomes. We provide a provisional definition of AP and specific recommendations that we believe will move the field forward.
Collapse
|
19
|
Abstract
BACKGROUND Fibromyalgia (FM) is a clinically well-defined chronic condition of unknown aetiology characterized by chronic widespread pain that often co-exists with sleep disturbances, cognitive dysfunction and fatigue. Patients often report high disability levels and negative mood. Psychotherapies focus on reducing key symptoms, improving daily functioning, mood and sense of personal control over pain. OBJECTIVES To assess the benefits and harms of cognitive behavioural therapies (CBTs) for treating FM at end of treatment and at long-term (at least six months) follow-up. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2013, Issue 8), MEDLINE (1966 to 28 August 2013), PsycINFO (1966 to 28 August 2013) and SCOPUS (1980 to 28 August 2013). We searched http://www.clinicaltrials.gov (web site of the US National Institutes of Health) and the World Health Organization Clinical Trials Registry Platform (ICTRP) (http://www.who.int/ictrp/en/) for ongoing trials (last search 28 August,2013), and the reference lists of reviewed articles. SELECTION CRITERIA We selected randomised controlled trials of CBTs with children, adolescents and adults diagnosed with FM. DATA COLLECTION AND ANALYSIS The data of all included studies were extracted and the risks of bias of the studies were assessed independently by two review authors. Discrepancies were resolved by discussion. MAIN RESULTS Twenty-three studies with 24 study arms with CBTs were included. A total of 2031 patients were included; 1073 patients in CBT groups and 958 patients in control groups. Only two studies were without any risk of bias. The GRADE quality of evidence of the studies was low. CBTs were superior to controls in reducing pain at end of treatment by 0.5 points on a scale of 0 to 10 (standardised mean difference (SMD) - 0.29; 95% confidence interval (CI) -0.49 to -0.17) and by 0.6 points at long-term follow-up (median 6 months) (SMD -0.40; 95% CI -0.62 to -0.17); in reducing negative mood at end of treatment by 0.7 points on a scale of 0 to 10 (SMD - 0.33; 95% CI -0.49 to -0.17) and by 1.3 points at long-term follow-up (median 6 months) (SMD -0.43; 95% CI -0.75 to -0.11); and in reducing disability at end of treatment by 0.7 points on a scale of 0 to 10 (SMD - 0.30; 95% CI -0.51 to -0.08) and at long-term follow-up (median 6 months) by 1.2 points (SMD -0.52; 95% CI -0.86 to -0.18). There was no statistically significant difference in dropout rates for any reasons between CBTs and controls (risk ratio (RR) 0.94; 95% CI 0.65 to 1.35). AUTHORS' CONCLUSIONS CBTs provided a small incremental benefit over control interventions in reducing pain, negative mood and disability at the end of treatment and at long-term follow-up. The dropout rates due to any reason did not differ between CBTs and controls.
Collapse
Affiliation(s)
- Kathrin Bernardy
- BG University Hospital Bergmannsheil GmbH, Ruhr University BochumDepartment of Pain MedicineCample‐de‐la Bürk Platz 1BochumGermany44789
| | - Petra Klose
- University of Duisburg‐EssenDepartment of Internal and Integrative Medicine, Kliniken Essen‐Mitte, Faculty of MedicineAm Deimelsberg 34 aEssenGermanyD‐45276
| | - Angela J Busch
- University of SaskatchewanSchool of Physical Therapy104 Clinic PlaceSaskatoonSKCanadaS7N 2Z4
| | - Ernest HS Choy
- Cardiff University School of MedicineSection of Rheumatology, Division of Infection and ImmunityTenovus BuildingHeath ParkCardiffUKCF14 4XN
| | - Winfried Häuser
- Technische Universität MünchenDepartment of Psychosomatic Medicine and PsychotherapyLangerstr. 3MünchenGermanyD‐81675
| | | |
Collapse
|
20
|
Bromley Milton M, Börsbo B, Rovner G, Lundgren-Nilsson Å, Stibrant-Sunnerhagen K, Gerdle B. Is Pain Intensity Really That Important to Assess in Chronic Pain Patients? A Study Based on the Swedish Quality Registry for Pain Rehabilitation (SQRP). PLoS One 2013; 8:e65483. [PMID: 23805183 PMCID: PMC3689769 DOI: 10.1371/journal.pone.0065483] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2013] [Accepted: 04/26/2013] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Incorporating the patient's view on care and treatment has become increasingly important for health care. Patients describe the variety of consequences of their chronic pain conditions as significant pain intensity, depression, and anxiety. We hypothesised that intensities of common symptoms in chronic pain conditions carry important information that can be used to identify clinically relevant subgroups. This study has three aims: 1) to determine the importance of different symptoms with respect to participation and ill-health; 2) to identify subgroups based on data concerning important symptoms; and 3) to determine the secondary consequences for the identified subgroups with respect to participation and health factors. METHODS AND SUBJECTS This study is based on a cohort of patients referred to a multidisciplinary pain centre at a university hospital (n = 4645, participation rate 88%) in Sweden. The patients answered a number of questionnaires concerning symptoms, participation, and health aspects as a part of the Swedish Quality Registry for Pain Rehabilitation (SQRP). RESULTS Common symptoms (such as pain intensity, depression, and anxiety) in patients with chronic pain showed great variability across subjects and 60% of the cohort had normal values with respect to depressive and anxiety symptoms. Pain intensity more than psychological symptoms showed stronger relationships with participation and health. It was possible to identify subgroups based on pain intensity, depression, and anxiety. With respect to participation and health, high depressive symptomatology had greater negative consequences than high anxiety. CONCLUSIONS Common symptoms (such as pain intensity and depressive and anxiety symptoms) in chronic pain conditions carry important information that can be used to identify clinically relevant subgroups.
Collapse
Affiliation(s)
- Maria Bromley Milton
- Rehabilitation Medicine, Department of Medicine and Health Sciences (IMH), Faculty of Health Sciences, University of Linköping, Linköping, Sweden
| | - Björn Börsbo
- Rehabilitation Medicine, Department of Medicine and Health Sciences (IMH), Faculty of Health Sciences, University of Linköping, Linköping, Sweden
- Clinical Department of Rehabilitation Medicine, County Hospital Ryhov, Jönköping, Sweden
| | - Graciela Rovner
- Institute of Neurosciences and Physiology, Rehabilitation Medicine, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden
| | - Åsa Lundgren-Nilsson
- Institute of Neurosciences and Physiology, Rehabilitation Medicine, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden
| | - Katharina Stibrant-Sunnerhagen
- Institute of Neurosciences and Physiology, Rehabilitation Medicine, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden
| | - Björn Gerdle
- Rehabilitation Medicine, Department of Medicine and Health Sciences (IMH), Faculty of Health Sciences, University of Linköping, Linköping, Sweden
- Pain and Rehabilitation Centre, University Hospital of Linköping, County Council, Linköping, Sweden
| |
Collapse
|
21
|
Fear of movement and avoidance behaviour toward physical activity in chronic-fatigue syndrome and fibromyalgia: state of the art and implications for clinical practice. Clin Rheumatol 2013; 32:1121-9. [DOI: 10.1007/s10067-013-2277-4] [Citation(s) in RCA: 82] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2013] [Accepted: 04/19/2013] [Indexed: 10/26/2022]
|
22
|
¿Por qué las personas con fibromialgia persisten en la actividad a pesar del dolor creciente?: estudio Delphi sobre el contenido del Cuestionario Clínic de Persistencia en la Actividad en Fibromialgia. REVISTA DE PSIQUIATRIA Y SALUD MENTAL 2013; 6:33-44. [DOI: 10.1016/j.rpsm.2012.03.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2011] [Revised: 03/06/2012] [Accepted: 03/08/2012] [Indexed: 11/20/2022]
|