Improving physical functional status in patients with fibromyalgia: a brief cognitive behavioral intervention.
OBJECTIVE
Sustained improvement in physical functional status was the primary goal of a brief, 6 session cognitive behavioral therapy (CBT) protocol for fibromyalgia (FM).


METHODS
One hundred forty-five patients with FM were randomly assigned to either (1) standard medical care that included pharmacological management of symptoms and suggestions for aerobic fitness, or (2) the same standard medical treatment plus 6 sessions of CBT aimed at improving physical functioning. Outcome measures included the Medical Outcome Study Short Form-36 Physical Component Score and McGill ratings of pain. Outcomes were treated dichotomously using a preestablished criterion for clinically significant success based upon the reliability of change index from baseline to one year posttreatment.


RESULTS
Twenty-five percent of the patients receiving CBT were able to achieve clinically meaningful levels of longterm improvement in physical functioning, whereas only 12% of the patients receiving standard care achieved the same level of improvement. There were no lasting differences on pain ratings between groups.


CONCLUSIONS
Lasting improvements in physical functioning have been among the most difficult outcomes to obtain in studies of FM. These data suggest that the inclusion of CBT to a standard medical regimen for FM can favorably influence physical functioning in a subset of patients.
Williams
David A
DA
Department of Psychiatry, Georgetown University Medical Center, Washington, DC 20007, USA. daw27@georgetown.edu
Cary
Meredith A
MA
Groner
Kimberly H
KH
Chaplin
William
W
Glazer
Lara J
LJ
Rodriguez
Alyssa M
AM
Clauw
Daniel J
DJ
D000328:Adult; D000368:Aged; D000700:Analgesics / Q000008:administration & dosage; D000928:Antidepressive Agents / Q000008:administration & dosage; D001521:Behavior Therapy / Q000379:methods; D002908:Chronic Disease; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003131:Combined Modality Therapy; D004359:Drug Therapy, Combination; D015444:Exercise; D005260:Female; D005356:Fibromyalgia / Q000175:diagnosis / Q000188:drug therapy* / Q000534:rehabilitation*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010349:Patient Compliance; D010809:Physical Fitness / Q000502:physiology* / Q000523:psychology; D011336:Probability; D011379:Prognosis; D012016:Reference Values; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D016896:Treatment Outcome
D000700:Analgesics; D000928:Antidepressive Agents