title: Combining cognitive-behavioral therapy and milnacipran for fibromyalgia: a feasibility randomized-controlled trial.
abstract: OBJECTIVE
  To evaluate the feasibility of a randomized-controlled trial and to obtain estimates of the effects of combined cognitive-behavioral therapy (CBT) and milnacipran for the treatment of fibromyalgia.
  
  
  METHODS
  Fifty-eight patients with fibromyalgia were randomized to 1 of the 3 treatment arms: (1) combination therapy (n = 20); (2) milnacipran+education (n = 19); and (3) placebo+CBT (n = 19). Patients received either milnacipran (100 mg/d) or placebo. Patients also received 8 sessions of phone-delivered CBT or educational instructions, but only from baseline to week 9. Assessments were conducted at baseline, week 9, and 21. The primary endpoints were baseline to week 21 changes in weekly average pain intensity and physical function (SF-36 physical function scale).
  
  
  RESULTS
  Compared with milnacipran, combination therapy demonstrated a moderate effect on improving SF-36 physical function (SE = 9.42 [5.48], P = 0.09, effect size = 0.60) and in reducing weekly average pain intensity (mean difference [SE] = -1.18 [0.62], P = 0.07, effect size = 0.67). Compared with milnacipran, CBT had a moderate to large effect in improving SF-36 physical function (mean difference [SE] = 11.0 [5.66], P = 0.06, effect size = 0.70). Despite the presence of concomitant centrally acting therapies, dropout rate was lower than anticipated (15% at week 21). Importantly, at least 6 out of the 8 phone-based therapy sessions were successfully completed by 89% of the patients; and adherence to the treatment protocols was > 95%.
  
  
  CONCLUSIONS
  In this pilot study, a therapeutic approach that combines phone-based CBT and milnacipran was feasible and acceptable. Moreover, the preliminary data supports conducting a fully powered randomized-controlled trial.
authors: Department of Medicine, Division of Rheumatology, Indiana University, Indianapolis, IN 46202, USA.
authors: Dennis C
authors: DC
authors: Ang
authors: Mark P
authors: MP
authors: Jensen
authors: Jennifer L
authors: JL
authors: Steiner
authors: Janna
authors: J
authors: Hilligoss
authors: Richard H
authors: RH
authors: Gracely
authors: Chandan
authors: C
authors: Saha
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015928:Cognitive Behavioral Therapy; D003521:Cyclopropanes / Q000627:therapeutic use*; D003863:Depression / Q000209:etiology / Q000628:therapy; D004311:Double-Blind Method; D005240:Feasibility Studies; D005260:Female; D005356:Fibromyalgia / Q000150:complications / Q000188:drug therapy* / Q000534:rehabilitation*; D006801:Humans; D008297:Male; D008875:Middle Aged; D000078764:Milnacipran; D017063:Outcome Assessment, Health Care; D010147:Pain Measurement; D058748:Pain Perception / Q000187:drug effects; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use*; D013997:Time Factors; D055815:Young Adult
chemical_list: D003521:Cyclopropanes; D000078764:Milnacipran; D017367:Selective Serotonin Reuptake Inhibitors