Telephone-delivered cognitive behavioural therapy and an exercise program, both separately and combined, are associated with short-term positive outcomes for patients with chronic widespread pain, and may offer benefits for patients diagnosed with fibromyalgia, according to a report published Online First by Archives of Internal Medicine, one of the JAMA/Archives journals.
“In the United States, mean [average] per-patient costs (including pain and non-pain-related medication, physician consultations, tests and procedures, and emergency department visits) in the six months following a new diagnosis of fibromyalgia were $3,481,” the authors write as background information in the article. “There is a need to develop clinically effective and cost-effective, acceptable interventions at a primary care level that could potentially be available to a large number of patients.”
John McBeth, M.A., Ph.D., then of the Arthritis Research U.K. Epidemiology Unit, University of Manchester, England, now of the Arthritis Research U.K. Primary Care Centre, Keele University, Staffordshire, England, and colleagues conducted a randomised controlled trial to assess the effects of a telephone-based cognitive behavioural therapy, exercise, or a combined intervention among patients with chronic widespread pain.
The authors randomised 442 patients with chronic widespread pain to receive six months of telephone-delivered cognitive behavioural therapy (TCBT), graded exercise, combined intervention, or treatment as usual (control group). The primary outcome was self-rated score measuring how patients felt their health had changed since the period prior to entering the trial, which was measured using a 7-point scale on a questionnaire or telephone interview conducted by study personnel. A “positive outcome” was defined as feeling “much better” or “very much better.”
After six months (end of the intervention period), 8.1 percent of participants in the control group reported positive outcomes, compared with 29.9 percent of the TCBT group, 34.8 percent of the exercise group and 37.2 percent of the combined intervention group. Results were similar at the nine-month follow-up, with 8.3 percent of participants in the control group, 32.6 percent of the TCBT group, 24.2 percent of the exercise group and 37.1 percent of the combined intervention group reporting positive outcomes.
At the six and nine-month follow-ups, the combined intervention was associated with improvements in the 6-Item Short Form Health Questionnaire physical component score and a reduction in passive coping strategies.
“This trial demonstrates short- to medium-term improvements in patients with chronic widespread pain,” the authors conclude. “Whether improvements continue in the longer term should be established. These results provide encouragement that short-term improvement is possible in a substantial proportion of patients with chronic widespread pain.”
For more information on chronic pain, including different types of chronic pain, living with chronic pain and treatments for managing chronic pain, see Chronic Pain.