Re: CBT group for Fibromyalgia

The idea of offering a CBT group for fibromyalgia sounds quite promising. Here are a few references which should give you a good start:

McCain, G. A. (1999). Treatment of the fibromyalgia syndrome. Journal of Musculoskeletal Pain, 7, 193-208. ABSTRACT: This study provides a brief overview of current approaches to treatment of fibromyalgia. Clinical trials reveal that amitriptyline (AM) and cyclobenzaprine (CB) are effective in fibromyalgia. "N-of-l" trials show that one-third of patients benefited from AM. CB improved evening fatigue and total sleep time while pain intensity, pain thresholds (PT) over fibrositic tender points (FTPs), and mood ratings did not change. Other studies show mixed results with imipramine, doxopin, fenfluramine and non-steroidal anti-inflammatory drugs. Non-pharmacological treatments: Improvements in PT measurements over FTPs, physician and patient global assessment scores have been noted in those receiving cardiovascular fitness training when compared with patients treated with flexibility exercises alone. 15 sessions of electromyography biofeedback over a 5 week observation period resulted in improvements in the number of FTPs, present pain intensity and morning stiffness persisting for up to six months after treatment. Several studies have shown significant improvements in pain severity, affective distress and decreased pain interference after cognitive behavioral therapy.

Turk, D. C.; Okifuji, A. (1997). Evaluating the role of physical, operant, cognitive, and affective factors in the pain behaviors of chronic pain patients. Behavior Modification, 21, 259-280. ABSTRACT: Evaluated the contributions of physical, operant, cognitive, and affective factors to individual differences in pain behaviors. Ss were 63 chronic pain patients (mean age 46.84 yrs) diagnosed with fibromyalgia. Ss underwent medical, physical, and psychological evaluations. Tests used included the Center for Epidemiologic Studies Depression Scale and the West Haven-Yale Multidimensional Pain Inventory. Hierarchical regression analyses revealed that the physical, cognitive, and affective factors, were significantly related to observed pain behaviors. The set of all factors accounted for 53% of the variance in observed pain behavior. Results suggest that pain behaviors should be conceptualized as behavioral manifestation of pain based on a complex interaction of various psychological and physical factors.

Keefe, F. J. (1998). Cognitive processes and the pain experience. Journal of Musculoskeletal Pain, 6, 41-45. ABSTRACT: Reviews the evidence for cognitive behavioral interventions in the rheumatic diseases, particularly osteoarthritis and rheumatoid arthritis. The author discusses the underpinnings of these interventions, such as the importance of self-efficacy and a structured approach to training patients in coping skills with the support of their spouses or partners. He provides evidence suggesting that these interventions deserve further investigation in fibromyalgia syndrome.

Keel, P. J.; Bodoky, C.; Gerhard, U.; Mueller, W. (1998 ). Comparison of integrated group therapy and group relaxation training for fibromyalgia. Clinical Journal of Pain, 14, 232-238. ABSTRACT: Tested the efficacy of an integrated, psychological treatment program involving 27 patients (mean age 48 yrs) with chronic musculoskeletal pain (fibromyalgia). The experimental treatment program consisted of instruction in various self-help techniques (e.g., cognitive behavioral strategies, relaxation, physical exercises) and information on chronic pain. Measures of pain, daily activities, general symptoms, and psychological functioning were assessed before and after treatment, and at 4 mo after termination of therapy. Results show that at the end of treatment, 7 patients showed significant clinical improvement in 3 of 6 parameters. At follow-up, the improvement was still present in 5 patients. Successful patients had been sick for a shorter period of time and were less impaired by their condition. It is concluded that psychological interventions in combination with physiotherapy can be effective in treating fibromyalgia patients, especially if applied early.

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Thank you, Jim!, by Willie Deuel, 07/25/00

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