Behavioral therapy plus exercise may ease fibromyalgia

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For people with troubling cases of fibromyalgia, a combination of behavioral counseling and exercise therapy tailored to their specific needs may bring some symptom relief, a new study suggests.

Fibromyalgia is a syndrome marked by widespread aches and pains—including discomfort at specific “tender points” in the body—along with symptoms such as fatigue and sleep problems. It is estimated to affect up to 5 million U.S. adults, most commonly middle-aged women.

The cause of fibromyalgia is unknown, and the condition can prove difficult to treat. Standard treatments include painkillers, antidepressants, cognitive-behavioral therapy and exercise therapy.

Recent studies have suggested that combinations of these therapies seem to work better than any treatment alone. A review of nine clinical trials, for example, found that at least in the shorter term, fibromyalgia patients treated with multiple therapies got more relief from pain, depression and fatigue than those given a single therapy.

A number of studies have examined the combination of cognitive behavioral therapy (CBT) and exercise, and found that it can be effective. However, those studies have also shown there to be “room for improvement,” according to Saskia van Koulil, of Radboud University Nijmegen Medical Center in the Netherlands.

So van Koulil and her colleagues decided to test a “tailored” approach to CBT and exercise, the researcher told Reuters Health by email.

The study focused on so-called high-risk fibromyalgia patients—those whose symptoms were causing a significant amount of distress, based on screening questionnaires looking at anxiety and depression symptoms.

The researchers separated the patients into two groups based on their usual manner of dealing with their pain: those who avoided any activities they feared would worsen their pain; and those who kept up various activities despite their pain.

Patients in both groups were randomly assigned to either undergo 16 sessions of CBT-plus-exercise therapy or go on a wait-list for treatment.

In general, CBT aims to help people recognize thought patterns and emotional responses that contribute to their symptoms, and give them practical ways to change their behavior. For patients in this study who typically sought to avoid pain, the CBT sessions were designed to help them deal with their fear of pain and set goals for boosting their daily activities.

For patients who typically tried to push through their pain, the CBT encouraged them to set more realistic goals and pace their daily activities to avoid overdoing it.

All patients had an exercise session with a physical therapist following each CBT session.

Overall, the researchers found that immediately after the treatment period, and six months later, both therapy groups were doing better than their counterparts on the waiting list.

At the six-month mark, two-thirds of treated patients had “clinically significant” improvements in at least some measure of physical well- being—pain, fatigue or disability—versus one-third of wait-list patients.

Similarly, 62 percent had improvements in anxiety or depression symptoms, compared with 33 percent of the wait-list group.

“Clinically significant” meant that patients had noticeable changes in their daily lives, van Koulil explained. People with improvements in functional disability, for example, said they were better able to walk, climb stairs and do household chores.

Van Koulil said that this appears to be the first study to test such a tailored approach to CBT and exercise therapy for fibromyalgia.

A key limitation of the study is that it did not include a group that received standard CBT plus exercise. More studies are needed, the researchers say, to see whether the tailored approach is any more or less effective than standard treatment.

And while standard CBT and exercise therapy are generally available options for people with fibromyalgia, that is not true of the tailored therapy—though, van Koulil said, based on the results of this study, it is now available at several medical centers in the Netherlands.

SOURCE:  Arthritis Care & Research, online June 2, 2010.

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