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Improving Physical Functional Status in Patients with Fibromyalgia: A Brief Cognitive Behavioral Intervention
DAVID A. WILLIAMS, MEREDITH A. CARY, KIMBERLY H. GRONER, WILLIAM CHAPLIN, LARA J. GLAZER, ALYSSA M. RODRIGUEZ, and DANIEL J. CLAUW
ABSTRACT.
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. Conclusion. 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. (J Rheumatol 2002;29:1280-6) Key Indexing Terms:
FIBROMYALGIA
From the Departments of Psychiatry and Medicine, Georgetown University Medical Center, Washington, DC, USA. Supported by a grant from the National Institutes of Health (R29MH54877) and DAMD 17-00-02-0018. D.A. Williams, PhD, Associate Professor, Departments of Psychiatry and Medicine, Chronic Pain and Fatigue Research Center, Georgetown University Medical Center, and Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, MD; M. Cary, PsyD, Assistant Professor, Departments of Psychiatry and Medicine, Chronic Pain and Fatigue Research Center; K.H. Groner, MSN, RN, CANP, Department of Medicine, Chronic Pain and Fatigue Research Center; L.J. Glazer, BA, Department of Psychiatry, Chronic Pain and Fatigue Research Center; A.M. Rodriguez, MPhil, Department of Psychiatry, Chronic Pain and Fatigue Research Center; D.J. Clauw, MD, Associate Professor, Department of Medicine, Chronic Pain and Fatigue Research Center, Georgetown University Medical Center; W.F. Chaplin, PhD, Chronic Pain and Fatigue Research Center, Associate Professor, Department of Psychology, University of Alabama at Tuscaloosa. Address reprint requests to Dr. D.A. Williams, Departments of Psychiatry and Medicine, Georgetown University Medical Center, 3750 Reservoir Rd., NW, Washington, DC 20007. E-mail: daw27@georgetown.edu Submitted August 3, 2001; revision accepted December 31, 2001. |