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June 18, 2010

CBT and Exercise Help Fibromyalgia

Fibromyalgia patients can better manage their pain with cognitive behavior therapy and exercise. Knowing how they cope helps, too.

People who suffer from the somewhat mysterious disorder fibromyalgia may be helped with a combination of cognitive behavioral therapy and exercise, reports a new study from The Netherlands. Fibromyalgia patients, who are most often women, typically suffer from chronic pain and fatigue, as well as certain psychological symptoms like sleep problems, depression, and Anxiety according to the National Fibromyalgia Association.

The avoidance group was taught to more effectively approach anxiety about pain and to create realistic goals for themselves. The persistence group was helped to push themselves less hard and also to set more realistic goals in their physical activities to reduce pain.

The syndrome is particularly frustrating because current treatments are not always effective and many are aimed at managing symptoms rather than treating the cause of the condition itself (this is partially because the root cause of fibromyalgia is still unknown). In the current study, Saskia van Koulil and her colleagues divided fibromyalgia sufferers into two groups, based on how they tended to cope with pain. The first, the “pain-avoidance” group, consisted of people who avoided activities because of their pain; the other, the “pain-persistence” group, tended to power through it and partake of physical activity despite the pain.

The researcher then offered half of each group 16 weeks of CBT sessions tailored to each of the two methods of coping. For example, the avoidance group was taught to more effectively approach anxiety about pain and to create realistic goals for themselves. The persistence group was helped to push themselves less hard and also to set more realistic goals in their physical activities to reduce pain. Both groups met with an exercise specialist after CBT sessions. The other half of the groups were on a “wait list”, meaning that they did not receive the treatments above, and served as the study’s controls.

Regardless of which tailored treatment group they were in, six months after the sessions had ended, the patients who underwent CBT-plus-exercise all had about a two-thirds reduction in their physical symptoms compared to only one-third reduction in the control groups. In terms of psychological symptoms like depression and anxiety, about 62% of the CBT-plus-exercise patients had significant reductions, compared to only 33% of the control groups.

The researchers do say that one limitation of the study is that it only tested the tailored approach – “standard, non-tailored treatment” was not considered. The researchers suggest that future studies should focus on just how standard treatments may, or may not, measure up to tailored ones in treating the symptoms of fibromyalgia.

Saskia van Koulil is a researcher at The Netherlands’ Radboud University Nijmegen Medical Center; the study was published in the June 2, 2010 online edition of Arthritis Care and Research.

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