412 Small benefit from cognitive behavioural therapies for fibromyalgia

April 08, 2014

PEARLS 412, November 2013, written by Brian R McAvoy

Clinical question
How effective are cognitive behavioural therapies (CBTs) for treating fibromyalgia?

Bottom line
CBTs were superior to controls in reducing pain at end of treatment by 0.5 points on a scale of 0 to 10 and by 0.6 points at long-term follow up (median 6 months); in reducing negative mood at end of treatment by 0.7 points and by 1.3 points at long-term follow up; and in reducing disability at end of treatment by 0.7 points and at long-term follow up by 1.2 points. The dropout rates did not differ between CBTs and controls. Optimum treatment intensity was between 5 and 25 hours. There was no evidence for benefit of self-managed programmes as single therapy.

Caveat
Positive effects were only verifiable for face-to-face CBTs but not for internet-based and telephone-based CBT at end of treatment. Positive effects were only detected in the comparison of CBTs with treatment as usual and waiting list controls but not with other active treatments (eg, aerobic exercise) or with attention control (except negative mood) at end of treatment. Studies that included patients with anxiety and depressive disorders demonstrated only a reduction in negative mood but not of pain and disability at end of treatment.

Context
Fibromyalgia is a clinically well-defined, chronic condition of unknown aetiology, characterised by chronic, widespread pain that often coexists with sleep disturbances, cognitive dysfunction and fatigue. Patients often report high disability levels and negative mood. CBTs focus on reducing key symptoms and improving daily functioning, mood and sense of personal control over pain.

Cochrane Systematic Review
Bernardy K et al. Cognitive behavioural therapies for fibromyalgia. Cochrane Reviews, 2013, Issue 9. Art. No.: CD009796.DOI: 10.1002/14651858. CD009796.pub2. This review contains 23 studies involving over 2031 participants.

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.