Cognitive-educational treatment of fibromyalgia (FM): a randomized clinical trial. I. Clinical effects

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OBJECTIVE: This randomized controlled clinical trial evaluates
the effectiveness of outpatient group cognitive/educational
treatment for patients with the fibromyalgia (FM) syndrome. We
hypothesized that the combination of group education with
cognitive treatment aimed at developing pain coping skills
wouldbe more effective than group education alone.

131patients with FM were randomly assigned to 3 conditions:
an experimental condition, which was the combined
cognitive/educational intervention (ECO); an attention control
condition consisting of group education plus group discussion
(EDI); and a waiting list control (WLC). For the treatment
conditions ECO and EDI, assessments were made 2 weeks before
treatment, at start of treatment, at post-treatment, and at 6
and12 mo followup. WLC patients received only 3 assessments.

RESULTS: There were no pretreatment differences between the
groups, or between dropouts and patients who remained in the
study. At post-treatment, and compared with the WLC, the ECO
patients improved in knowledge about FM (p = 0.007) and pain
coping (p < 0.001). EDI patients improved on pain coping (p =
0.005) and pain control (p = 0.002). EDI patients reported
significantly less fear than ECO patients (p = 0.005). There
were no other differential effects between ECO and EDI at
post-treatment or 6 mo or 12 mo followup. Based on the
reliability of change index for clinical significance, the
relative short term success rates are 6.4 and 18.4% for ECO
and EDI, respectively.

CONCLUSION: The surplus value of a
highly structured, 12 session group cognitive treatment added
to groupeducation cannot be supported by our study. In EDI,
fear reduction might have enhanced pain coping and pain
control, while poor compliance, the difficulty of homework
assignments, and lack of individual support may have limited
the effectiveness of ECO.

MCM: "The surplus value of a highly structured, 12 session
group cognitive treatmenmt added to group education cannot be
supported by our study"

Vlaeyen JW, Teeken-Gruben NJ, Goossens ME, Rutten-van Molken MP
Pelt RA, van Eek H, Heuts PH