Effectiveness of cognitive behaviour therapy for the treatment of catastrophisation in patients with fibromyalgia: a randomised controlled trial

Abstract

IntroductionNo randomised, controlled trials have been conducted to date on the efficacy of psychological and pharmacological treatments of pain catastrophising (PC) in patients with fibromyalgia. Our aim in this study was to assess the effectiveness of cognitive-behaviour therapy (CBT) and the recommended pharmacological treatment (RPT) compared with treatment as usual (TAU) at the primary care level for the treatment of PC in fibromyalgia patients.MethodsWe conducted a six-month, multicenter, randomized, blinded, parallel group, controlled trial in which patients were randomly assigned to one of three study arms: CBT (n = 57), RPT (n = 56) and TAU at the primary care level (n = 56). The major outcome of this study was PC in patients with fibromyalgia. The secondary variables were pain acceptance, depression, anxiety, pain, global function and quality of life.ResultsCBT significantly decreased global PC at the six-month follow-up examination with effect sizes of Cohen's d = 0.73 and 1.01 compared with RPT and TAU, respectively. CBT was also more effective than RPT and TAU at increasing pain acceptance at the six-month follow-up examination (effect sizes of Cohen's d = 0.77 and 0.80, respectively). Compared with RPT and TAU, CBT was more effective at improving global function based on the Fibromyalgia Impact Questionnaire (six-month effect sizes Cohen's d = 0.44 and 0.53, respectively) and quality of life based on the European Quality of Life Scale (six-month effect sizes Cohen's d = 0.11 and 0.40, respectively). There were no differences among the three treatments with regard to pain and depression.ConclusionsCBT shows higher efficacy than RPT and TAU not only in key outcomes in FM, such as function and quality of life, but also in relevant mediators of treatment effects, such as pain catastrophising and pain acceptance.Trial registrationISRCTN: ISRCTN10804772

Efficacy, acceptability and safety of cognitive behavioural therapies in fibromyalgia syndrome – A systematic review and meta‐analysis of randomized controlled trials

“…Only one study had a total treatment time <5 h (Ang et al, 2010) and seven studies had a treatment time of >25 h (Wigers et al, 1996;Soares and Grossi, 2002;Thieme et al, 2003;Thieme et al, 2006;Falcao et al, 2008;Castel et al, 2012;Karlsson et al, 2015). The remaining studies had a treatment time between 5 and 25 h. Fourteen studies reported on average attendance rates of participants (Wigers et al, 1996;Oliver et al, 2001;King et al, 2002;Redondo et al, 2004;Thieme et al, 2006;Rooks et al, 2007;Alda et al, 2011;Luciano et al, 2011Luciano et al, , 2014Miro et al, 2011;Castel et al, 2012;Parra-Delgado and Latorre-Postigo, 2013;Martınez et al, 2014;Karlsson et al, 2015). The median of attended CBTs sessions was 77% (range 42-93%).…”

“…Twenty-three studies provided traditional CBT (Burckhardt et al, 1994;Vlaeyen et al, 1996;Wigers et al, 1996;Nicassio et al, 1997;King et al, 2002;Soares and Grossi, 2002;Williams et al, 2002;Redondo et al, 2004;Edinger et al, 2005;Kashikar-Zuck et al, 2005;Thieme et al, 2006;Falcao et al, 2008;Castel et al, 2009Castel et al, , 2012Ang et al, 2010;Alda et al, 2011;Luciano et al, 2011;Miro et al, 2011;Kashikar-Zuck et al, 2012;Woolfolk et al, 2012;Martınez et al, 2014;Garcia-Palacios et al, 2015;Karlsson et al, 2015), three studies offered acceptance/mindfulness-based therapy (Parra-Delgado and Latorre-Postigo, 2013; Wicksell et al, 2013;Luciano et al, 2014) and two studies each provided self management education (Oliver et al, 2001;Rooks et al, 2007) and operant therapy (Thieme et al, 2003(Thieme et al, , 2006. All studies were conducted by live face-toface contact except one study which was delivered by telephone (voice-to-voice) (Ang et al, 2010).…”

“…These studies added 546 new participants. We included 22 studies from the first version of the review (Burckhardt et al, 1994;Vlaeyen et al, 1996;Wigers et al, 1996;Nicassio et al, 1997;Oliver et al, 2001;King et al, 2002;Soares and Grossi, 2002;Williams et al, 2002;Thieme et al, 2003;Redondo et al, 2004;Edinger et al, 2005;Kashikar-Zuck et al, 2005;Thieme et al, 2006;Rooks et al, 2007;Castel et al, 2009Castel et al, , 2012Ang et al, 2010;Alda et al, 2011;Luciano et al, 2011;Kashikar-Zuck et al, 2012;Woolfolk et al, 2012;Bernardy et al, 2013). In sum, 29 studies with 31 study arms were included into the qualitative and quantitative analysis (see Fig.…”

“…Eighteen studies were conducted in Europe (Burckhardt et al, 1994;Vlaeyen et al, 1996;Wigers et al, 1996;Soares and Grossi, 2002;Thieme et al, 2003Thieme et al, , 2006Redondo et al, 2004;Castel et al, 2009Castel et al, , 2012Alda et al, 2011;Luciano et al, 2011Luciano et al, , 2014Miro et al, 2011;Parra-Delgado and Latorre-Postigo, 2013;Wicksell et al, 2013;Martınez et al, 2014;Garcia-Palacios et al, 2015;Karlsson et al, 2015), of which 10 were conducted in Spain (Redondo et al, 2004;Castel et al, 2009Castel et al, , 2012Alda et al, 2011;Luciano et al, 2011Luciano et al, , 2014Miro et al, 2011;ParraDelgado and Latorre-Postigo, 2013;Martınez et al, 2014;Garcia-Palacios et al, 2015), five in Scandinavian countries (Burckhardt et al, 1994;Wigers et al, 1996;Soares and Grossi, 2002;Wicksell et al, 2013;Karlsson et al, 2015), two studies in Germany (Thieme et al, 2003(Thieme et al, , 2006 and one study in the Netherlands (Vlaeyen et al, 1996). Ten studies were conducted in North America (USA) (Nicassio et al, 1997;Oliver et al, 2001;King et al, 2002...…”

“…All studies but one (Thieme et al, 2003) were outpatient-based. Most studies reported the setting in which CBTs were delivered: four studies in primary care settings (Rooks , 2007;Alda et al, 2011;Luciano et al, 2011;Karlsson et al, 2015), by six studies in rheumatology clinics (Burckhardt et al, 1994;Thieme et al, 2003;Redondo et al, 2004;Kashikar-Zuck et al, 2005Woolfolk et al, 2012) by two studies each in pain clinics (Castel et al, 2009(Castel et al, , 2012, psychology departments (Thieme et al, 2006;Martınez et al, 2014) and rehabilitation clinics (Vlaeyen et al, 1996;King et al, 2002) and by one study in the home of the patients (Ang et al, 2010). All studies except six (Oliver et al, 2001;Rooks et al, 2007;Alda et al, 2011;Luciano et al, 2011Luciano et al, , 2014Kashikar-Zuck et al, 2012) were single-centre studies.…”