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The effects of long- and short-term interdisciplinary treatment approaches in women with fibromyalgia: a randomized controlled trial

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Abstract

We investigated the effects of long- and short-term interdisciplinary treatment approaches for reducing symptoms and improving health-related quality of life (HRQoL) and physical functions of patients with fibromyalgia and compared the effects of two different interdisciplinary treatment approaches. We conducted a prospective, randomized, controlled trial involving 66 women with fibromyalgia eligible for the study at a university hospital setting. The patients were randomized into three groups (allocation ratio 1:1:1) using a computer-generated random numbers: a long-term interdisciplinary treatment group (LG, n = 22) that participated in 10 sessions (3-h once-weekly session for 10 weeks) of cognitive behavioral therapy (CBT) together with exercise training and other fibromyalgia related educational programs (two full days); a short-term interdisciplinary treatment group (SG, n = 22) that received two full days of educational, exercise, and CBT programs; and a control group (CG, n = 22). The patients were evaluated at baseline and 6 months after treatment using the visual analog scale (pain, fatigue, and sleep), Fibromyalgia Impact Questionnaire, Beck Depression Inventory, Short Form-36, tender point numbers, and pressure algometry as primary outcomes. The statistical analysis was confined to the ‘per-protocol’ set. No blinding was performed. The number of patients analyzed was 21 in the LG, 19 in the SG, and 19 in the CG. The intensity of pain (p < 0.001), severity of fatigue (p = 0.048), number of tender points (p = 0.002), and pressure pain threshold (p = 0.012) decreased significantly in both the LG and SG groups compared with controls. Moreover, physical functions (p = 0.017) and physical components of the HRQoL (p = 0.036) improved significantly in the intervention groups compared with the controls. However, there was no significant difference between intervention groups and the control group at the end of study in terms of quality of sleep (p = 0.055), severity of depressive symptoms (p = 0.696), and mental components of the HRQoL (p = 0.229). Finally, with the exception of the severity of fatigue and physical components of the HRQoL, there was no obvious significant difference between the efficacies of the two treatment approaches when compared with controls; the long-term treatment was found more effective in reducing pain than the short-term. Both, long- and short-term interdisciplinary treatments were effective in reducing the severity of some symptoms and disease activity in patients with fibromyalgia. The short-term program well meets the needs of women with fibromyalgia particularly in relation to pain and health status as measured using FIQ; however, a long-term program may be beneficial in reducing fatigue and improving physical function to a higher extent.

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References

  1. Rooks DS (2007) Fibromyalgia treatment update. Curr Opin Rheumatol 19:111–117

    PubMed  Google Scholar 

  2. Wolfe F, Smythe HA, Yunus M et al (1990) The American College of Rheumatology 1990 criteria for the classification of fibromyalgia. Arthritis Rheum 33:160–172

    Article  CAS  PubMed  Google Scholar 

  3. Queiroz LP (2013) Worldwide epidemiology of fibromyalgia. Curr Pain Headache Rep 17:356

    Article  PubMed  Google Scholar 

  4. Silverman SL, Harnett J, Zlateva G, Mardekian J (2010) Identifying fibromyalgia-associated symptoms and conditions from a clinical perspective: a step toward evaluating healthcare resource utilization in fibromyalgia. Pain Pract 10:520–529

    Article  PubMed  Google Scholar 

  5. Häuser W, Thieme K, Turk DC (2010) Guidelines on the management of fibromyalgia syndrome—a systematic review. Eur J Pain 14:5–10

    Article  PubMed  Google Scholar 

  6. Sarzi-Puttini P, Buskila D, Carrabba M, Doria A, Atzeni F (2008) Treatment strategy in fibromyalgia syndrome: where are we now? Semin Arthritis Rheum 37:353–365

    Article  CAS  PubMed  Google Scholar 

  7. Fitzcharles MA, Shir Y, Ablin JN et al (2013) Classification and clinical diagnosis of fibromyalgia syndrome: recommendations of recent evidence-based interdisciplinary guidelines. Evid Based Complement Alternat Med 2013:528952

    Article  PubMed  PubMed Central  Google Scholar 

  8. Scascighini L, Toma V, Dober-Spielmann S, Sprott H (2008) Multidisciplinary treatment for chronic pain: a systematic review of interventions and outcomes. Rheumatology 47:670–678

    Article  CAS  PubMed  Google Scholar 

  9. Carville SF, Arendt-Nielsen L, Bliddal H et al (2008) EULAR evidence-based recommendations for the management of fibromyalgia syndrome. Ann Rheum Dis 67:536–541

    Article  CAS  PubMed  Google Scholar 

  10. Ablin J, Fitzcharles MA, Buskila D, Shir Y, Sommer C, Häuser W (2013) Treatment of fibromyalgia syndrome: recommendations of recent evidence-based interdisciplinary guidelines with special emphasis on complementary and alternative therapies. Evid Based Complement Alternat Med 2013:485272

    PubMed  PubMed Central  Google Scholar 

  11. Oral A, Ilieva EM, Kucukdeveci AA et al (2013) Generalised and regional soft tissue pain syndromes. The role of physical and rehabilitation medicine physicians. The European perspective based on the best evidence. A paper by the UEMS-PRM Section Professional Practice Committee. Eur J Phys Rehabil Med 49:535–549

    CAS  PubMed  Google Scholar 

  12. Sindel D, Saral I, Esmaeilzadeh S (2012) Management approaches in fibromyalgia syndrome. Turk J Phys Med Rehabil 58:136–142

    Article  Google Scholar 

  13. Häuser W, Bernardy K, Arnold B, Offenbächer M, Schiltenwolf M (2009) Efficacy of multicomponent treatment in fibromyalgia syndrome: a meta-analysis of randomized controlled clinical trials. Arthritis Rheum 61:216–224

    Article  PubMed  Google Scholar 

  14. Boutron I, Moher D, Altman DG, Schulz K, Ravaud P, for the CONSORT group (2008) Extending the CONSORT statement to randomized trials of nonpharmacologic treatment: explanation and elaboration. Ann Intern Med 148:295–309. http://www.consort-statement.org/extensions?ContentWidgetId=558. Accessed 2 Feb 2016

  15. Carlsson AM (1983) Assessment of chronic pain. I. Aspects of the reliability and validity of the visual analogue scale. Pain 16:87–101

    Article  CAS  PubMed  Google Scholar 

  16. Salaffi F, Sarzi-Puttini P, Ciapetti A, Atzeni F (2009) Assessment instruments for patients with fibromyalgia: properties, applications and interpretation. Clin Exp Rheumatol 27(5 Suppl 56):S92–105

    CAS  PubMed  Google Scholar 

  17. Tastekin N, Birtane M, Uzunca K (2007) Which of the three different tender points assessment methods is more useful for predicting the severity of fibromyalgia syndrome? Rheumatol Int 27:447–451

    Article  PubMed  Google Scholar 

  18. Burckhardt CS, Clark SR, Bennett RM (1991) The fibromyalgia impact questionnaire: development and validation. J Rheumatol 18:728–733

    CAS  PubMed  Google Scholar 

  19. Sarmer S, Ergin S, Yavuzer G (2000) The validity and reliability of the Turkish version of the Fibromyalgia Impact Questionnaire. Rheumatol Int 20:9–12

    Article  CAS  PubMed  Google Scholar 

  20. Beck AT, Ward CH, Mendelson M, Mock J, Erbaugh J (1961) An inventory for measuring depression. Arch Gen Psychiatry 4:561–571

    Article  CAS  PubMed  Google Scholar 

  21. Hisli NH (1989) Beck Depresyon Envanterinin universite ogrencileri icin gecerligi, guvenirligi. Turkish Psychol J 7:3–13

    Google Scholar 

  22. Ware JE Jr, Sherbourne CD (1992) The MOS 36-item short form health survey (SF-36). 1. Conceptual frame-work and item selection. Med Care 30:473–481

    Article  PubMed  Google Scholar 

  23. Kocyigit H, Aydemir O, Fisek G, Olmez N, Memis A (1999) Validity and reliability of Turkish version of Short-form 36: a study of a patients with romatoid disorder. J Drug Therapy 12:102–106

    Google Scholar 

  24. Bennett R, Nelson D (2006) Cognitive behavioral therapy for fibromyalgia. Nat Clin Pract Rheumatol 2:416–424

    Article  PubMed  Google Scholar 

  25. Hassett AL, Gevirtz RN (2009) Nonpharmacologic treatment for fibromyalgia: patient education, cognitive-behavioral therapy, relaxation techniques, and complementary and alternative medicine. Rheum Dis Clin North Am 35:393–407

    Article  PubMed  PubMed Central  Google Scholar 

  26. Glombiewski JA, Sawyer AT, Gutermann J, Koenig K, Rief W, Hofmann SG (2010) Psychological treatments for fibromyalgia: a meta-analysis. Pain 151:280–295

    Article  PubMed  Google Scholar 

  27. Martín J, Torre F, Padierna A et al (2014) Impact of interdisciplinary treatment on physical and psychosocial parameters in patients with fibromyalgia: results of a randomised trial. Int J Clin Pract 68:618–627

    Article  PubMed  Google Scholar 

  28. Suman AL, Biagi B, Biasi G et al (2009) One-year efficacy of a 3-week intensive multidisciplinary non-pharmacological treatment program for fibromyalgia patients. Clin Exp Rheumatol 27:7–14

    CAS  PubMed  Google Scholar 

  29. Redondo JR, Justo CM, Moraleda FV et al (2004) Long-term efficacy of therapy in patients with fibromyalgia: a physical exercise-based program and a cognitive-behavioral approach. Arthritis Rheum 15:184–192

    Article  Google Scholar 

  30. van Koulil S, van Lankveld W, Kraaimaat FW et al (2011) Tailored cognitive-behavioural therapy and exercise training improves the physical fitness of patients with fibromyalgia. Ann Rheum Dis 70:2131–2133

    Article  PubMed  Google Scholar 

  31. Bernardy K, Klose P, Busch AJ, Choy EH, Häuser W (2013) Cognitive behavioural therapies for fibromyalgia. Cochrane Database Syst Rev 9:CD009796

    PubMed  Google Scholar 

  32. Häuser W, Klose P, Langhorst J et al (2010) Efficacy of different types of aerobic exercise in fibromyalgia syndrome: a systematic review and meta-analysis of randomised controlled trials. Arthritis Res Ther 12:R79

    Article  PubMed  PubMed Central  Google Scholar 

  33. Winkelmann A, Häuser W, Friedel E et al (2012) Physiotherapy and physical therapies for fibromyalgia syndrome. Systematic review, meta-analysis and guideline. Schmerz 26:276–286

    Article  CAS  PubMed  Google Scholar 

  34. Lera S, Gelman SM, López MJ et al (2009) Multidisciplinary treatment of fibromyalgia: does cognitive behavior therapy increase the response to treatment? J Psychosom Res 67:433–441

    Article  PubMed  Google Scholar 

  35. Moldofsky H (2010) Rheumatic manifestations of sleep disorders. Curr Opin Rheumatol 22:59–63

    Article  PubMed  Google Scholar 

  36. Wigers SH, Stiles TC, Vogel PA (1996) Effects of aerobic exercise versus stress management treatment in fibromyalgia. A 4.5 year prospective study. Scand J Rheumatol 25:77–86

    Article  CAS  PubMed  Google Scholar 

  37. Kashikar-Zuck S, Ting TV, Arnold LM et al (2012) Cognitive behavioral therapy for the treatment of juvenile fibromyalgia: a multisite, single-blind, randomized, controlled clinical trial. Arthritis Rheum 64:297–305

    Article  PubMed  PubMed Central  Google Scholar 

  38. Kecklund G, Akerstedt T (1992) The psychometric properties of the Karolinska Sleep Questionnaire. J Sleep Res 1(Suppl 1):113

    Google Scholar 

  39. Soares JFF, Grossi G (2002) A randomized, controlled comparison of educational and behavioural interventions for women with Fibromyalgia. Scand J Occup Ther 9:35–45

    Article  Google Scholar 

  40. Okun ML, Kravitz HM, Sowers MF, Moul DE, Buysse DJ, Hall M (2009) Psychometric evaluation of the Insomnia Symptom Questionnaire: a self-report measure to identify chronic insomnia. J Clin Sleep Med 5:41–51

    PubMed  PubMed Central  Google Scholar 

  41. Edinger JD, Wohlgemuth WK, Krystal AD, Rice JR (2005) Behavioral insomnia therapy for fibromyalgia patients: a randomized clinical trial. Arch Intern Med 28:2527–2535

    Article  Google Scholar 

  42. Hays RD, Stewart AL (1992) Sleep measures. In: Stewart AL, Ware JE (eds) Measuring functioning and well-being: the medical outcomes study approach. Duke University Press, Durham, pp 235–259

    Google Scholar 

  43. Castel A, Cascón R, Padrol A, Sala J, Rull M (2012) Multicomponent cognitive-behavioral group therapy with hypnosis for the treatment of fibromyalgia: long-term outcome. J Pain 13:255–265

    Article  PubMed  Google Scholar 

  44. Casanueva-Fernández B, Llorca J, Rubió JB, Rodero-Fernández B, González-Gay MA (2012) Efficacy of a multidisciplinary treatment program in patients with severe fibromyalgia. Rheumatol Int 32:2497–2502

    Article  PubMed  Google Scholar 

  45. Martínez MP, Miró E, Sánchez AI et al (2014) Cognitive-behavioral therapy for insomnia and sleep hygiene in fibromyalgia: a randomized controlled trial. J Behav Med 37:683–697

    Article  PubMed  Google Scholar 

  46. Buysse DJ, Reynolds CF, Monk TH, Berman SR, Kupfer DJ (1989) The Pittsburgh Sleep Quality Index: A new instrument for psychiatric practice and research. Psychiatry Res 28:193–213

    Article  CAS  PubMed  Google Scholar 

  47. Morgenthaler T, Kramer M, Alessi C, American Academy of Sleep Medicine et al (2006) Practice parameters for the psychological and behavioral treatment of insomnia: an update. An American Academy of Sleep Medicine report. Sleep 29:1415–1419

    PubMed  Google Scholar 

  48. Kroese M, Schulpen G, Bessems M, Nijhuis F, Severens J, Landewé R (2009) The feasibility and efficacy of a multidisciplinary intervention with aftercare meetings for fibromyalgia. Clin Rheumatol 28:923–929

    Article  PubMed  PubMed Central  Google Scholar 

  49. Martín J, Torre F, Aguirre U et al (2014) Evaluation of the interdisciplinary PSYMEPHY treatment on patients with fibromyalgia: a randomized control trial. Pain Med 15:682–691

    Article  PubMed  Google Scholar 

  50. Hammond A, Freeman K (2006) Community patient education and exercise for people with fibromyalgia: a parallel group randomized controlled trial. Clin Rehabil 20:835–846

    PubMed  Google Scholar 

  51. Pfeiffer A, Thompson JM, Nelson A et al (2003) Effects of a 1.5-day multidisciplinary outpatient treatment program for fibromyalgia: a pilot study. Am J Phys Med Rehabil 82:186–191

    PubMed  Google Scholar 

  52. Oh TH, Stueve MH, Hoskin TL et al (2010) Brief interdisciplinary treatment program for fibromyalgia: six to twelve months outcome. Am J Phys Med Rehabil 89:115–124

    Article  PubMed  Google Scholar 

  53. Lemstra M, Olszynski WP (2005) The effectiveness of multidisciplinary rehabilitation in the treatment of fibromyalgia: a randomized controlled trial. Clin J Pain 21:166–174

    Article  PubMed  Google Scholar 

  54. Rodero B, García J, Casanueva B, Sobradiel N (2008) Imagined exposure as treatment of catastrophizing in fibromyalgia: a pilot study. Actas Esp Psiquiatr 36:223–226

    CAS  PubMed  Google Scholar 

  55. Papadopoulou D, Fassoulaki A, Tsoulas C, Siafaka I, Vadalouca A (2015) A meta-analysis to determine the effect of pharmacological and non-pharmacological treatments on fibromyalgia symptoms comprising OMERACT-10 response criteria. Clin Rheumatol 35:573–586

    Article  PubMed  Google Scholar 

  56. Kroenke K, Swindle R (2000) Cognitive-behavioral therapy for somatization and symptom syndromes: a critical review of controlled clinical trials. Psychother Psychosom 69:205–215

    Article  CAS  PubMed  Google Scholar 

  57. Martins MR, Gritti CC, dos Santos Junior R et al (2014) Randomized controlled trial of a therapeutic intervention group in patients with fibromyalgia syndrome. Rev Bras Reumatol 54:179–184

    Article  PubMed  Google Scholar 

  58. Amris K, Wæhrens EE, Christensen R, Bliddal H, Danneskiold-Samsøe B; IMPROvE Study Group (2014) Interdisciplinary rehabilitation of patients with chronic widespread pain: primary endpoint of the randomized, nonblinded, parallel-group IMPROvE trial. Pain 155:1356–1364

    Article  PubMed  Google Scholar 

  59. Angst F, Brioschi R, Main CJ, Lehmann S, Aeschlimann A (2006) Interdisciplinary rehabilitation in fibromyalgia and chronic back pain: a prospective outcome study. J Pain 7:807–815

    Article  PubMed  Google Scholar 

  60. Vincent A, Whipple MO, Oh TH, Guderian JA, Barton DL, Luedtke CA (2013) Early experience with a brief, multimodal, multidisciplinary treatment program for fibromyalgia. Pain Manag Nurs 14:228–235

    Article  PubMed  Google Scholar 

  61. Arnold LM, Williams DA, Hudson JI et al (2012) Development of responder definitions for fibromyalgia clinical trials. Arthritis Rheum 64:885–894

    Article  PubMed  PubMed Central  Google Scholar 

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Authors and Affiliations

  1. Department of Physical Medicine and Rehabilitation, Istanbul Faculty of Medicine, Istanbul University, Millet Cad, Capa, Fatih, 34093, Istanbul, Turkey

    Ilknur Saral, Dilsad Sindel, Sina Esmaeilzadeh & Aydan Oral

  2. Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Istanbul Medipol University, Istanbul, Turkey

    Ilknur Saral

  3. Department of Clinical Psychology, Faculty of Letters, Istanbul University, Istanbul, Turkey

    Hanife Ozlem Sertel-Berk

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  1. Ilknur Saral
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  2. Dilsad Sindel
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Correspondence to Sina Esmaeilzadeh.

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All authors declare no conflict of interest. No grant or industry support was received for this study.

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Saral, I., Sindel, D., Esmaeilzadeh, S. et al. The effects of long- and short-term interdisciplinary treatment approaches in women with fibromyalgia: a randomized controlled trial. Rheumatol Int 36, 1379–1389 (2016). https://doi.org/10.1007/s00296-016-3473-8

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