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Multimodal Treatment and Fibromyalgia

This team of researchers evaluated a specific pain controlling treatment plan for FM patients, which involved cognitive-behavioral training such as relaxation techniques, cognitive reconstructing and diversion, and gymnastic exercise. They compared the efficacy of such a program to one that was limited only to relaxation techniques, hoping to find the former more effective due to its educational package.

27 patients participated; 14 in the experimental group and 13 in the relaxation group. Both groups were psychologically comparable at the outset of the study. Significant improvements were found in the educational group; they consisted of: general symptoms, sleep disturbances, medication consumption, pain scores, physical therapies, and patients' global assessments. Five of the 14 (36%) experimental group patients showed improvement four months after treatment, while none of the relaxation group patients did.

In comparing the successful to unsuccessful patients, the researchers assessed the following conclusions:

"The five successful patients had suffered from their pain for a shorter time, which highlights the importance of early intervention. The goals of the treatment program seem to have fitted their attitude and expectations. They were able to decrease their excess work-activity and extreme helpful nature (learning to say no). Depression did not predict outcome, but negative outcome was associated with an increase in depressive symptoms, which might reflect the helplessness and resignation of the unsuccessful patients."

Improvements in the relaxation technique group were smaller, and had vanished at the follow-up. The researchers conclude, "...because relaxation training and some discussion time were elements common to both groups, we can assume that information about the illness and a clear cognitive-behavioral concept fostering self-control were effective ingredients of the experimental groups."

Keel PJ, Bodoky C, Gerhard U, Muller W. Comparison of integrated group therapy and group relaxation training for fibromyalgia. The Clinical Journal of Pain 1998;14:232-238.