NEW YORK (Reuters Health) - Patients with fibromyalgia who received a short program of cognitive behavioral therapy were more likely to show improvements in functioning after the treatment than those who were not given the therapy, according to new research.

However, patients who had the therapy reported no less pain than others, the authors note.

Fibromyalgia is a chronic condition marked by widespread muscular and joint pain, as well as specific "tender" points that typically occur in the neck, spine, hips and shoulders. Other symptoms include sleep disturbances and fatigue, depression and irritable bowel syndrome. The condition affects an estimated 2% to 4% of the population, but is seen most often in women of reproductive age.

Cognitive behavioral therapy seeks to help patients deal with problems by focusing on self-control and coping strategies.

During the study, 145 patients with fibromyalgia were given standard treatment for the condition, which included antidepressants, pain-relievers and instructions about exercise. Half of the patients also enrolled in six sessions of cognitive behavioral therapy, conducted over a 4-week period.

In this study, cognitive behavioral therapy consisted of six hour-long group sessions with an experienced therapist that focused on teaching patients skills to improve their physical functioning. During the sessions, the therapist instructed patients on how to relax their muscles, increase their functioning without increasing their pain, and manage the negative thoughts and beliefs that can affect their functioning.

One year after the treatment ended, patients reported how much pain they were experiencing and their levels of physical functioning.

The investigators found that 25% of patients who had behavioral therapy experienced a significant increase in physical functioning after the treatment, an improvement seen in only 12% of patients who did not receive it. Both groups of patients had the same pain levels one year after the treatment, according to the report in the recent issue of the Journal of Rheumatology.

In an interview with Reuters Health, lead author Dr. David A. Williams of the University of Michigan in Ann Arbor--who was at Georgetown University in Washington, DC at the time of the study--said that cognitive behavioral therapy (CBT) may help some aspects of fibromyalgia, but not others.

Fibromyalgia "is thought to be the result of many bodily systems becoming dysregulated," Williams explained. "Therefore, there are probably many subtypes of (fibromyalgia) depending upon how the body has become dysregulated. CBT may work better for some types of dysregulation than for others," he added.

Indeed, previous studies of CBT in fibromyalgia have shown mixed results, perhaps due to changes in how the therapy was administered, Williams noted. For example, CBT can focus on functional status, pain, or psychological well-being, he pointed out.

"Therefore, while all have been called CBT, each has actually been quite different in terms of skills taught, length of treatment and focus of treatment," he said.

One of the next steps is to see whether longer periods of CBT produce better results, Williams added.

SOURCE: The Journal of Rheumatology 2002;29:1280-1286.

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