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Pain Research and Management
Volume 2, Issue 3, Pages 145-150
Original Article

Out-Patient Cognitive-Behavioural Treatment of Fibromyalgia: Impact on Pain Response and Health Status

Warren R Nielson, Manfred Harth, and David A Bell

Division of Rheumatology, Department of Medicine, London Health Sciences Centre, University of Western Ontario, London, Ontario, Canada

Received 14 April 1997; Accepted 20 June 1997

Copyright © 1997 Hindawi Publishing Corporation. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


OBJECTIVE: To evaluate a cognitive-behavioural out-patient program for patients with fibromyalgia syndrome.

PATIENTS AND METHODS: A quasi-experimental design was used to evaluate 101 patients who participated in a four-week program that included psychological, family educational, occupational therapy and physiotherapy interventions. After discharge, patients were seen four times over one year for day-long review sessions. Five pain response scales from the Multidimensional Pain Inventory (MPI) and the Fibromyalgia Impact Questionnaire (FIQ) were used to assess treatment effects. Data were analyzed using multivariate ANOVAs followed by multiple comparisons using Tukey's honestly significant difference test.

RESULTS: The overall multivariate effect for the MPI was significant (P<0.0001). Subsequent multiple comparisons indicated consistent improvement in pain severity, life interference, life control, emotional distress and activity level scores at discharge, but no change during a no-treatment waiting list control interval. These effects were maintained at a 12-month follow-up with the exception of activity level. The multivariate effect across the FIQ scales was significant (P<0.01). Multiple comparisons indicated that all variables except physical impairment improved at discharge. Impairment (P<0.05), anxiety and well-being (P<0.01) improved at follow-up compared with scores at admission.

CONCLUSIONS: Pain response and health status improve following intensive cognitive-behavioural treatment. These effects persist at one year but are generally weaker than at discharge. The largest effects were on indexes that reflect emotional status and general well-being. Implications of these findings for fibromyalgia treatment programs are discussed.