Psychosocial Treatment of Fibromyalgia

Psychosocial Treatment of Fibromyalgia

This study¹ compared the clinical effects of a behavioral and educational intervention on FM patients. The behavioral treatment involved:

1. Education on FM pain and the role of cognition in experience and expression of pain.
2. Progressive relaxation exercises.
3. Goal setting to increase functioning.
4. A support person (of relation or acquaintance) aware of pain management skills.

The educational model consisted of various educational videos and group discussion and support.

During the 10-week trial no significant changes occurred, but at the 6-month follow-up, progress was noted. Reductions in depression, self-reported pain behavior, observed pain behavior, and trigger point scores were evident. Pain, however, did not decrease.

The researchers found that reductions in helplessness resulted in improvement in pain and depression; whereas, improvements in passive coping correlated to the patient's self-reported pain behavior. And there was no difference between the two groups—indicating that both behavioral and educational approaches are beneficial.

Improvement was also seen in the patient's trigger point scores, which suggests the efficacy of psychosocial interventions with FM patients. To explain the occurrence, the researchers offer:

"It is possible that tender point pain may be an indicator of generalized stress rather than a biological marker of the disorder. Reductions in tender point severity would thus coincide with the improvement noted in depression and pain behavior."

The improvements indicate that these interventions may be "instrumental to clinical change in FM."

The greatest benefit of the interventions seemed to be in terms of dealing with "helplessness." There is a growing awareness in the medical literature that fibromyalgia is getting out of control—one study² found that as many as 25% of FM patients in the US have received some type of disability or injury compensation. This "disability" mentality may be most harmful to the patient himself. As Wolfe (one of the original researchers who came up with the diagnostic criteria for FM) recently wrote:

"That FM will always be with us because patients suffer with its symptoms is true regardless of what we name the syndrome. It is possible to improve the lot of those with FM, but first we must take control of our own beliefs about FM as a disease, about the effectiveness of treatment, and about the role of psychological factors. We must halt the trend to label patients with FM as disabled, and we must interfere with the societal trend toward encouragement of the disability concept."³

1. Nicassio PM, Radojevic V, Weisman MH, et al. A comparison of behavioral and educational interventions for fibromyalgia. Journal of Rheumatology 1997;24:2000-2007.
2. Wolfe F, Anderson J, Harkness D, et al. The work and disability status of persons with fibromyalgia. Journal of Rheumatology 1997;24:1171-1178.
3. Wolfe F. The fibromyalgia problem. Editorial. Journal of Rheumatology 1997;24:1247-1249.