CBT, one of the few treatment options for fibromyalgia, has been the "psychological treatment of choice," with techniques that include relaxation training, distraction and pleasant imagery, cognitive reappraisal of distressing thoughts, as well as scheduling and engaging in pleasant activities and healthy behaviors like exercise, he said.
The goal of CBT for fibromyalgia is to shift patients from a "medical treatment cure model" to a "chronic illness self-management" model. However, while CBT has resulted in significant changes over various control conditions, the effect sizes reported in studies have been too small to be noticed by patients, Dr. Lumley said. For example, based on the results of a 2013 Cochrane review, a patient with fibromyalgia could be told that with CBT, the "average patient’s pain improves about 0.5 points more on a 0-10 rating scale," compared with typical treatments, he said (<cf number=\"1\">ystematic reviews.\" </cf>Cochrane Database Syst. Rev. 2013 [doi:10.1002/14651858.CD009796.pub2]).
Fibromyalgia has been considered a psychosomatic condition or an unknown immune disorder in the past, but "a consensus is developing that it is sort of a central nervous system problem, [with] mostly brain, a little bit of spinal cord, and a little bit of the peripheral body involved," he said. In addition to chronic widespread pain and tenderness, symptoms include fatigue and sleep and cognitive problems.
Dr. Lumley had no disclosures; the multicenter study is funded by the National Institutes of Health.