Cognitive Behavioral Therapy Trial in Fibromyalgia

NCT ID: NCT01004458

Last Updated: 2009-10-30

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

48 participants

Study Classification

INTERVENTIONAL

Study Start Date

2001-01-31

Study Completion Date

2008-12-31

Brief Summary

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Previous studies have shown that the disorder fibromyalgia often is preceded by long-term stress. Moreover, an association has been shown between stress, pain and co-morbidity in these patients. Cognitive behavioral therapy (CBT) has been shown effective in reducing stress, anxiety and pain in rheumatoid arthritis and fibromyalgia. The purpose of the present trial was to assess whether CBT may reduce pain and other symptoms and increase well-being and general function, affect biological markers for pain and long-term stress, to a larger extent than treatment "as usual".

Forty eight women with verified fibromyalgia were randomly allocated to an early treatment group or a waiting list group. The early treatment group received CBT group treatment during six months. Measurements of outcome and potential outcome affecting variables were made at baseline, after six months and one year after baseline. The waiting list group received the same CBT treatment as the early treatment group after six months on the waiting list.

The design is thus a traditional "waiting list design", allowing a two parallel group comparison during the first six months and a "before-after" analysis in both groups when the treatment was concluded.

Detailed Description

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Long-lasting pain is a common cause for disability. In several studies 30-40% of the adult general population suffer from pain. In this group of subjects the fibromyalgia syndrome (FMS) is common,. This is a well defined disorder with generalized pain, well defined tenderpoints according to the American Collage of Rheumatology (ACR) criteria, and a number of other associated symptoms. About 5-10% of the general female population suffers from fibromyalgia. The disorder is infrequent among men.

The etiology of the condition is unknown. However, a multi-factorial origin is postulated, where some form of stress is a contributing factor. Also neuro-endocrine disturbances have been observed. Cognitive behavioral therapy CBT) is an evidence based efficient treatment method in depression and panic disorder. In open studies it has proved to be an effective stress and pain reducer.

The purpose of the trial was to evaluate the effect of CBT in a group of female FMS patients regarding pain, stress, and well-being (outcome). A purpose was also to study mediating factors, such as biological markers for stress and pain, and psycho-social factors.

The study population consisted of 48 women, 27-62 years of age, living in Östhammar municipality, central Sweden, with a verified FMS according to the 1992 ACR criteria, and no other serious disorder. The were recruited by advertising in the local printed press and meetings with the local rheumatology patient association.

54 subjects were screened for participation. A physical examination was performed, a medical history was taken, blood samples and saliva specimens for biological markers regarding metabolic status, pain and stress were taken, and a questionnaire was filled out. 48 women fulfilled the inclusion criteria and gave informed consent to participation. A randomized block design was used by which the women were randomly allocated to two groups, an early treatment group and a waiting list group.

The early treatment group was subdivided into four treatment groups with six participants in each. The CBT treatment was given by certified therapists and supervised by the chief therapist, an experienced psychologist. Each group had the same therapist throughout the trial. The therapy was given as group sessions once a week for 20 weeks. When the therapy was completed the outcome variables were measured by means of questionnaire, and the same blood and saliva specimens as at baseline were taken. During the next six months two booster CBT sessions were performed. One year after baseline a final follow-up evaluation was made.

The waiting list group served as reference (or control) group to the early treatment group during the first six months from baseline. No CBT therapy was given, but otherwise exactly the same procedure was followed. When the control period was over the waiting list group got their CBT treatment and evaluations following the same protocol as the early treatment group.

The outcome evaluation are based on a number of questionnaire instruments, such as the Multidimensional Pain Inventory (MPI), the Type A behavior instrument (Everyday stress), The Maastricht Questionnaire ("Vital exhaustion"), and the self administered Montgomery Åsberg Depression Rating Scale (MADRS-S) instrument. The blood sampling aimed at analyzing the neuro-peptides substance P, Met-Enkephalin-Arginine-Phenylalanine (MEAP), beta-endorphin, and neuro-peptide Y, in addition to estrogen, testosterone, prolactin and dehydroepiandrosterone (DHEA). The saliva specimens were intended to measure diurnal variation of cortisol. To standardize the hormonal level all evaluations were done in ovulation phase of the menstrual cycle.

Conditions

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Fibromyalgia

Keywords

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fibromyalgia cognitive behavioral therapy women pain stress type A behavior

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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Early treatment group

The experimental group receiving CBT

Group Type ACTIVE_COMPARATOR

Cognitive behavioral therapy

Intervention Type BEHAVIORAL

The treatment, adopted to reduce hostility and stress behavior, was given during group sessions once a week during six months with two follow-up occasions during the next six months

Waiting list group

The waiting list group served as referents during the trial

Group Type NO_INTERVENTION

Waiting list

Intervention Type OTHER

The group served as referents during the trial and received no intervention other than measurements at the same points in time as the intervention group

Interventions

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Cognitive behavioral therapy

The treatment, adopted to reduce hostility and stress behavior, was given during group sessions once a week during six months with two follow-up occasions during the next six months

Intervention Type BEHAVIORAL

Waiting list

The group served as referents during the trial and received no intervention other than measurements at the same points in time as the intervention group

Intervention Type OTHER

Eligibility Criteria

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Inclusion Criteria

* Fibromyalgia according to the American College of Rheumatology criteria
* Women
* Age 18-65
* Living in Östhammar municipality, Sweden
* Swedish speaking

Exclusion Criteria

* severe mental disease
* drug or alcohol abuse
Minimum Eligible Age

18 Years

Maximum Eligible Age

65 Years

Eligible Sex

FEMALE

Accepts Healthy Volunteers

No

Sponsors

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Uppsala County Council, Sweden

OTHER_GOV

Sponsor Role collaborator

National Social Insurance Board, Sweden

UNKNOWN

Sponsor Role collaborator

The Swedish Society of Medicine

OTHER

Sponsor Role collaborator

Reumatikerförbundet

UNKNOWN

Sponsor Role collaborator

Uppsala University

OTHER

Sponsor Role lead

Responsible Party

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Uppsala University

Principal Investigators

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Bo Karlsson, MD

Role: PRINCIPAL_INVESTIGATOR

Uppsala University

Locations

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Dept of Public Health and Caring Sciences, Family Medicin and Clinical Epidemiology Section

Uppsala, , Sweden

Site Status

Countries

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Sweden

References

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Karlsson B, Nyberg F, Svardsudd K, Burell G, Bjorkegren K, Kristiansson P. Neuropeptide Y and measures of stress in a longitudinal study of women with the fibromyalgia syndrome. Scand J Pain. 2022 Jun 21;23(1):59-65. doi: 10.1515/sjpain-2022-0016. Print 2023 Jan 27.

Reference Type DERIVED
PMID: 35728621 (View on PubMed)

Related Links

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http://www.pubcare.uu.se

Link to department website where the study is briefly described

Other Identifiers

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UCC2000

Identifier Type: -

Identifier Source: org_study_id