Internet-enhanced management of fibromyalgia: A randomized controlled trial Differential efficacy of a cognitive – behavioral intervention versus pharmacological treatment in the management of fibromyalgic syndrome Integrating Virtual Reality With Activity Management for the Treatment of Fibromyalgia: Acceptability and Preliminary Efficacy Multidisciplinary treatment of fibromyalgia: does cognitive behavior therapy increase the response to treatment? Operant behavioral treatment of fibromyalgia: a controlled study. Fibromyalgia Benefits From Massage Therapy and Transcutaneous Electrical Stimulation Cognitive behavioral therapy for the treatment of juvenile fibromyalgia: a multisite, single-blind, randomized, controlled clinical trial. Efficacy of cognitive-behavioral intervention for juvenile primary fibromyalgia syndrome. Challenges in demonstrating the effectiveness of multidisciplinary treatment on quality of life, participation and health care utilisation in patients with fibromyalgia: a randomised controlled trial The efficacy of the Rességuier method in the treatment of fibromyalgia syndrome: a randomized controlled trial. A comparative evaluation of a fibromyalgia rehabilitation program. Changes in pain coping, catastrophizing, and coping efficacy after cognitive-behavioral therapy in children and adolescents with juvenile fibromyalgia. Comparison of integrated group therapy and group relaxation training for fibromyalgia. Occupational therapy in multiple system atrophy: a pilot randomized controlled trial. Long-term efficacy of therapy in patients with fibromyalgia: a physical exercise-based program and a cognitive-behavioral approach. Affective-Cognitive Behavioral Therapy for Fibromyalgia: A Randomized Controlled Trial Effectiveness of multidisciplinary therapy on symptomatology and quality of life in women with fibromyalgia.
& NA ; Both pharmacological and non‐pharmacological interventions have demonstrated efficacy in the management of fibromyalgia ( FM ) .  Non‐pharmacological interventions however are far less likely to be used in clinical setting s , in part due to limited access . This manuscript presents the findings of a r and omized controlled trail of an Internet‐based exercise and behavioral self‐management program for FM design ed for use in the context of a routine clinical care . 118 individuals with FM were r and omly assigned to either ( a ) st and ard care or ( b ) st and ard care plus access to a Web‐Enhanced Behavioral Self‐Management program ( WEB‐SM ) grounded in cognitive and behavioral pain management principles . Individuals were assessed at baseline and again at 6 months for primary endpoints : reduction of pain and an improvement in physical functioning . Secondary outcomes included fatigue , sleep , anxiety and depressive symptoms , and a patient global impression of improvement . Individuals assigned to the WEB‐SM condition reported significantly greater improvement in pain , physical functioning , and overall global improvement . Exercise and relaxation techniques were the most commonly used skills throughout the 6 month period . A no‐contact , Internet‐based , self‐management intervention demonstrated efficacy on key outcomes for FM . While not everyone is expected to benefit from this approach , this study demonstrated that non‐pharmacological interventions can be efficiently integrated into routine clinical practice with positive outcomes Abstract Given that studies about the differential efficacy of existing treatments in fibromyalgia syndrome are scarce , the aim of this study was to compare the differential efficacy of a cognitive – behavioral and a pharmacological therapy on fibromyalgia . Using a r and omized controlled clinical trial , 28 fibromyalgic patients were assigned to one of following experimental conditions : ( a ) pharmacological treatment ( i.e. , cyclobenzaprine ) , ( b ) cognitive – behavioral intervention ( i.e. , stress inoculation training ) , ( c ) combined pharmacological and cognitive – behavioral treatment and ( d ) no treatment . The results show the superiority of  cognitive – behavioral intervention to reduce the severity of fibromyalgia both at the end of the treatment and at follow-up . We conclude that cognitive – behavioral interventions must be considered a primary treatment of fibromyalgia syndrome Objectives : Cognitive-behavioral therapies ( CBT ) for fibromyalgia syndrome ( FMS ) are important interventions in the management of this condition . Empirical evidence reports that although the results are promising , further research is needed to respond more appropriately to these patients . This study focuses on exploring the use of Virtual Reality ( VR ) as an adjunct to the activity management component . The aim of this study is to present the results of a small-sized r and omized controlled trial to test the preliminary efficacy and acceptability of this component . Material s and Methods : The final sample was composed of 61 women diagnosed with FMS according to the American College of Rheumatology . The sample was r and omly allocated to 2 conditions : VR treatment and treatment as usual . Results : Participants in the VR condition achieved significant improvements in the primary outcome : disability measured with the FIQ . The improvement was also significant in secondary outcomes , such as perceived quality of life and some of the coping strategies included in the Chronic Pain Coping Inventory : task persistence and exercise . There were no differences in other secondary outcome measures like pain intensity and interference and depression . Participants reported high satisfaction with the VR component . Discussion : The effects were related to the psychological aspects targeted in the treatment . The component was well accepted by FMS patients referred from a public hospital . These findings show that the VR component could be useful in the CBT treatment of FMS and encourage us to continue exploring the use of integrating VR with CBT interventions for the treatment of FMS OBJECTIVE Multidisciplinary treatments ( MTs ) are usually recommended for reducing fibromyalgia ( FM ) symptoms and include physical exercise , drug management , education , and cognitive behavior therapy ( CBT ) . However , there is no evidence that CBT adds efficacy to the other therapeutic components . This r and omized controlled trial analyzed the response of FM patients to two MTs , with and without CBT , according to the presence of concurrent symptoms . METHODS Eighty-three women with FM were r and omly assigned to MT or combined MT and CBT . The MT included medical intervention , physical training , education , and discussion of the syndrome . The CBT focused on coping with stress , modifying lifestyles , and changing pain behaviors . Demographic and clinical data , information regarding tender points , and question naire responses about functional capability [ Fibromyalgia Impact Question naire ( FIQ ) ] , health status [ 36-item Short Form Health Survey ( SF-36 ) ] , and mental health [ Symptom Checklist-90-Revised ( SCL-90-R ) ] were obtained at the beginning , at the end of the 15-week treatment , and at 6-month follow-up . Subgroups are identified in relation to treatment response . RESULTS Sixty-six women ( 80 % ) completed treatment . Although the variance of the total sample had changed at posttreatment ( F=2.67 , P=.031 ) , there was no significant effect for the TimexTreatment interaction ( F=1.65 , P=.16 ) . Univariate tests detected a significant fall in the FIQ score . The subgroup of patients with fatigue showed a better response with MT+CBT than with MT . At 6-month follow-up , the statistical differences had been maintained . Intention-to-treat analysis ratified these results . CONCLUSIONS MT improves functional capability and reduces symptom impact . CBT increases mildly the effect of MT in patients with fatigue OBJECTIVE To evaluate the efficacy of operant pain treatment for fibromyalgia syndrome ( FMS ) in an inpatient setting . METHODS Sixty-one patients who fulfilled the American College of Rheumatology criteria for FMS were r and omly assigned to the operant pain treatment group ( OTG ; n = 40 ) or a st and ardized medical program with an emphasis on physical therapy ( PTG ; n = 21 ) . Pain assessment s were performed before , immediately after , 6 months after , and 15 months after treatment . RESULTS The OTG patients reported a significant and stable reduction in pain intensity , interference , solicitous behavior of the spouse , medication , pain behaviors , number of doctor visits , and days at a hospital as well as an increase in sleeping time . Sixty-five percent of the OTG compared with none of the patients in the PTG showed clinical ly significant improvement . CONCLUSION These results suggest that operant pain treatment provided in an inpatient setting is an effective treatment for FMS , whereas a purely somatically oriented program may lead to a deterioration of the pain problem Thirty adult fibromyalgia syndrome subjects were r and omly assigned to a massage therapy , a transcutaneous electrical stimulation ( TENS ) , or a transcutaneous electrical stimulation no-current group ( Sham TENS ) for 30-minute treatment sessions two times per week for 5 weeks . The massage therapy subjects reported lower anxiety and depression , and their cortisol levels were lower immediately after the therapy sessions on the first and last days of the study . The TENS group showed similar changes , but only after therapy on the last day of the study . The massage therapy group improved on the dolorimeter measure of pain . They also reported less pain the last week , less stiffness and fatigue , and fewer nights of difficult sleeping . Thus , massage therapy was the most effective therapy with these fibromyalgia patients OBJECTIVE Juvenile fibromyalgia syndrome ( FMS ) is a chronic musculoskeletal pain disorder in children and adolescents for which there are no evidence -based treatments . The objective of this multisite , single-blind , r and omized clinical trial was to test whether cognitive-behavioral therapy ( CBT ) was superior to fibromyalgia ( FM ) education in reducing functional disability , pain , and symptoms of depression in juvenile FMS . METHODS Participants were 114 adolescents ( ages 11 - 18 years ) with juvenile FMS . After receiving stable medications for 8 weeks , patients were r and omized to either CBT or FM education and received 8 weekly individual sessions with a therapist and 2 booster sessions . Assessment s were conducted at baseline , immediately following the 8-week treatment phase , and at 6-month followup . RESULTS The majority of patients ( 87.7 % ) completed the trial per protocol . Intent-to-treat analyses showed that patients in both groups had significant reductions in functional disability , pain , and symptoms of depression at the end of the study , and CBT was significantly superior to FM education in reducing the primary outcome of functional disability ( mean baseline to end-of-treatment difference between groups 5.39 [ 95 % confidence interval 1.57 , 9.22 ] ) . Reduction in symptoms of depression was clinical ly significant for both groups , with mean scores in the range of normal/nondepressed by the end of the study . Reduction in pain was not clinical ly significant for either group ( < 30 % decrease in pain ) . There were no study -related adverse events . CONCLUSION In this controlled trial , CBT was found to be a safe and effective treatment for reducing functional disability and symptoms of depression in adolescents with juvenile FMS OBJECTIVE There are currently no controlled studies of behavioral interventions for juvenile primary fibromyalgia syndrome ( JPFM ) . In this small- sample r and omized study , we tested the efficacy of a behavioral intervention , i.e. , coping skills training ( CST ) , for the treatment of adolescents with JPFM . Outcomes tested in this study were functional disability , pain intensity , pain-coping efficacy , and depressive symptoms . METHODS Thirty patients with JPFM were r and omly assigned to 8 weeks of either CST or self-monitoring . Adolescents in the CST condition received training in active pain-coping techniques , while those in the self-monitoring condition monitored daily pain intensity and sleep quality with no instructions about behavior change . After posttreatment assessment , subjects were crossed over into the opposite treatment arm for 8 weeks ( so that all adolescents eventually received both CST and self-monitoring ) and were reassessed at Week 16 . RESULTS At Week 8 , adolescents in both conditions showed significant decrease in depressive symptoms and functional disability . Those who received CST showed significantly greater ability to cope with pain than those in the self-monitoring condition and a trend toward decreased pain intensity . At Week 16 , adolescents had significantly lower levels of disability and depressive symptoms compared to baseline , but those who received self-monitoring followed by CST seemed to receive the most benefit . CONCLUSION CST can lead to improved functioning among JPFM patients . Although some of the improvement may be due to increased monitoring and attention , CST provides the specific benefit of improving  adolescents ' ability to cope with pain This study aim ed to examine the effectiveness of a multidisciplinary intervention with aftercare ( MD ) compared to aerobic exercise ( AE ) and usual care ( UC ) in recently diagnosed patients with fibromyalgia ( FM ) . In a Zelen-like design , eligible patients from the outpatient rheumatology clinics of three medical centres in the South of the Netherl and s were consecutively recruited and pre-r and omised to MD ( n = 108 ) , AE ( n = 47 ) or UC ( n = 48 ) .  MD consisted of a 12-week course of sociotherapy , physiotherapy , psychotherapy and creative arts therapy ( three half days per week ) , followed by five aftercare meetings in 9 months . AE was given twice a week in a 12-week course . UC varied but incorporated at least education and lifestyle advice . Primary outcomes were health-related quality of life ( HR-Qol ) , participation and health care utilisation . Secondary outcome was the Fibromyalgia Impact Question naire ( FIQ ) . Total follow-up duration of the study was 21–24 months . As willingness to participate in AE was limited , this group has been analysed but interpretation of the data is considered arguable . Within the MD group , a statistically significantly improved HR-Qol and a statistically significant reduction in number of hours sick leave , number of contacts with general practitioners and number of contacts with medical specialists was found . Moreover , statistically significant improvements were found on the FIQ , which increased after the intervention . However , no statistically significant between-group differences were found at the endpoint of the study . MD seemed to yield positive effects , but firm conclusions with regard to effectiveness can not be formulated due to small between-group differences and limitations of the study OBJECTIVES In fibromyalgia syndrome ( FMS ) defined rehabilitation guidelines are yet to be vali date d. Our aim is to evaluate the efficacy of the Rességuier method ( RM ) in FMS . METHODS Forty-one patients were r and omly assigned to Interventional ( 22 pts ) and Observational ( 19 pts ) Group ( IG and OG ) . The study lasted 8 months . Patients were assessed at baseline ( T0 ) after a 2-month rehabilitation ( T1 ) and at a 6-month follow-up ( T2 ) ( only IG ) with SF-36 Physical ( PSI ) and Mental Synthetic Index ( MSI ) , Regional Pain Scale ( RPS ) , Fibromyalgia Impact Question naire ( FIQ ) , Number Rating Scales 0 - 10 to measure pain , movement quality , sleep , relax ability , analgesics number/per week . OG patients maintained their lifestyle for the duration of the study . RM aims to obtain patient awareness and control of bodily perceptions , thus reaching a modulation of responses to pain . Therapist controls patient attention and perception by verbal and manual contacts and leads them to perform bodily and respiratory active and conscious movements . RESULTS In IG , at T1 all items were improved : PSI and MSI ( p<0.001 and = 0.001 ) , FIQ ( p<0.0001 ) , RPS ( p<0.001 ) , pain ( p<0.0001 ) , movement quality ( p=0.001 ) , relax ability ( p<0.0001 ) , sleep ( p<0.001 ) ; analgesics number/per week was reduced ( p<0.001 ) . All results obtained at T1 , except FIQ , were maintained at T2 . In OG at T1 versus T0 , no difference in any of the assessed parameters was observed . CONCLUSION In FMS patients , the rehabilitation with RM  improves HRQoL , FMS-related disability and perceived pain , thus reducing the assumption of analgesics OBJECTIVE To compare an evidence -based clinical fibromyalgia program , referred to as Fibro-Fit , with results of controlled clinical trials . METHODS An interdisciplinary group education and exercise program with 36 sessions over 12 weeks was used . Demographic , clinical , and outcome variables were collected on 149 participants , of whom 71 % completed the program . Outcomes included measures of self-efficacy , pain , physical fitness , function , and coping skills . RESULTS Results of the prospect i ve before-after evaluation showed statistically significant ( P < 0.005 ) improvements in all outcomes except for grip strength . These results were comparable with controlled clinical trials found in the literature . Data suggest that smoking , fibromyalgia support groups , and medications may be important modifiable factors . CONCLUSIONS Results suggest that Fibro-Fit was effective in improving physical impairments and function . Further investigation is required to refine the effective components of these programs and determine how modifiable factors can be used to improve outcomes UNLABELLED A recent r and omized multisite clinical trial found that cognitive-behavioral therapy ( CBT ) was significantly more effective than fibromyalgia education ( FE ) in reducing functional disability in adolescents with juvenile fibromyalgia ( JFM ) . The primary objective of this study was to examine the psychological processes of CBT effectiveness by evaluating changes in pain coping , catastrophizing , and coping efficacy and to test these changes as mediators of continued improvements in functional disability and depressive symptoms at 6-month follow-up . One hundred adolescents ( 11 - 18 years old ) with JFM completed the clinical trial .  Coping , catastrophizing , and coping efficacy ( Pain Coping Question naire ) and the outcomes of functional disability ( Functional Disability Inventory ) and depressive symptoms ( Children 's Depression Inventory ) were measured at baseline , posttreatment , and 6-month follow-up . Participants in both conditions showed significant improvement in coping , catastrophizing , and efficacy by the end of the study , but significantly greater improvements were found immediately following treatment for those who received CBT .  Treatment gains were maintained at follow-up . Baseline to posttreatment changes in coping , catastrophizing , and efficacy were not found to mediate improvements in functional disability or depressive symptoms from posttreatment to follow-up . Future directions for underst and ing mechanisms of  CBT effectiveness in adolescents with chronic pain  are discussed . PERSPECTIVE CBT led to significant improvements in pain coping , catastrophizing , and efficacy that were sustained over time in adolescents with juvenile fibromyalgia . Clinicians treating adolescents with JFM should focus on teaching a variety of adaptive coping strategies to help patients simultaneously regain functioning and improve mood OBJECTIVE The efficacy of an integrated , psychological treatment program was tested in a controlled study involving 27 patients with chronic musculoskeletal pain ( fibromyalgia ) . DESIGN The experimental treatment program consisted of instruction in various self-help techniques ( e.g. , cognitive behavioral strategies , relaxation , physical exercises ) as well as information on chronic pain . Control groups were instructed only in autogenic training .  Measures of pain , daily activities , general symptoms , and psychological functioning were assessed before and after treatment , as well as at 4 months after termination of therapy ( follow-up ) . RESULTS At the end of treatment , 7 patients from the experimental group and 2 from the control group showed significant clinical improvement in 3 of 6 parameters ( NS ) . At follow-up , the improvement was still present in 5 experimental cases but in none of the controls ( p = 0.024 ) . Successful patients had been sick for a shorter period of time and were less impaired by their condition . CONCLUSIONS Psychological interventions in combination with physiotherapy can be effective in treating fibromyalgia patients , especially if applied early There is some evidence that rehabilitation therapies may be useful in progressive neurological conditions , but this usefulness has not been studied in multiple system atrophy ( MSA ) to date . The aim of this small pilot study was to identify the feasibility of a larger r and omized controlled trial of occupational therapy and to report preliminary data on the impact of occupational therapy on disability , mood , and health-related quality of life in patients with MSA . Patient groups were comparable for age , gender distribution , type of MSA , and severity . The active occupational therapy intervention group experienced a significant reduction of Unified Parkinson 's Disease Rating Scale ( total score and Activities of Daily Living [ ADL ] section ) , and PDQ-39 scores ( total scores and ADL subsection ) . An occupational therapy program may improve functional abilities in patients with mild to moderate MSA . A larger multicenter study is needed OBJECTIVE To analyze the long-term efficacy of 2 interventions for female fibromyalgia ( FM ) patients : 1 ) cognitive-behavioral therapy ( CBT ) , and 2 ) a physical exercise (PE)-based strategy . METHODS We conducted a prospect i ve , long-term , r and omized , parallel clinical trial . The outcome variables are physical activity , aerobic capacity , and results of the Fibromyalgia Impact Question naire ( FIQ ) , Short Form 36 , Beck Anxiety and Depression Inventory , Chronic Pain Self-Efficacy Scale , and Chronic Pain Coping Inventory . All were measured at baseline , posttreatment , 6 months , and 1 year . The duration of both treatments was 8 weeks . RESULTS Some items of the FIQ and some strategies to cope with pain improved significantly in both groups after treatment . All variables measuring functional capacity improved significantly in the PE group , whereas only physical activity of the vertebral column improved in the CBT group . There were no differences in anxiety , depression , and self efficacy after treatment in either group . After 1 year of followup , most of the parameters had returned to baseline values in both groups . However , in the PE group , functional capacity remained significantly better . CONCLUSIONS PE and CBT improve clinical manifestations in FM patients only for short periods of time . Improvement in self efficacy and physical fitness are not associated with improvement in clinical manifestations A r and omized controlled trial was conducted to assess the efficacy of an individually administered form of cognitive behavioral treatment for fibromyalgia . In an additive design , 76 patients diagnosed with fibromyalgia were r and omly assigned to either the experimental treatment ( affective-cognitive behavioral therapy , 10 individual sessions , one per week ) administered concurrently with treatment-as-usual or to an unaugmented treatment-as-usual condition . Statistical analysis conducted at the end of treatment ( 3 months after the baseline assessment ) and at a followup ( 9 months after the baseline assessment ) indicated that the patients receiving the experimental treatment reported less pain and overall better functioning than control patients , both at posttreatment and at followup . The implication s of these findings for future research are discussed OBJECTIVES To study the effects of a 3-month multidisciplinary intervention based on exercise and psychological therapy on symptomatology and quality of life in women with fibromyalgia . METHODS Seventy-five women with fibromyalgia volunteered to participate and were allocated to a 3-month ( 3-times/week ) multidisciplinary ( pool , l and -based and psychological session based on the Acceptance and Commitment Therapy ) intervention ( n=41 ) , or to a usual care group ( n=34 ) . Sixty-five women with fibromyalgia completed the study protocol ( n=33 multidisciplinary intervention , aged 51.4±7.4 years and n=32 usual care group , aged 50.0±7.3 years ) . The outcomes variables were Fibromyalgia Impact Question naire ( FIQ ) , Short Form Health Survey 36 ( SF-36 ) , Hospital Anxiety and Depression Scale , V and erbilt Pain Management Inventory and Rosenberg Self-Esteem Scale . RESULTS We observed a significant interaction effect ( group*time ) for the FIQ total score , the subscales fatigue , stiffness , anxiety and depression , and the subscales of SF-36 physical role , bodily pain , vitality and social functioning . Post-hoc analysis revealed significant improvements in total score of FIQ ( p<0.001 ) , fatigue ( p=0.001 ) , stiffness ( p<0.001 ) , anxiety ( p=0.011 ) , depression ( p=0.008 ) , physical role ( p=0.002 ) , bodily pain ( p<0.001 ) , vitality ( p<0.001 ) and social functioning ( p<0.001 ) in the intervention group , whereas in the control group , there was a significant worsening in the subscale depression ( p=0.006 ) and social functioning ( p=0.019 ) . CONCLUSIONS A 3-month low-moderate intensity multidisciplinary intervention improved fibromyalgia symptomatology and quality of life in women with fibromyalgia
Strong evidence was found for interventions categorized for this review as  cognitive – behavioral interventions ; relaxation and stress management ; emotional disclosure ; physical activity ;  and  multidisciplinary interventions for improving daily living , pain , depressive symptoms , and fatigue .
There was limited to no evidence for self-management , and few interventions result ed in better sleep .
Although the evidence supports interventions within the scope of occupational therapy practice for people with fibromyalgia , few interventions were occupation based
This systematic review addresses the effectiveness of occupational therapy – related interventions for adults with fibromyalgia .