Multidisciplinary treatment of fibromyalgia: does cognitive behavior therapy increase the response to treatment? Cognitive behavioral therapy for the treatment of juvenile fibromyalgia: a multisite, single-blind, randomized, controlled clinical trial. Psychological pain treatment in fibromyalgia syndrome: efficacy of operant behavioural and cognitive behavioural treatments Neurotherapy of fibromyalgia? Internet-enhanced management of fibromyalgia: A randomized controlled trial Fibromyalgia: a randomised, controlled trial of a treatment programme based on self management Integrating Virtual Reality With Activity Management for the Treatment of Fibromyalgia: Acceptability and Preliminary Efficacy Responder criteria for operant and cognitive-behavioral treatment of fibromyalgia syndrome. Fibromyalgia: the role of sleep in affect and in negative event reactivity and recovery. Is brief psychodynamic psychotherapy in primary fibromyalgia syndrome with concurrent depression an effective treatment? A randomized controlled trial. Assessment of the effects of aquatic therapy on global symptomatology in patients with fibromyalgia syndrome: a randomized controlled trial. The efficacy of the Rességuier method in the treatment of fibromyalgia syndrome: a randomized controlled trial. Meditation awareness training for the treatment of fibromyalgia syndrome: A randomized controlled trial Improving physical functional status in patients with fibromyalgia: a brief cognitive behavioral intervention. Values-Based Action in Fibromyalgia: Results From a Randomized Pilot of Acceptance and Commitment Therapy Behavioral insomnia therapy for fibromyalgia patients: a randomized clinical trial. Effects of unilateral repetitive transcranial magnetic stimulation of the motor cortex on chronic widespread pain in fibromyalgia.
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 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 The present study focused on the evaluation of the effects of operant behavioural ( OBT ) and cognitive behavioural ( CBT ) treatments for fibromyalgia syndrome ( FMS ) . One hundred and twenty-five patients who fulfilled the American College of Rheumatology criteria for FMS were r and omly assigned to OBT ( n = 43 ) , CBT ( n = 42 ) , or an attention-placebo ( AP ) treatment ( n = 40 ) that consisted of discussion s of FMS-related problems . Assessment s of physical functioning , pain , affective distress , and cognitive and behavioural variables were performed pre-treatment and post-treatment as well as 6 and 12 months post-treatment . Patients receiving the OBT or CBT reported a significant reduction in pain intensity post-treatment ( all Fs > 3.89 , all Ps < 0.01 ) . In addition , the CBT group reported statistically significant improvements in cognitive ( all Fs > 7.95 , all P < 0.01 ) and affective variables ( all Fs > 2.99 , all Ps < 0.02 ) , and the OBT group demonstrated statistically significant improvements in physical functioning and behavioural variables ( all Fs > 5.99 , all Ps < 0.001 ) compared with AP . The AP group reported no significant improvement but actually deterioration in the outcome variables . The post-treatment effects for the OBT and CBT groups were maintained at both the 6- and 12-month follow-ups . These results suggest that both OBT and CBT are effective in treating patients with FMS with some differences in the outcome measures specifically targeted by the individual treatments compared with an unstructured discussion group . The AP group showed that unstructured discussion of FMS-related problems may be detrimental OBJECTIVE To evaluate the efficacy of a novel variant of electroencephalograph biofeedback , the Low Energy Neurofeedback System ( LENS ) , that utilizes minute pulses of electromagnetic stimulation to change brainwave activity for the amelioration of fibromyalgia ( FM ) symptoms . DESIGN R and omized , double-blind , placebo-controlled clinical trial . SETTING Tertiary referral academic medical center , outpatient . PATIENTS Thirty-four patients diagnosed with FM according to 1990 American College of Rheumatology classification criteria . INTERVENTIONS Active or sham LENS , depending on r and omization , for 22 treatment sessions . OUTCOME MEASURES Primary outcome measure was the Fibromyalgia Impact Question naire total score . Secondary outcome measures included number of tender points ( TPs ) and pressure required to elicit TPs on physical examination , quantitative sensory testing heat pain threshold , and self-reported cognitive dysfunction , fatigue , sleep problems , global psychological distress , and depression obtained at baseline , immediate post-treatment , and 3- and 6-month follow-up . RESULTS Participants who received the active or sham interventions improved ( Ps < 0.05 ) on the primary and a variety of secondary outcome measures , without statistically significant between group differences in evidence at post-treatment or 3- or 6-month follow-up . Individual session self-reported ratings of specific symptoms ( cognitive dysfunction , fatigue , pain , and sleep , and overall activity level ) over the course of the 22 intervention sessions indicated significant linear trends for improvement for the active intervention condition only ( Ps < 0.05 ) . CONCLUSION LENS can not be recommended as a single modality treatment for FM . However , further study is warranted to investigate the potential of LENS to interact synergistically with other pharmacologic and nonpharmacologic therapies for improving symptoms in FM & 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 Objective : To evaluate the efficacy of a treatment programme for patients with fibromyalgia ( FM ) based on self management , using pool exercises and education . Methods : R and omised controlled trial with a 6 month follow up to evaluate an outpatient multidisciplinary programme ; 164 patients with FM were allocated to an immediate 6 week programme ( n = 84 ) or to a waiting list control group ( n = 80 ) . The main outcomes were changes in quality of life , functional consequences , patient satisfaction and pain , using a combination of patient question naires and clinical examinations . The question naires included the Fibromyalgia Impact Question naire ( FIQ ) , Psychological General Well-Being ( PGWB ) index , regional pain score diagrams , and patient satisfaction measures . Results : 61 participants in the treatment group and 68 controls completed the programme and 6 month follow up examinations . Six months after programme completion , significant improvements in quality of life and functional consequences of FM were seen in the treatment group as compared with the controls and as measured by scores on both the FIQ ( total score p = 0.025 ; fatigue p = 0.003 ; depression p = 0.031 ) and PGWB ( total score p = 0.032 ; anxiety p = 0.011 ; vitality p = 0.013 , ) . All four major areas of patient satisfaction showed greater improvement in the treatment than the control groups ; between-group differences were statistically significant for “ control of symptoms ” , “ psychosocial factors ” , and “ physical therapy ” No change in pain was seen . Conclusion : A 6 week self management based programme of pool exercises and education can improve the quality of life of patients with FM and their satisfaction with treatment . These improvements are sustained for at least 6 months after programme completion 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 To predict the effects of cognitive-behavioral therapy ( CBT ) and operant-behavioral therapy ( OBT ) in fibromyalgia syndrome ( FMS ) . METHODS A total of 125 patients who fulfilled the American College of Rheumatology FMS criteria were r and omly assigned to CBT ( n = 42 ) , OBT ( n = 43 ) , or attention placebo ( AP ; n = 40 ) . The pretreatment to 12-month followup reliability change index was used to determine clinical ly meaningful changes in pain intensity and physical impairment . Multinominal logistic regression analyses were used to determine the predictors of improvement in pain intensity and physical impairment for the entire sample . Analyses of variance were computed to compare the characteristics of responders and nonresponders in each of the 3 interventions . RESULTS At the 12-month followup , 53.5 % , 45.2 % , and 5 % of patients in the OBT , CBT , and AP groups , respectively , reported clinical ly meaningful improvements in pain intensity . Similarly , 58.1 % , 38.1 % , and 7.5 % of patients treated with OBT , CBT , and AP , respectively , reported clinical ly significant improvements in physical impairment . Prior to treatment , the OBT physical impairment responders displayed significantly more pain behaviors , physical impairment , physician visits , solicitous spouse behaviors , and level of catastrophizing compared with nonresponders . The CBT physical impairment responders , compared with nonresponders , reported higher levels of affective distress , lower coping , less solicitous spouse behavior , and lower pain behaviors . CONCLUSION The results of this study suggest that pretreatment patient characteristics are important predictors of treatment response and may serve as a basis for matching treatments to patient characteristics . Prospect i ve outcome studies are needed to confirm whether the tailoring of treatment actually leads to better outcomes for patients with FMS OBJECTIVE Fibromyalgia ( FM ) syndrome is a chronic pain condition characterized by diffuse muscle pain , increased negative mood , and sleep disturbance . Until recently , sleep disturbance in persons with FM has been modeled as the result of the disease process or its associated pain . The current study examined sleep disturbance ( i.e. , sleep duration and sleep quality ) as a predictor of daily affect , stress reactivity , and stress recovery . DESIGN AND MEASURES A hybrid of daily diary and ecological momentary assessment methodology was used to evaluate the psychosocial functioning of 89 women with FM . Participants recorded numeric ratings of pain , fatigue , and positive and negative affect 3 times throughout the day for 30 consecutive days . At the end of each day , participants completed daily diary records of positive and negative life events . In addition , participants reported on their sleep duration and sleep quality each morning . RESULTS After accounting for the effects of positive events , negative events , and pain on daily affect scores , it was found that sleep duration and quality were prospect ively related to affect and fatigue . Furthermore , the effects of inadequate sleep on negative affect were cumulative . In addition , an inadequate amount of sleep prevented affective recovery from days with a high number of negative events . CONCLUSIONS These results lend support to the hypothesis that sleep is a component of allostatic load and has an upstream role in daily functioning OBJECTIVE There are no studies investigating the efficacy of short-term psychodynamic psychotherapy in primary fibromyalgia syndrome ( FMS ) . We conducted a r and omized controlled trial evaluating an adapted form of individual short-term psychodynamic psychotherapy ( ASTPP ) versus primary care management ( TAU ) . The study focused on FMS patients with psychiatric comorbidity . METHODS Forty-six female patients with FMS and an International Classification of Diseases , 10th Revision diagnosis of a comorbid depression or anxiety disorder were recruited in a hospital setting . Participants were r and omized to receive either ASTPP ( 25 sessions , 1 session/week ) or TAU ( 4 consultations/6 months ) . Outcome measures included the Fibromyalgia Impact Question naire ( FIQ ) , the Hospital Anxiety and Depression Scale ( HADS ) , the Pain Disability Index , the Symptom Checklist 27 and the health-related quality of life . Primary endpoints of the outcome assessment were the FIQ total score and the HADS depression scale at 12-month follow-up . RESULTS Both treatments were effective in reducing the FIQ total score ( ES=0.56 and ES=0.75 , respectively ) . Intent-to-treat analyses failed to provide evidence suggesting a marked superiority of individual psychodynamic psychotherapy as compared to TAU . CONCLUSIONS A high-st and ard routine treatment focusing on the improvement of health behavior and including antidepressant and analgesic medication is equally effective as a short-term individual psychodynamic psychotherapy in improving fibromyalgia-related symptoms OBJECTIVES To evaluate the effects of a 16-week exercise therapy in a chest-high pool of warm water through applicable tests in the clinical practice on the global symptomatology of women with fibromyalgia ( FM ) and to determine exercise adherence levels . DESIGN A r and omized controlled trial . SETTING Testing and training were completed at the university . PARTICIPANTS Middle-aged women with FM ( n=60 ) and healthy women ( n=25 ) . INTERVENTION A 16-week aquatic training program , including strength training , aerobic training , and relaxation exercises . MAIN OUTCOME MEASURES Tender point count ( syringe calibrated ) , health status ( Fibromyalgia Impact Question naire ) ; sleep quality ( Pittsburgh Sleep Quality Index ) ; physical ( endurance strength to low loads tests ) , psychologic ( State Anxiety Inventory ) , and cognitive function ( Paced Auditory Serial Addition Task ) ; and adherence 12 months after the completion of the study . RESULTS For all the measurements , the patients showed significant deficiencies compared with the healthy subjects . Efficacy analysis ( n=29 ) and intent-to-treat analysis ( n=34 ) of the exercise therapy was effective in decreasing the tender point count and improving sleep quality , cognitive function , and physical function . Anxiety remained unchanged during the follow-up . The exercise group had a significant improvement of health status , not associated exclusively with the exercise intervention . There were no changes in the control group . Twenty-three patients in the exercise group were exercising regularly 12 months after completing the program . CONCLUSIONS An exercise therapy 3 times a week for 16 weeks in a warm pool could improve most of the symptoms of FM and cause a high adherence to exercise in unfit women with heightened FM symptomatology . The therapeutic intervention 's effects can be assessed through applicable tests in the clinical practice 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 OBJECTIVES The purpose of this study was to conduct the first r and omized controlled trial ( RCT ) to evaluate the effectiveness of a second-generation mindfulness-based intervention ( SG-MBI ) for treating fibromyalgia syndrome ( FMS ) . Compared to first-generation mindfulness-based interventions , SG-MBIs are more acknowledging of the spiritual aspect of mindfulness . DESIGN A RCT employing intent-to-treat analysis . METHODS Adults with FMS received an 8-week SG-MBI known as meditation awareness training ( MAT ; n = 74 ) or an  active control intervention known as cognitive behaviour theory for groups ( n = 74 ) . Assessment s were performed at pre- , post- , and 6-month follow-up phases . RESULTS Meditation awareness training participants demonstrated significant and sustained improvements over control group participants in FMS symptomatology , pain perception , sleep quality , psychological distress , non-attachment ( to self , symptoms , and environment ) , and civic engagement . A mediation analysis found that ( 1 ) civic engagement partially mediated treatment effects for all outcome variables , ( 2 ) non-attachment partially mediated treatment effects for psychological distress and sleep quality , and ( 3 ) non-attachment almost fully mediated treatment effects for FMS symptomatology and pain perception . Average daily time spent in meditation was found to be a significant predictor of changes in all outcome variables . CONCLUSIONS Meditation awareness training may be a suitable treatment for adults with FMS and appears to ameliorate FMS symptomatology and pain perception by reducing attachment to self . Statement of contribution What is already known on this subject ? Design ing interventions to treat fibromyalgia syndrome ( FMS ) continues to be a challenge . There is growing interest into the applications of mindfulness-based interventions for treating FMS . Second-generation mindfulness-based interventions ( SG-MBIs ) are a key new direction in mindfulness research . What does this study add ? Meditation awareness training - an SG-MBI - result ed in significant reductions in FMS symptomatology . SG-MBIs recognize the spiritual aspect of mindfulness and may have a role in the treatment of FMS OBJECTIVE Sustained improvement in physical functional status was the primary goal of a brief , 6 session cognitive behavioral therapy ( CBT ) protocol for fibromyalgia ( FM ) . METHODS One hundred forty-five patients with FM were r and omly assigned to either ( 1 ) st and ard medical care that included pharmacological management of symptoms and suggestions for aerobic fitness , or ( 2 ) the same st and ard medical treatment plus 6 sessions of CBT aim ed at improving physical functioning . Outcome measures included the Medical Outcome Study Short Form-36 Physical Component Score and McGill ratings of pain . Outcomes were treated dichotomously using a preestablished criterion for clinical ly significant success based upon the reliability of change index from baseline to one year posttreatment . RESULTS Twenty-five percent of the patients receiving CBT were able to achieve clinical ly meaningful levels of longterm improvement in physical functioning , whereas only 12 % of the patients receiving st and ard care achieved the same level of improvement . There were no lasting differences on pain ratings between groups . CONCLUSION Lasting improvements in physical functioning have been among the most difficult outcomes to obtain in studies of FM . These data suggest that the inclusion of CBT to a st and ard medical regimen for FM can favorably influence physical functioning in a subset of patients Fibromyalgia Syndrome ( FMS ) is a chronic pain condition characterized by pain , fatigue , and nonrestorative sleep . The disruptive symptoms of FMS are associated with reductions in quality of life related to family , intimate relationships , and work . The present study was part of a r and omized pilot study of an 8-week Acceptance and Commitment Therapy ( ACT ) intervention compared to education in a sample of 28 women with FMS . The Chronic Pain Values Inventory was administered at baseline , postintervention , and 12 week follow-up . Both groups showed significant improvements in family success , which were maintained at follow-up . Groups showed a differential pattern of success in work . The ACT group demonstrated significant , maintained improvements in success in intimate relationships , while the education group reported no changes over time . Findings suggest that both interventions may lead to improvements in valued living ; however different interventions may be best suited for certain valued domains . The results of this study indicate that FMS patients are able to improve their success in family and intimate relationships and losses in these areas are not necessarily permanent BACKGROUND Insomnia is common and debilitating to fibromyalgia ( FM ) patients .  Cognitive-behavioral therapy ( CBT ) is effective for many types of patients with insomnia , but has yet to be tested with FM patients . This study compared CBT with an alternate behavioral therapy and usual care for improving sleep and other FM symptoms . METHODS This r and omized clinical trial enrolled 47 FM patients with chronic insomnia complaints . The study compared CBT , sleep hygiene ( SH ) instructions , and usual FM care alone . Outcome measures were subjective ( sleep logs ) and objective ( actigraphy ) total sleep time , sleep efficiency , total wake time , sleep latency , wake time after sleep onset , and question naire measures of global insomnia symptoms , pain , mood , and quality of life . RESULTS Forty-two patients completed baseline and continued into treatment . Sleep logs showed CBT-treated patients achieved nearly a 50 % reduction in their nocturnal wake time by study completion , whereas SH therapy- and usual care-treated patients achieved only 20 % and 3.5 % reductions on this measure , respectively . In addition , 8 ( 57 % ) of 14 CBT recipients met strict subjective sleep improvement criteria by the end of treatment compared with 2 ( 17 % ) of 12 SH therapy recipients and 0 % of the usual care group . Comparable findings were noted for similar actigraphic improvement criteria . The SH therapy patients showed favorable outcomes on measures of pain and mental well-being . This finding was most notable in an SH therapy subgroup that self-elected to implement selected CBT strategies . CONCLUSIONS Cognitive-behavioral therapy represents a promising intervention for sleep disturbance in FM patients . Larger clinical trials of this intervention with FM patients seem warranted Non-invasive unilateral repetitive transcranial magnetic stimulation ( rTMS ) of the motor cortex induces analgesic effects in focal chronic pain syndromes , probably by modifying central pain modulatory systems . Neuroimaging studies have shown bilateral activation of a large number of structures , including some of those involved in pain processing , suggesting that such stimulation may induce generalized analgesic effects . The goal of this study was to assess the effects of unilateral rTMS of the motor cortex on chronic widespread pain in patients with fibromyalgia . Thirty patients with fibromyalgia syndrome ( age : 52.6 + /- 7.9 ) were r and omly assigned , in a double-blind fashion , to two groups , one receiving active rTMS ( n = 15 ) and the other sham stimulation ( n = 15 ) , applied to the left primary motor cortex in 10 daily sessions . The primary outcome measure was self-reported average pain intensity over the last 24 h , measured at baseline , daily during the stimulation period and then 15 , 30 and 60 days after the first stimulation . Other outcome measures included : sensory and affective pain scores for the McGill pain Question naire , quality of life ( assessed with the pain interference items of the Brief Pain Inventory and the Fibromyalgia Impact Question naire ) , mood and anxiety ( assessed with the Hamilton Depression Rating Scale , the Beck Depression Inventory and the Hospital Anxiety and Depression Scale ) . We also assessed the effects of rTMS on the pressure pain threshold at tender points ipsi- and contralateral to stimulation . Follow-up data were obtained for all the patients on days 15 and 30 and for 26 patients ( 13 in each treatment group ) on day 60 . Active rTMS significantly reduced pain and improved several aspects of quality of life ( including fatigue , morning tiredness , general activity , walking and sleep ) for up to 2 weeks after treatment had ended . The analgesic effects were observed from the fifth stimulation onwards and were not related to changes in mood or anxiety . The effects of rTMS were more long-lasting for affective than for sensory pain , suggesting differential effects on brain structures involved in pain perception . Only few minor and transient side effects were reported during the stimulation period . Our data indicate that unilateral rTMS of the motor cortex induces a long-lasting decrease in chronic widespread pain and may therefore constitute an effective alternative analgesic treatment for fibromyalgia
CBTs provided a small incremental benefit over control interventions in reducing pain , negative mood and disability at the end of treatment and at long-term follow-up .
The dropout rates due to any reason did not differ between CBTs and controls
BACKGROUND Fibromyalgia ( FM ) is a clinical ly well-defined chronic condition of unknown aetiology characterized by chronic widespread pain that often co-exists with sleep disturbances , cognitive dysfunction and fatigue .
Patients often report high disability levels and negative mood .
Psychotherapies focus on reducing key symptoms , improving daily functioning , mood and sense of personal control over pain .
OBJECTIVES To assess the benefits and harms of cognitive behavioural therapies ( CBTs ) for treating FM at end of treatment and at long-term ( at least six months ) follow-up .