Cognitive-behavioral mechanisms in a pain-avoidance and a pain-persistence treatment for high-risk fibromyalgia patients

S van Koulil; F W Kraaimaat; W van Lankveld; T van Helmond; A Vedder; H van Hoorn; A R T Donders; K Thieme; H Cats; P L C M van Riel; A W M Evers

doi:10.1002/acr.20445

Cognitive-behavioral mechanisms in a pain-avoidance and a pain-persistence treatment for high-risk fibromyalgia patients

Arthritis Care Res (Hoboken). 2011 Jun;63(6):800-7. doi: 10.1002/acr.20445.

Authors

S van Koulil¹, F W Kraaimaat, W van Lankveld, T van Helmond, A Vedder, H van Hoorn, A R T Donders, K Thieme, H Cats, P L C M van Riel, A W M Evers

Affiliation

¹ Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands. s.vankoulil@mps.umcn.nl

PMID: 21312345
DOI: 10.1002/acr.20445

Abstract

Objective: The heterogeneity of cognitive-behavioral patterns in patients with fibromyalgia (FM) has been proposed to underlie the variability in treatment outcomes. It has previously been shown that pain-avoidance and pain-persistence treatments tailored to the patient's pattern are effective in improving physical and psychological functioning and overall impact in high-risk patients with heightened psychological distress. In the present study, the cognitive-behavioral effects of these treatments were evaluated to provide insight into the main proposed mechanisms, specifically pain-avoidance behaviors and activity pacing in the pain-avoidance and pain-persistence treatments, respectively.

Methods: High-risk FM patients were classified into 2 groups, pain avoidance and pain persistence, and randomized in groups to the relevant treatment or waiting-list control condition. The pain-avoidance and pain-persistence treatments both comprised 16 twice-weekly sessions of cognitive-behavioral therapy and exercise training. Cognitive--behavioral factors assessed at pre- and posttreatment and 6 months of followup were evaluated using linear mixed models.

Results: A significant treatment effect was found for pain-avoidance behavior in the pain-avoidance treatment and for activity pacing in the pain-persistence treatment, showing improvements in the treatment condition relative to the controls. Furthermore, the effect on functioning was mediated by changes in pain-avoidance behavior in the pain-avoidance treatment and by changes in activity pacing in the pain-persistence treatment. Both treatments also showed significant improvements in other relevant cognitive-behavioral factors.

Conclusion: Both the pain-avoidance and pain-persistence treatments are effective in improving cognitive-behavioral factors in high-risk FM patients. Pain-avoidance behavior and activity pacing might be important mediating mechanisms for beneficial outcomes in pain-avoidance and pain-persistence treatments, respectively.

Trial registration: ClinicalTrials.gov NCT00268606.

Publication types

Comparative Study
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

MeSH terms

Adult
Avoidance Learning / physiology*
Cognitive Behavioral Therapy / methods*
Female
Fibromyalgia / psychology
Fibromyalgia / therapy*
Follow-Up Studies
Humans
Male
Middle Aged
Pain / psychology
Pain Management*
Pain Measurement / methods
Treatment Outcome

Associated data

ClinicalTrials.gov/NCT00268606