Treating chronic widespread pain, a hallmark of fibromyalgia, can be difficult and expensive. Researchers from the United Kingdom investigated therapies that could be initiated in a primary care setting to determine whether they made a difference in patients' pain or their perception of their health status.

Researchers mailed questionnaires to nearly 46,000 primary care patients to screen for chronic widespread pain, leading to the eventual randomization of 442 patients into four distinct therapy groups. Intervention recipients underwent telephonic cognitive behavioral therapy, exercise, or both; control patients received standard care. Standard care wasn't controlled for or defined.

Patients assigned to receive phone therapy first had an hour-long assessment with a therapist, followed by one session per week for seven weeks. Therapy involved discussion and goal creation. Techniques such as identifying unhelpful thought patterns and working to better control sleep were used.

The exercise intervention and combined-intervention groups had unlimited access to a gym for six months and one trainer-led exercise management session. These groups recorded the frequency and duration of their exercise in a diary. The main study outcome, also ascertained using a questionnaire, was the patients' perceptions of how (and whether) their health had changed after six and nine months in the trial.

The questionnaires revealed positive changes in perceived health status, reported as either "much better" or "very much better," at six months and nine months at the rates of 30% and 33%, respectively, in the therapy-alone arm, 35% and 24% in the exercise-alone arm, 37% and 37% in the combined arm, and 8% and 8% in the standard-care arm.

Although the dual-therapy arm had the highest overall positive percentages, these were not statistically or clinically significant in relation to either intervention by itself, leading the researchers to conclude that telephonic cognitive behavioral therapy may be the best option in terms of efficacy and cost-effectiveness in primary care treatment of chronic widespread pain.-AK

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