Review Question

Are cognitive behavioral therapies (CBTs) effective in the treatment of fibromyalgia?

Type of Review

This is a Cochrane systematic review of 23 randomized controlled trials (RCTs) investigating the impact of CBTs compared with alternative or no therapies on the treatment of fibromyalgia.

Relevance for Nursing

Fibromyalgia is characterized by widespread chronic pain that is often associated with cognitive dysfunction, physical fatigue, and disturbed sleep. It is accompanied by high levels of disability, reduced quality of life, and extensive use of health care services. Treating fibromyalgia with CBTs may be an effective way to relieve the symptoms of this condition, improve the quality of life of its sufferers, and reduce the strain it places on the health care system.

Characteristics of the Evidence

This review includes 2,031 participants with a clinical diagnosis of fibromyalgia, 1,073 in the CBT treatment groups and 958 in control groups. A median 96% of participants in the CBT groups were women; therefore the generalizability of the results to men is limited. Two studies included only children and adolescents, while the remaining 21 studies included only adults. The median of the mean age of participants was 47.5 years, with a range of 15.2 to 55.4 years. The studies were inconsistent in the exclusion of comorbidities, with 12 studies including participants with comorbid anxiety and/or depressive disorders. Of the 23 studies, 12 were conducted in Europe, 10 in North America, and one in South America.

The CBTs were delivered using face-to-face methods in all but two studies. The duration, number of sessions, and number of hours of therapy varied greatly among the studies.

The primary outcomes of this review were self-reported pain, negative mood, and disability at the end of treatment and at long-term (at least six months) follow-up; and acceptability of the treatment assessed by dropout rate. Meta-analysis was conducted to combine the data from the studies across each of these outcomes. CBT was slightly superior to controls in reducing pain at the end of treatment and at follow-up, in reducing negative mood at the end of treatment and at follow-up, and in reducing disability at the end of treatment and at follow-up. No statistically significant difference was found in dropout rates between the CBT and control groups.

The studies investigating face-to-face delivery of CBTs generally produced statistically significant results for their outcomes of interest. CBTs between 25 and 50 hours in duration had a moderate and statistically significant impact on negative mood. CBTs of five to 25 hours had a small but statistically significant impact on negative mood and disability.

Best Practice Recommendations

CBTs are effective in slightly reducing the symptoms of fibromyalgia after six months of face-to-face treatment. The duration of contact between the patient and the therapist should be between five and 25 hours over the six-month period.

Research Recommendations

Additional RCTs with large sample sizes and of high methodological quality that compare CBTs with alternative psychological or drug treatments or aerobic exercise are required in fibromyalgia treatment research because much of the research in this field is of low to moderate methodological quality. Future studies should focus on the adolescent, senior, and male populations and ensure that the sample is reflective of the fibromyalgia patient population in terms of comorbidities.

Reference