Are psychological treatments effective for fibromyalgia pain?

This article considers four broad classes of psychological techniques and their effects on fibromyalgia (FM) pain. A literature search identified 14 randomized controlled trials (RCTs) of cognitive-behavioral therapy (CBT) and operant-behavioral therapy (OBT), five relaxation RCTs, five biofeedback RCTs, five hypnotherapy RCTs, and two writing intervention RCTs. For psychoanalytic therapy in FM, no RCTs have been published. The highest effect sizes (r = 0.53-2.14) for pain reduction are found after CBT and OBT group treatments. Relaxation as a single treatment has not been proven useful. Hypnotherapy and writing intervention have demonstrated mild treatment effects, whereas psychological treatment is effective in FM pain. Considering the heterogeneity of FM, the promising effects of matched interventions such as CBT and OBT with pharmacotherapy, exercise, and other treatment domains require further research.

Management of fibromyalgia syndrome--an interdisciplinary evidence-based guideline.

The prevalence of fibromyalgia syndrome (FMS) of 1-2% in the general population associated with high disease-related costs and the conflicting data on treatment effectiveness had led to the development of evidence-based guidelines designed to provide patients and physicians guidance in selecting among the alternatives. Until now no evidence-based interdisciplinary (including patients) guideline for the management of FMS was available in Europe. Therefore a guideline for the management of fibromyalgia syndrome (FMS) was developed by 13 German medical and psychological associations and two patient self-help organisations. The task was coordinated by two German scientific umbrella organisations, the Association of the Scientific Medical Societies in Germany AWMF and the German Interdisciplinary Association of Pain Therapy DIVS. A systematic search of the literature including all controlled studies, systematic reviews and meta-analyses of pharmacological and non-pharmacological treatments of FMS was performed in the Cochrane Library (1993-12/2006), Medline (1980-12/2006), PsychInfo (1966-12/2006) and Scopus (1980-12/ 2006). Levels of evidence were assigned according to the classification system of the Oxford-Centre for Evidence Based Medicine. Grading of the strengths of recommendations was done according to the German program for disease management guidelines. Standardized procedures were used to reach a consensus on recommendations. The guideline was reviewed and finally approved by the boards of the societies involved and published online by the AWMF on april 25, 2008: http://www.uni-duesseldorf.de/AWMF/ll/041-004.htm. A short version of the guideline for patients is available as well: http://www.uni-duesseldorf.de/AWMF/ll/041-004p.htm. The following procedures in the management of fms were strongly recommended: information on diagnosis and therapeutic options and patient-centered communication, aerobic exercise, cognitive and operant behavioural therapy, multicomponent treatment and amitriptyline. Based on expert opinion, a stepwise FMS-management was proposed. Step 1 comprises confirming the diagnosis and patient education and treatment of physical or mental comorbidities or aerobic exercise or cognitive behavioural therapy or amitriptyline. Step 2 includes multicomponent treatment. Step 3 comprises no further treatment or self-management (aerobic exercise, stress management) and/or booster multicomponent therapy and/or pharmacological therapy (duloxetine or fluoxetine or paroxetine or pregabalin or tramadol/aminoacetophen) and/or psychotherapy (hypnotherapy or written emotional disclosure) and/or physical therapy (balneotherapy or whole body heat therapy) and/or complementary therapies (homeopathy or vegetarian diet). The choice of treatment options should be based on informed decision-making and respect of the patients' preferences.

Psychophysiological responses in patients with fibromyalgia syndrome.

Physical and emotional stress and altered reactivity of the autonomic nervous system have been implicated in the development and maintenance of fibromyalgia syndrome (FMS). This study investigated blood pressure, heart rate (HR), skin conductance levels (SCL), and surface electromyograms (EMG) from the trapezius muscle in 30 FMS patients and 30 age- and sex-matched healthy controls (HCs). All measures were continuously recorded during baseline (BL), social conflict, mental arithmetic, and relaxation tasks. The FMS patients showed significantly higher stress ratings and self-reported stress responses. Baseline EMG levels were significantly lower, and BL HR was significantly elevated. During both stress tasks, HR reactivity was significantly lower, and SCL reactivity was significantly higher in the FMS group. This pattern of low BL muscle tension and high BL HR, along with low HR and high SCL reactivity to stress, is discrepant to other chronic pain syndromes and suggests unique psychophysiological features associated with FMS. Several potential mechanisms for these psychophysiological responses are discussed.