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20-11-2011 | Legal medicine | Article

Telephone CBT treats chronic widespread pain


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MedWire News: Patients who receive cognitive behaviour therapy (CBT) over the telephone show improvements in chronic widespread pain (CWP) symptoms, suggest results published in an Archives of Internal Medicine study.

In this study, John McBeth (University of Manchester, UK) and colleagues investigated the clinical impact of a 6-month course of telephone-delivered CBT (TCBT), graded exercise, a combination of both, or treatment as usual (TAU) in 442 patients with CWP. The patients met American College of Rheumatology criteria for fibromyalgia, were aged an average of 56.2 years, and 69.5% were female.

All treatment interventions were provided in addition to their usual treatment prescribed by the patient's family physician, but the precise details of this TAU were not recorded.

TCBT involved an initial assessment that enabled therapists to tailor treatment to suit individual patients. The treatment drew on CBT techniques including increasing or decreasing activities, identifying unhelpful thinking, and making lifestyle changes, such as sleep routine. An additional six weekly sessions were devoted to implementing these, followed by sessions 3 and 6 months after randomization designed to prevent relapse.

The study used a leisure facility- and gym-based exercise program based on American College of Sport Medicine guidelines for improving cardiorespiratory fitness. The patients received six monthly sessions supervised by an instructor .

The patients were asked to report on their change in health since the beginning of the trial according to a 7-point global assessment scale ranging from "very much worse" to "very much better." This was conducted at baseline, at 6 months, and at 9 months.

The percentage of patients reporting positive outcomes of "much better" or "very much better" was 8% at both 6 and 9 months in the TAU patients, compared with 30% and 33%, respectively for the TCBT group, and 35% and 24% for the exercise group. The combined intervention group had 37% of patients reporting positive outcomes at both time-points.

The researchers conclude that they were able to demonstrate "substantial, significant, clinically meaningful," short- to medium-term improvements in the patients' overall health using TCBT.

They say the next step is to investigate the long-term effects of their program.

Seth Berkowitz and Mitchell Katz, from Los Angeles County Department of Health Services in California, USA, highlight the benefits conferred by the methods investigated in an accompanying editorial: "[Exercise and CBT] represent a management strategy that puts patients firmly in charge. The skills learned in CBT, for example, are available after hours and over long weekends and do not require monthly refills.

"Moreover, because CBT can be administered by telephone, this intervention is convenient and can be made available to a wide range of patients."

By Chloe McIvor

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