Arthritis & Rheumatism, Volume 60,
October 2009 Abstract Supplement

The 2009 ACR/ARHP Annual Scientific Meeting
Philadelphia October 16-21, 2009.

Telephone-Delivered Cognitive Behavioral Therapy (CBT) On Clinical Symptoms and Nociceptive Responding in Fibromyalgia (FM)A Pilot Study

Ang¹, Dennis C., Chakr¹, Rafael, Mazzuca², Steven A., France³, Christopher

Indiana University, Indianapolis, IN
Indiana Univ Sch of Med, Indianapolis, IN
Ohio University, Athens, OH

Purpose:

Traditional CBT (face-to-face) has been shown to improve the clinical symptoms of FM. However, due to cost and scarcity of skilled therapist, practical application of CBT is limited. More importantly, although various psychological models have been theorized to explain CBT's beneficial effects, the biological mechanisms of CBT have been unexplored. Thus, we sought to determine the effects of telephone-delivered CBT on self-reported pain, physical function and nociceptive responsivity (i.e., nociceptive flexion reflex/NFR). NFR is a neurophysiological tool that measures responsivity to noxious stimulation via elicitation of a spinal withdrawal reflex upon stimulation of a sensory nerve.

Method:

FM patients with Fibromyalgia Impact Questionnaire (FIQ)-pain score >= 4 and FIQ-physical impairment (FIQ-PI) score >= 2 were randomized to 6 sessions of telephone-delivered CBT or usual care (UC). CBT was delivered from week 0 to 6. Assessments were done at baseline, week 6 and 12. Study endpoint was the change from baseline in NFR threshold (milliamperes/mA). Clinical endpoints were the changes from baseline in the FIQ-PI, FIQ-pain; and the proportion of subjects achieving a clinically meaningful reduction (i.e. 14%) in the total FIQ.

Results:

The 28 female participants had a mean age of 47 ± 11 years, mean disease duration of 12 ± 6 years, and were 80% white, and 83% with > high school education. At study entry, 15 (53%) were on narcotics and 19 (68%) were on antidepressant other than tricyclics. There were no differences in the demographics, depression severity, and medication usage between the treated and the usual care groups.

Compared to usual care, CBT resulted in marginal improvements in clinical outcomes (table) and in the percent of patients with clinically meaningful improvements in total FIQ score (33% vs. 15%, p=0.3). However, CBT also resulted in a significant lowering of nociceptive responding, as evidenced by an increase in the NFR threshold, relative to controls.

Baseline Characteristics

	CBT (n=15)	UC (n=13)
Nociceptive Responsivity
NFR threshold (mA^†)	32.5 ± 15	37.6 ± 10
Clinical Outcomes
FIQ-PI (0–10*)	5.6 ± 1.8	5.4 ± 1.7
FIQ-pain (0–10*)	7.6 ± 1.8	7.8 ± 1.4
Total FIQ (0–100*)	62.2 ± 15	67.8 ± 12
^†Lower values reflect higher responsivity to electrical stimulation.
* Higher scores reflect more severe symptoms.

Mean Changes from Baseline to Week 12

	CBT (n=15)	UC (n=13)	Mean Difference	P value
Nociceptive Responsivity
NFR threshold	7.3 ± 9.2	-5.4 ± 13.5	-12.7 ± 11.4	0.006
Clinical Outcomes
FIQ–PI	-0.6 ± 2.3	0.5 ± 1.2	1.1 ± 1.9	0.13
FIQ-pain	-0.6 ± 1.6	-0.3 ± 1.7	0.3 ± 1.7	0.6

Conclusion:

This small pilot study was powered primarily to detect an effect of CBT on the NFR threshold. These data indicate the need for a larger study to confirm that changes in central sensitization, as reflected in the NFR, may underlie the benefits of CBT in FM patients.

To cite this abstract, please use the following information:
Ang, Dennis C., Chakr, Rafael, Mazzuca, Steven A., France, Christopher; Telephone-Delivered Cognitive Behavioral Therapy (CBT) On Clinical Symptoms and Nociceptive Responding in Fibromyalgia (FM)A Pilot Study [abstract]. Arthritis Rheum 2009;60 Suppl 10 :105
DOI: 10.1002/art.25188

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