Arthritis & Rheumatism, Volume 62,
November 2010 Abstract Supplement

Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Atlanta, Georgia November 6-11, 2010.


Fibromyalgia Patients with High Global Disease Severity, Depression, Anxiety or Cognitive Dysfunction Are Likely To Benefit from Cognitive Behavioral Therapy.

Boomershine1,  Chad S., Hammonds1,  Cara L., Hong2,  Jennifer Y., Wallston2,  Kenneth A.

Vanderbilt University, Nashville, TN
Vanderbilt University

Background:

Cognitive behavioral therapy (CBT) is recommended for treating fibromyalgia (FM) patients. However, due to cost and limited availability, a system for identifying patients most likely to benefit from CBT is needed. Because CBT works by increasing two aspects of cognitive adaptability (CA), perceived competence (PC) and dispositional optimism (DO), FM patients with low CA are likely to benefit from CBT. We studied CA levels in FM patients to identify characteristics that could be used to guide patient selection for CBT.

Methods:

Data from FM patients (n=99) referred to a rheumatology clinic were analyzed. FM diagnosis was made on clinical grounds by an experienced rheumatologist (CSB). CA was measured using the 8-item CA Index (CAI),1 with higher CAI scores reflecting greater PC and DO. Severity of FM symptoms were assessed using the Fibromyalgia Impact Questionnaire (FIQ) for global disease severity, the fatigue severity scale (FSS) for fatigue, the Everyday Cognition Scale 20 (ECog20) for cognitive dysfunction, the Athens Insomnia Scale (AIS) for sleep quality, the Physician Health Questionnaire 9 (PHQ9) for depression, the Generalized Anxiety Disorder 7 (GAD7) for anxiety and a pain visual analogue scale (VAS pain) for pain. The Regional Pain Scale (RPS) and tender point count (TPC) were both used to quantify number of painful body areas. Spearman rank correlations and Mann-Whitney U testing compared questionnaire scores (PASW Statistics 17). Data is reported as median (interquartile range).

Results:

CA level negatively correlated with global FM disease severity (CAI vs FIQ global r=-0.53, p<0.001) and the severity of mental symptoms including fatigue (CAI vs FSS score r=-0.36, p<0.0001), cognitive dysfunction (CAI vs ECog20 r=-0.46, p<0.0001), sleep quality (CAI vs AIS r=-0.33, p=0.001), depression (CAI vs PHQ9 score r=-0.70, p<0.0001), and anxiety (CAI vs GAD7 score r=-0.59, p<0.0001). CA level did not correlate with the severity of physical symptoms including pain severity (CAI vs VAS pain score r=-0.08, p=0.458) or number of painful body areas (CAI vs RPS r=-0.20, p=0.053; CAI vs TPC r=0.03, p=0.842). To determine characteristics that best identified patients with low CA, patients were divided into two groups: those with normal (CAI >=36) versus below-normal (CAI <36) CA levels. Median scores on questionnaires that significantly correlated with CAI scores were compared between the CA level groups. FM patients with low CA were best identified as those with high levels of global disease severity [FIQ global 72.3 (63.9,79.8) vs 60.6 (45.8,63.7), p<0.0001], depression [PHQ9 16 (12,19.25) vs 7.86 (4.25,10.75), p<0.0001], anxiety [GAD7 13.5 (8,19) vs 3 (2,10), p<0.0001] or cognitive dysfunction [ECog20 41 (32,47) vs 28 (22,36), p<0.0001].

Conclusions:

CA level negatively correlates with the severity of mental symptoms of fatigue, cognitive dysfunction, sleep quality, depression and anxiety but not physical symptoms of pain or number of painful body areas in FM patients. FM patients with high global disease severity, depression, anxiety or cognitive dysfunction are most likely to benefit from cognitive behavioral therapy.

1Wagner,  et al. AIDS Behav. 2008; 14 410–20.

To cite this abstract, please use the following information:
Boomershine, Chad S., Hammonds, Cara L., Hong, Jennifer Y., Wallston, Kenneth A.; Fibromyalgia Patients with High Global Disease Severity, Depression, Anxiety or Cognitive Dysfunction Are Likely To Benefit from Cognitive Behavioral Therapy. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :802
DOI: 10.1002/art.28570

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