Comparing Patients with Fibromyalgia and Chronic Low Back Pain
Participating in an Outpatient Cognitive-Behavioral Treatment Program

Journal of Musculoskeletal Pain, Vol. 11, No. 3, 2003, pp 5-12

Carol Wells-Fedennan, Paul Arnstein, Margaret Caudill-Slosberg

Carol Wells-Federman, MEd, APRN, BC, was Adjunct Senior Lecturer, Simmons
College, Boston, MA 02115.
Paul Arnstein, APRN, BC, Pill, is Assistant Professor, Boston College, 140
Commonwealth Avenue, Chestnut Hill, MA 02467.
Margaret Caudill-Slosberg, MD, PhD, is Adjunct Associate Professor of
Anesthesiology, Dartmouth Medical School, 1 Rope Ferry Road, Hanover, NH 03755.

Address correspondence to: Carol Wells-Federman, 117 Primrose Road,
Carbondale, CO 81623.

The authors wish to thank Jay Galipeault for her assistance with this project.

Submitted: June 25, 2002.
Revision accepted: April 10, 2003.

ABSTRACT. Objectives: To compare base­line characteristics and outcomes of
patients with fibromyalgia [FMS] and chronic low back pain [CLBP]
participating in a cognitive-behavioral treatment program.

Methods: Pretreatment and posttreatment data obtained by questionnaire from
53 participants with fibromyalgia syndrome and 57 patients with CLBP who
completed a 10-session cognitive-behavioral treatment program and at one
year were examined. Demographics, pain, distress, self-efficacy,
disability, and symptoms of depression were measured.

Results: At baseline patients with FMS and CLBP differed in a number of
character­istics. Fibromyalgia syndrome patients were more likely to be
female [P < .001], have higher education [P < .018], and were more
self-efficacious in their ability to manage their pain [P < .027]. The CLBP
patients reported higher levels of pain sensation [P < .049] and distress
[P < .014], were more often prescribed opiates [P < .012], and more likely
to be in litigation and receiving compensation [P < .005]. Postprogram each
group reported a significant improvement in self­efficacy, pain, distress,
disability, and symptoms of depression [P < .05]. There were no between
group differences. Furthermore, these gains were sustained at one-year
follow-up [P < .001] with no significant difference in gains made by the
CLBP or FMS patients.

Conclusions: Despite considerable between group differences at baseline,
patients with FMS and CLBP experienced similar improvements in
self-efficacy, pain, distress, disability, and symptoms of depression
im­mediately upon completion and up to a year
following a comprehensive cognitive-behavioral treatment program.


KEYWORDS. Cognitive-behavioral, non­pharmacologic pain management
interven­tions, psychological interventions, pain man­agement outcomes


INTRODUCTION

Together chronic low back pain [CLBP] and fibromyalgia syndromes [FMS]
affect over 10 million Americans and impose a tremen­dous burden on
individuals, their families, and society (1,2). The incidence of CLBP
appears to be equal among men and women (3) and is one of the most common
reasons for seeking health care (4,5) and for utilization of sick leave
(6). Fibromyalgia is found to be more prevalent in women (7), and while
women in the fourth and fifth decades of life are dispro­portionately
affected, there is almost a linear increase with aging (8). Currently,
there is no cure for either syndrome and persistent symp­toms of pain and
sleep disturbance negatively impact the quality of life for individual
sufferers and their families.

Successful treatment has traditionally included a multifactorial approach
within diag­nostic groups. A recent critical review of available research
by Nielson and Weir (9) concluded that multimodal biopsychosocial
treatments [such as cognitive-behavioral therapy] are effective for CLBP
and FMS for at least 12 months following treatment. Despite strong support,
they point out that many studies were hindered by a variety of design
defects including heterogeneous subjects. There is concern that treating
mixed diagnostic patient groups generically would not be successful in
meeting problem-specific needs. However, the ability to engage a group of
chronic pain patients in a comprehensive treatment approach could
potentially be more cost effective than problem-specific groups. In fact,
previous observational studies on cognitive­behavioral treatment [CBT]
programs have demonstrated benefits for patients with a variety of chronic
pain conditions (10,11). These benefits included a reduction in health care
visits, significant improvements in self-efficacy for managing, coping, and
functioning with persistent pain, as well as significant reductions in
disability and depressive symptoms.

The purpose of this study was to compare baseline characteristics of FMS
and CLBP patients participating in a comprehensive CBT program and whether
their outcomes differed in measures of pain sensation, distress,
disability, and self-efficacy.


© 2003 by The Haworth Press, Inc. All rights reserved.