Long-term effects of cognitive behaviour therapy and exercise for chronic widespread pain

Marcus Beasley, Gordon Prescott, John McBeth, Karina Lovell, Philip Keeley, Paul McNamee, Steve Woby, Chrysa Gkazinou, Elizabeth A. Jones, Gary J. Macfarlane, MUSICIAN Study team

Research output: Contribution to journalAbstract

Abstract

Background
Cognitive behaviour therapy (CBT) and exercise have been shown to improve short-term outcomes for chronic widespread pain (CWP) patients. There is little data on whether improvement maintains long-term.

Methods or theme
The MUSICIAN Trial was a 2 x 2 factorial randomised controlled trial. A survey of general practitioner (GP)-registers identified CWP patients consulting their GP in the last year. Random assignation was to four study arms: the Cognitive Behavior Therapist (tCBT), exercise, combined treatment, or treatment as usual (TAU). tCBT participants had eight weekly telephone sessions and three and six month follow-up calls. Exercise group participants followed an individual fitness-instructor designed program over six months with monthly review. Combined treatment participants received both interventions. TAU participants received usual care. Follow-up by postal questionnaire or telephone was 24 months post-treatment. Positive outcome was patient-reported change in health of ‘much’ or ‘very much’ better. Analysis was by logistic regression and odds ratios (ORs) with 95% confidence intervals (CIs) are reported.

Results
Totally 442 persons participated (median age 57 years, 69% female) – 361 had 24-month follow-up. Of 94 respondents, 12 (12.8%) in TAU reported positive outcomes, 29 of 82 in tCBT (35.4%), 27 of 92 in exercise (29.3%) and 29 of 93 in combined treatment (31.2%). ORs compared to TAU were: tCBT, OR 4.0 (95% CI, 1.8–8.7); exercise, 2.9 (1.4–6.3); combined, 3.5 (1.6–7.5). Improvement odds did not differ across active treatments – there was no advantage in receiving both interventions.

Conclusions
tCBT and/or exercise for CWP are associated with long-term patient-reported health improvements. These are amongst the largest, longest-term benefits reported for CWP and offer potential management strategies.
Original languageEnglish
Pages (from-to)E20-E20
Number of pages1
JournalScottish Medical Journal
Volume60
Issue number3
Early online date10 Aug 2015
DOIs
Publication statusPublished - Aug 2015
EventScottish Society for Rheumatology Autumn Meeting 2013 - Dundee, United Kingdom
Duration: 28 Nov 201329 Nov 2013

Keywords

  • Chronic pain
  • cognitive behavioural therapy
  • exercise
  • fibromyalgia
  • primary care
  • multicomponent therapy
  • telephone therapy

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