Canadian researchers writing in The Journal of Pain reported that fibromyalgia (FM) patients participating in online acceptance and commitment therapy (ACT) and treatment as usual (TAU) showed significant improvement in primary disease outcomes, such as depression, pain, sleep and pain acceptance, compared with TAU alone.

Acceptance and commitment therapy is a newer intervention within cognitive-behavioral therapy that relies on mindfulness and acceptance strategies.  In contrast with traditional interventions, ACT aims to facilitate the development of psychological flexibility through six interrelated processes:  acceptance, contact with the present moment, cognitive diffusion, self as context, connecting with personal values, and willingness and commitment. 

In several randomized controlled studies, ACT has been shown to reduce the negative impact of FM on function.  The researchers from the University of Manitoba sought to evaluate, for the first time, the efficacy of an online ACT protocol for FM.  They hypothesized that subjects treated with online ACT and TAU would improve significantly on the primary measures of FM compared to TAU control group.

Sixty-seven participants with fibromyalgia were randomly assigned to an ACT and TAU protocol or a TAU control group.  Study subjects completed the Fibromyalgia Impact Questionnaire and a battery of self-report measures to assess disease impact. 

Results showed that online ACT significantly reduced FM impact relative to TAU, and 70 percent of online ACT participants were classified as treatment responders.  The authors concluded their study shows that individuals with FM may benefit from online ACT with minimal additional monitoring. 

 “This study is important for two reasons. One, it provides evidence that ACT, a newer treatment approach that promotes psychological flexibility and valued living, can be particularly helpful or people with chronic pain conditions such as FM, for which sustained symptom reduction tends be less obtainable; and two, it suggests a method of delivering ACT to many people with FM who may otherwise not be able to obtain help due to limited access to trained clinicians and treatment centers, or prohibitive costs, ” said Gregg Tkachuk, PhD, CPsych., assistant professor, Dept. of Clinical Health Psychology, Max Rady College of Medicine, University of Manitoba.

Patients with fibromyalgia who use tobacco products are at greater risk for cognitive impairment and other symptoms that affect quality of life, according to the results of a study from the Mayo Clinic in Rochester, MI.

Fibromyalgia is a common disorder affecting more than five million Americans. Although widespread pain is a fundamental symptom, cognitive impairment is actually one of the major manifestations and is sometimes colloquially referred to as “fibrofog.” Cognitive impairment may be even more disabling than pain symptoms, leading to memory decline, mental confusion, and concentration difficulties.

To identify potential risk factors, D’Souza et al. investigated the association of tobacco use and cognition in 668 patients with fibromyalgia from May 2012–November 2013. Specifically, the researchers found an association of worse overall cognitive function, language, verbal memory, visual-spatial memory, and concentration. They also identified that tobacco use was associated with increased fibromyalgia symptom severity, worse quality of life, worse sleep, and increased anxiety and depression.

Dr Philip Lage-Hansen and colleagues used the EULAR Congress to share their new data on the prevalence of fulfilment of survey-based criteria for fibromyalgia among 248 newly referred patients in a rheumatic outpatient clinic. This observational cohort study also aimed to compare the use of secondary health care services between survey-based fibromyalgia and nonfibromyalgia cases.
Dr Philip Lage-Hansen and colleagues used the EULAR Congress to share their new data on the prevalence of fulfilment of survey-based criteria for fibromyalgia among 248 newly referred patients in a rheumatic outpatient clinic. This observational cohort study also aimed to compare the use of secondary health care services between survey-based fibromyalgia and non-fibromyalgia cases.

Of those completing the questionnaire, 36% fulfilled fibromyalgia criteria at enrolment. These cases were primarily women, and received more public economical support than those without fibromyalgia. At 7 years follow up, adjusted results showed that fibromyalgia cases had higher number of hospital courses, and had undergone more invasive procedures; however, differences concerning number of diagnoses between groups were small.

The study also found that the burden to the secondary health care system is significant. Neurologists, gastroenterologists, endocrinologists, pain-specialists, psychiatrists, and abdominal surgeons were all consulted more often by people with fibromyalgia compared to those without. However, there was minimal difference between the groups with regards resulting diagnoses. This finding underlines that prolonged and excessive use of health care services with referral to multiple specialists should be avoided. A timely and coordinated effort across medical specialties, could reduce diagnostic delay, facilitate management, and reduce health care utilisation in people with fibromyalgia.

EULAR evidence-based recommendations for the management of fibromyalgia state that optimal management should focus on prompt diagnosis, patient education and non-pharmacological treatments. In addition, a recent systematic review showed a small to moderate beneficial health effect for mindfulness and acceptance-based interventions for patients with fibromyalgia. Dr Heidi Zangi presented results from such an intervention – followed by low threshold physical exercise counselling – compared to treatment as usual for patients diagnosed with fibromyalgia.

Overall, 56.5% of those randomized to the intervention group responded to the questionnaires; of these, only 15% reported clinically relevant improvement. However, there were small improvements evident in pain, fatigue, and self-efficacy for physical activity.

The improvement seen in patients’ tendency to be mindful at 12 months was sustained, although only 58% were in paid work compared to 70% at baseline. Although patients still reported high symptom burden and no improvement in their health status, there was no worsening of symptoms, which might have been the case without any intervention.