Cognitive Behavioral Therapy Improved QoL in Patients at Risk of Chronic Widespread Pain

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Researchers set out to discover if cognitive behavioral therapy, which has been effective in the management of chronic widespread pain, can prevent its onset among adults at high risk.

Patients at high risk for chronic widespread pain (CWP) had improved quality of life after a short course of telephone-based cognitive behavioral therapy (tCBT), but onset of CWP was not prevented. These findings, from a population-based randomized controlled prevention trial, were published in the Annals of the Rheumatic Diseases.

Patients (N=996) reporting pain that did not fit the definition of CWP were recruited in 2016 at 16 general practices in the United Kingdom in a population-based randomized controlled prevention trial. Randomization occurred in a 1:1 ratio to receive usual care (n=496) or tCBT (n=500). The tCBT comprised an initial 45- to 60-minute assessment followed by 6 weekly 30- to 45-minute sessions. At 3-, 12-, and 24-month follow-ups, patients were assessed for CWP and by the instruments EuroQol Questionnaire-5 dimensions-5 levels (EQ-5D-5L), General Health Questionnaire (GHQ), Widespread Pain Index (WPI), and Symptom Severity Scale (SSS).

Patients in the tCBT and control groups had a median age of 58.8 and 59.5 years, 58.2% and 58.9% were women, and 94.8% and 94.0% had 2 CWP risk factors, respectively.

At 1 year, 18.0% of the tCBT and 17.5% of the usual care participants were diagnosed with CWP (adjusted odds ratio [aOR], 1.05; 95% CI, 0.75-1.48). Similar observations were made during all 3 follow-ups, indicating no evidence of an effect of tCBT on CWP over time (aOR, 1.00; 95% CI, 0.96-1.04; P =.91).

Despite little evidence of clinical improvement, at 12 months patients receiving the tCBT reported an improvement in health (aOR ordinal logistic regression [OLR], 0.51; 95% CI, 0.39-0.67), quality of life (EQ-5D-5L: adjusted mean difference [aMD], 0.024; 95% CI, 0.009-0.040) and distress (GHQ: aOR, 0.65; 95% CI, 0.50-0.86), and lower illness behavior (aMD, -0.81; 95% CI, -1.54 to -0.09), fatigue (Chalder Scale: aMD, -1.02; 95% CI, -1.63 to -0.42), sleep difficulty scores (aMD, -0.95; 95% CI, -1.48 to -0.42), WPI scores (adjusted incident rate ratio [aIRR], 0.88; 95% CI, 0.80-0.98), and SSS scores (aMD, -0.52; 95% CI, -0.75 to -0.28).

On the basis of the improvement to quality of life, the patients receiving tCBT had an average of 0.023 (95% CI, 0.007-0.039) more quality-adjusted life-years, which cost the health care system £42.30 (95% CI, -£451.19 to £597.90), corresponding with an incremental cost-effectiveness ratio of £1828.

Although CBT has previously been shown to improve symptoms of fibromyalgia, results from this study did not clarify whether or not CBT may be a viable treatment for the pain symptoms associated with CWP.

The study authors concluded a short tCBT course was highly cost-effective, significantly improving quality of life and clinical health indicators. Additional studies are needed to determine whether tCBT may be appropriate for use among patients with a range of musculoskeletal symptoms.


Macfarlane GJ, Beasley M, Scott N, et al. Maintaining musculoskeletal health using a behavioural therapy approach: a population-based randomised controlled trial (the MAmMOTH Study). Ann Rheum Dis. Published online February 1, 2021. doi:10.1136/annrheumdis-2020-219091