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

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.

Reference

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