Operant Learning May Provide More Benefits Than Energy Conservation in Fibromyalgia

Operant learning may provide additional benefits compared with energy conservation in patients with fibromyalgia syndrome.

Operant learning may provide additional benefits compared with energy conservation in patients with fibromyalgia syndrome, according to a study published in the Journal of Pain.

Activity pacing, which includes operant learning and energy conservation, is a type of cognitive behavioral therapy used in chronic pain management. Although both approaches are thought to enhance adaptive coping, their core differences have led to conflicting results being reported in the literature.

The efficacy of operant learning vs energy conservation for the treatment of fibromyalgia syndrome was examined in a Canadian single-blinded randomized controlled pilot study (Clinicaltrials.gov identifier NCT01674335) examined. A total of 178 patients were randomly assigned to receive delayed (n=36) or immediate (n=54) operant learning or delayed (n=35) or immediate (n=53) energy conservation treatments (2-hour sessions) weekly for 10 weeks, with the delayed groups serving as controls. Participants answered questionnaires at baseline, after 10 weeks of therapy, and 3 months post-treatment.

Primary outcomes were average pain and usual fatigue (measured with the Brief Pain and Brief Fatigue Inventories, respectively). Secondary outcomes were pain/fatigue interference, physical/psychological functioning, depressive/anxiety symptoms, and sleep quality (assessed using the Medical Outcomes Study 36-item Short Form version 2 and the Hospital Anxiety and Depression Scale). Tertiary outcome was pain-related activity trends, evaluated with the Patterns of Activity Measure-Pain and Patients’ Global Impression of Change Scales.

A total of 32 and 37 participants completed the study in the operant learning and energy conservation groups, respectively; 43 were in the control group. Both therapies were unsuccessful in relieving pain or fatigue symptoms, but were associated with improved physical functioning, sleep quality, activity pacing, and overdoing patterns. Operant learning, but not energy conservation, was associated with an improvement in depressive symptoms and a reduction in activity avoidance (P <.0005 and P =.007, respectively) and with non-significant improvements in pain and fatigue interference, as well as psychological functioning.

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Study limitations include potential lack of generalizability to other patient populations, a small sample size resulting in lower study power, lack of intent-to-treat analysis due to a high drop-out rate, and the use of patient self-reports.

 “The findings suggest the possibility that an [operant learning] approach to activity management may be an effective stand-alone activity pacing treatment for patients with [fibromyalgia syndrome],” noted the study authors.

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Racine M, Jensen M, Harth M, Morley-Forster P, Nielson WR. Operant learning versus energy conservation activity pacing treatments in a sample of patients with fibromyalgia syndrome: a pilot randomized controlled trialJ Pain. October 2018:1-43. doi:10.1016/j.jpain.2018.09.013