A Cochrane review measured the impact of cognitive behavioral therapy (CBT) on fibromyalgia symptoms «Bernardy K, Klose P, Busch AJ, et al. Cognitive be...»1. It suggested a decrease in fibromyalgia-related pain of 8.5 % (95 % CI 3.1 % to 14.0 %) at the end of treatment. Furthermore, it suggested a reduction in negative mood (relative 15 %, 95 % CI 7.7 % to 22.3 %) and improvement in physical disability (relative 25 %, 95 % CI 6.9 % to 43.7 %). The impact may be slightly smaller in a longer follow-up (6 months). About half of the included studies included active control, such as education on pain management strategies and/or exercise.
Furthermore, CBT may slightly decrease fatigue (SMD -0.25 [-0.49 to -0.02]), sleep problems (SMD -0.40 [-0.85 to 0.05]), and improve health-related quality of life (SMD -0.23[-0.38 to -0.08]).
A couple of newer systematic reviews measured the impact of CBT on fibromyalgia symptoms and suggested a similar impact «Climent-Sanz C, Valenzuela-Pascual F, Martínez-Nav...»2, «Pathak A, Kelleher EM, Brennan I, et al. Treatment...»3.
Adverse events were not reported.
The quality of evidence was downgraded due to imprecision, study limitations, and indirectness.
| Reference | Study type | Population | Intervention and comparison | Outcomes | Risk of bias |
|---|---|---|---|---|---|
| «Bernardy K, Klose P, Busch AJ, et al. Cognitive be...»1 | SR/MA | Adult patients with Fibromyalgia | Cognitive behavioral therapy vs placebo | Pain, mood, disability, sleep problems | High |
| RCT=randomized controlled trial; SR=systematic review; MA=meta-analysis | |||||
| Reference | Comments |
|---|---|
| «Bernardy K, Klose P, Busch AJ, et al. Cognitive be...»1 | Both groups could include co-interventions such as medication. About half of the trials
included active control, such as education on pain management or exercise. RoB: Randomization: OK, Allocation concealment: insufficiently reported in most trials, Missing data: most trials either did not report, had per-protocol analysis, or had large amount of missing data Blinding: no blinding |
Results
| Reference | Number of studies and number of patients (I/C) | Follow-up time | Mean (SD) I | Mean (SD) C | Mean difference (95% CI) |
|---|---|---|---|---|---|
| «Bernardy K, Klose P, Busch AJ, et al. Cognitive be...»1 | 20 trials, 1382 patients | 2-12 months | Not reported | Not reported | SMD -0.29 (-0.47 to -0.11) Relative effect: -8.5 % (-3.1 % to -14.0 %) |
| Level of evidence: Low The quality of evidence was downgraded one time due to imprecision, and one time due to study limitations. We did not rate down more because of indirectness since some trials having active control likely bias the impact towards null. I=intervention; C=comparison; CI=confidence interval |
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| Reference | Number of studies and number of patients (I/C) | Follow-up time | Mean (SD) I | Mean (SD) C | Mean difference (95% CI) |
|---|---|---|---|---|---|
| «Bernardy K, Klose P, Busch AJ, et al. Cognitive be...»1 | 18 trials, 1578 patients | 2-12 months | Not reported | Not reported | SMD -0.33 (-0.49 to -0.17) Relative effect: -15.0 % (-7.7 % to -22.3 %) |
| Level of evidence: Low The quality of evidence was downgraded one time due to imprecision, and one time due to study limitations. We did not rate down more because of indirectness since some trials having active control likely bias the impact towards null. I=intervention; C=comparison; CI=confidence interval |
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| Reference | Number of studies and number of patients (I/C) | Follow-up time | Mean (SD) I | Mean (SD) C | Mean difference (95% CI) |
|---|---|---|---|---|---|
| «Bernardy K, Klose P, Busch AJ, et al. Cognitive be...»1 | 15 trials, 1163 patients | 2-12 months | Not reported | Not reported | SMD -0.30 (-0.51 to -0.08) Relative effect: 25.8 % (6.9 % to 43.7 %) improvement |
| Level of evidence: Low The quality of evidence was downgraded one time due to imprecision, and one time due to study limitations. We did not rate down more because of indirectness since some trials having active control likely bias the impact towards null. I=intervention; C=comparison; CI=confidence interval |
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