Subgroups of Fibromyalgia Syndrome (FMS): Symptoms, Beliefs, and Tailored Treatment
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ClinicalTrials.gov Identifier: NCT00762125 |
Recruitment Status :
Completed
First Posted : September 30, 2008
Last Update Posted : December 2, 2014
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Condition or disease | Intervention/treatment | Phase |
---|---|---|
Fibromyalgia | Behavioral: CR+ST Behavioral: ET Behavioral: AC treatment | Phase 2 |
Fibromyalgia syndrome (FMS) is a condition without a known cause or cure. Differing theories place the blame on abnormal sensitivity to pain receptors in the brain, changes in metabolism and hormones, abnormalities in the autonomic nervous system, sleep disturbances, infection, or injury. A diagnosis of FMS, therefore, is based on a set of symptoms. These include pain in muscles, ligaments, and tendons; fatigue; and multiple tender points on the body, where even slight pressure causes pain.
Although there is no cure, FMS can be treated to reduce the severity or presence of symptoms. One of the most reliable ways to do this is through progressive exercise, which involves starting at low levels of exercise and building up to longer and more strenuous levels. Despite the benefit of exercise, FSM sufferers often drop out of supervised exercise programs or discontinue exercise once they are no longer supervised. Some FMS patients may have a fear-based avoidance of exercise, believing it will provoke pain or deterioration of their condition and experiencing significant negative emotional arousal when they exercise. This may be due to a prior painful or uncomfortable experience while exercising.
This study will employ multiple treatments that are usually used for treatment of phobias and will aim to reduce fear, increase exercising, and improve FMS symptoms. Under the purview of cognitive behavioral therapy (CBT) are multiple types of treatments. Cognitive restructuring (CR) and coping skills training (ST) paired together address maladaptive beliefs and facilitate the development of more effective coping strategies. Exposure therapy (ET) reduces the level of emotional arousal when patients are exposed to the feared stimulus, in this case exercising. Attention control (AC) treatment, not a type of CBT, provides patients with support and controls for nonspecific factors related to exposure to their feared stimulus. AC will be used as the control treatment in this study.
Participation in this study will last 4 months. After recruitment and an initial evaluation, participants will be placed on a waiting list for 8 weeks to determine whether their symptoms improve or change naturally. They will then be reassessed and randomly assigned to one of the following groups for 8 weeks of treatment:
- CR+ST: This group will help participants develop adaptive ways of thinking and acting to alter maladaptive beliefs in general and beliefs about certain exercises in specific.
- ET: This group will help participants to decrease their fear response during specific exercises through progressive, controlled exposure to the feared stimulus.
- COMB: This group will combine CR+ST and ET treatment plans so that adaptive thoughts and behaviors will be emphasized in the first 4 weeks, and exposure to feared stimuli will be emphasized in the second 4 weeks.
- AC: This group will offer participants non-directive, supportive counseling. Each treatment group will meet in weekly 90-minute group sessions for the first 4 weeks and in weekly 60-minute individual sessions for the second 4 weeks. Participants will have 60-minute physical therapy sessions accompanying every treatment session. Participants will also be given weekly homework assignments specific to their treatment group.
Participants will undergo a series of assessments that include self-report measures, medical and psychological evaluations, and a physical capability evaluation by a physical trainer. These assessments will be performed at recruitment, after the 8-week waiting period, after treatment, at 1- and 3-month mail and telephone follow-ups, and at a 6-month follow-up in the treatment clinic. They will assess fear, health, physical ability, and psychological health.
Study Type : | Interventional (Clinical Trial) |
Actual Enrollment : | 266 participants |
Allocation: | Randomized |
Intervention Model: | Parallel Assignment |
Masking: | Single (Participant) |
Primary Purpose: | Treatment |
Official Title: | Subgroups of Fibromyalgia Syndrome (FMS): Symptoms, Beliefs, and Tailored Treatment |
Study Start Date : | December 2005 |
Actual Primary Completion Date : | January 2012 |
Actual Study Completion Date : | January 2012 |

Arm | Intervention/treatment |
---|---|
Experimental: Cognitive restructuring and coping skills training (CR+ST) |
Behavioral: CR+ST
Addresses maladaptive beliefs in general and includes education and training in the use of specific coping strategies |
Experimental: Exposure therapy (ET) |
Behavioral: ET
Addresses beliefs and emotional arousal during confrontations with feared element (exercising) through use of counter-conditioning and corrective feedback |
Experimental: Combination (COMB) treatment |
Behavioral: CR+ST
Addresses maladaptive beliefs in general and includes education and training in the use of specific coping strategies Behavioral: ET Addresses beliefs and emotional arousal during confrontations with feared element (exercising) through use of counter-conditioning and corrective feedback |
Active Comparator: Attention control (AC) treatment |
Behavioral: AC treatment
Provides support and controls for nonspecific factors associated with exposure to therapists and other FMS sufferers, but does not directly address either maladaptive beliefs or emotional arousal |
- Oswestry Disability Index (ODI) [ Time Frame: Measured at the initial evaluation; after 8 weeks on a waiting list; immediately after treatment; and 1, 3, and 6 months after treatment ]

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Ages Eligible for Study: | 18 Years to 65 Years (Adult, Older Adult) |
Sexes Eligible for Study: | Female |
Accepts Healthy Volunteers: | No |
Inclusion Criteria:
- Meet American College of Rheumatology (ACR) criteria for the diagnosis of fibromyalgia
- Able to comply with functional assessment and treadmill exercise
Exclusion Criteria:
- History of psychiatric hospitalization, suicide attempt, or significant problems with chemical dependency during the 6 months prior to enrollment in the study
- Evidence of severe psychiatric disorder that would prevent participation
- Medical conditions, such as significant cardiac disease, that make it medically unsuitable for participation in a progressive exercise program
- A medical condition, such as multiple sclerosis, that has a high likelihood of obscuring effects of the experimental treatments
- Anxiety or mood disorders in which symptoms are severe enough to prevent participation

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.
Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT00762125
United States, Washington | |
University of Washington | |
Seattle, Washington, United States, 98115 |
Principal Investigator: | Dennis C. Turk, PhD | University of Washington |
Responsible Party: | Dennis Turk, Professor, University of Washington |
ClinicalTrials.gov Identifier: | NCT00762125 |
Other Study ID Numbers: |
R01AR044724-07 ( U.S. NIH Grant/Contract ) R01AR044724-07 ( U.S. NIH Grant/Contract ) |
First Posted: | September 30, 2008 Key Record Dates |
Last Update Posted: | December 2, 2014 |
Last Verified: | December 2014 |
Fibromyalgia Syndrome FMS Physical Therapy Psychotherapy |
Group Counseling Individual Counseling Chronic Pain |
Fibromyalgia Myofascial Pain Syndromes Muscular Diseases Musculoskeletal Diseases |
Rheumatic Diseases Neuromuscular Diseases Nervous System Diseases |