Internet-enhanced management of fibromyalgia: a randomized controlled trial
David A Williams1, David Kuper, Michelle Segar
1Anesthesiology, Medicine, Psychiatry, and Psychology, The University of Michigan, USA Avera Research Institute, The Avera McKennan Hosptial and Health Center, Sioux Falls, SD, USA Institute for Research on Women and Gender, The University of Michigan, USA Medicine, The University of Pittsburgh, USA The Avera McKennan Hosptial and Health Center, Sioux Falls, SD, USA Anesthesiology, Medicine, and Psychiatry, The University of Michigan, USA.
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Both pharmacological and non-pharmacological interventions have demonstrated efficacy in the management of fibromyalgia (FM). Non-pharmacological interventions however are far less likely to be used in clinical settings, in part due to limited access. This manuscript presents the findings of a randomized controlled trail of an Internet-based exercise and behavioral self-management program for FM designed for use in the context of a routine clinical care. 118 individuals with FM were randomly assigned to either (a) standard care or (b) standard care plus access to a Web-Enhanced Behavioral Self-Management program (WEB-SM) grounded in cognitive and behavioral pain management principles. Individuals were assessed at baseline and again at 6 months for primary endpoints: reduction of pain and an improvement in physical functioning. Secondary outcomes included fatigue, sleep, anxiety and depressive symptoms, and a patient global impression of improvement. Individuals assigned to the WEB-SM condition reported significantly greater improvement in pain, physical functioning, and overall global improvement. Exercise and relaxation techniques were the most commonly used skills throughout the 6 month period. A no-contact, Internet-based, self-management intervention demonstrated efficacy on key outcomes for FM. While not everyone is expected to benefit from this approach, this study demonstrated that non-pharmacological interventions can be efficiently integrated into routine clinical practice with positive outcomes.
