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Investigating Pain-Related Avoidance Behavior using a Robotic Arm-Reaching Paradigm

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Cognitive behavior therapy, exercise, or both for treating chronic widespread pain.

John McBeth¹, Gordon Prescott, Graham Scotland

¹Arthritis Research UK Epidemiology Unit, University of Manchester, Manchester, England. john.mcbeth@manchester.ac.uk

Archives of Internal Medicine

|November 16, 2011

Summary

Telephone-delivered cognitive behavioral therapy (TCBT) and exercise significantly improved health outcomes for chronic widespread pain patients. These interventions offered sustained benefits compared to usual care.

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Area of Science:

Rheumatology
Behavioral Medicine
Clinical Trials

Background:

The clinical effectiveness of telephone-delivered cognitive behavioral therapy (TCBT), exercise, or combined interventions for primary care patients with chronic widespread pain (CWP) remains unclear.
Chronic widespread pain affects a significant patient population, necessitating effective management strategies.

Purpose of the Study:

To evaluate the clinical impact of TCBT, graded exercise, and a combined intervention compared to treatment as usual (TAU) in patients with CWP.
To assess the sustained effects of these interventions over a 9-month period.

Main Methods:

A randomized controlled trial involving 442 patients meeting American College of Rheumatology criteria for CWP.
Patients were assigned to TCBT, graded exercise, combined intervention, or TAU for 6 months.
The primary outcome was patient global assessment of health change, analyzed via logistic regression (intention-to-treat).

Main Results:

Active interventions significantly improved patient global assessment compared to TAU (P < .001).
TCBT, exercise, and combined interventions showed odds ratios ranging from 5.0 to 7.1 at 6 months and 3.6 to 6.2 at 9 months.
The combined intervention also improved physical health scores and reduced passive coping strategies.

Conclusions:

TCBT demonstrated substantial, statistically significant, and sustained improvements in patient global assessment for CWP.
Both exercise and combined interventions also yielded significant improvements, highlighting their therapeutic potential.