Pain Related Cognitive Behavioral Mechanisms and Fibro

An article by Dutch researchers has suggested that screening for pain persistance and pain avoidance patterns in patients with Fibromyalgia Syndrome (Fibro) can lead to finding more effective treatments for individual patients. [1]

In the article, published in the International Journal of Behavioural Medicine, the researchers say that the variations between Fibro patients as regards pain-related cognitive-behavioral mechanisms, has been proposed as a reason why some patients do better than others with some treatments. [1]

Pain-related cognitive-behavioral mechanisms include pain avoidance, characterised by avoiding activities because they may cause pain (even though, in some cases, e.g. with exercise, this can lead to more pain in the long-term), and pain persistance, characterised by continuing with activities in spite of pain (even though this may lead to more pain).

The Dutch researchers used a self-reported screening instrument, that assesses pain-avoidance behavior, to distinguish betweenpatients with pain-persistence and pain-avoidance patterns. [1]

The two resultant groups of patients were then compared with regard to several pain-related cognitive-behavioral factors, as well as their performance on a physical fitness test. They were also compared with regard to the judgments of trained therapists based on a semi-structured interview. [1]

They found that the results of the self-reported screening instrument they used corresponded with the other results in terms of which patients were assessed as having pain-avoidance and pain-persistence patterns.

The researchers concluded that:

"...a short self-report screening instrument can be used to distinguish between pain-avoidance and pain-persistence patterns within the heterogeneous population of [Fibro] patients, which offers promising possibilities to improve treatment efficacy by tailoring treatment to specific patient patterns." [1]

A previous article published earlier this year discussed 2 case studies where cognitive behavioural therapy (CBT) and exercise therapy for patients with Fibro were tailored for whether the patients fell into pain-avoidance or pain-persistence pattern groups. [2]

That study found that tailoring the CBT and exercise therapy to take the pain-avoidance/pain-persistence patterns into account can contribute to the improvement of the care of Fibro patients. [2]

References:

1. van Koulil S, Kraaimaat FW, van Lankveld W, van Helmond T, Vedder A, van Hoorn H, Cats H, van Riel PL, Evers AW. Screening for pain-persistence and pain-avoidance patterns in fibromyalgia. Int J Behav Med. 2008;15(3):211-20.
2. van Koulil S, van Lankveld W, Kraaimaat FW, van Helmond T, Vedder A, van Hoorn H, Cats H, van Riel PL, Evers AW. Tailored cognitive-behavioral therapy for fibromyalgia: two case studies. Patient Educ Couns. 2008 May;71(2):308-14. Epub 2008 Jan 9.