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Efficacy, acceptability and safety of cognitive behavioural therapies in fibromyalgia syndrome – A systematic review and meta‐analysis of randomized controlled trials
Author(s) -
Bernardy K.,
Klose P.,
Welsch P.,
Häuser W.
Publication year - 2018
Publication title -
european journal of pain
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.305
H-Index - 109
eISSN - 1532-2149
pISSN - 1090-3801
DOI - 10.1002/ejp.1121
Subject(s) - medicine , meta analysis , randomized controlled trial , physical therapy , strictly standardized mean difference , mood , cochrane library , quality of life (healthcare) , fibromyalgia , medline , psycinfo , psychiatry , nursing , political science , law
This updated systematic review aimed at evaluating the efficacy, acceptability and safety of cognitive behavioural therapies ( CBT s) in fibromyalgia syndrome ( FMS ). Clinicaltrials.gov, Cochrane Library, MEDLINE , Psyc INFO and SCOPUS were searched from September 2013 to May 2017. Randomized controlled trials ( RCT s) comparing CBT s with controls were analysed. Primary outcomes were ≥50% pain relief, ≥20% improvement of health‐related quality of life ( HRQoL ), negative mood, fatigue, disability, acceptability and safety at end of therapy and at 6 months follow‐up. Effects were summarized by a random effects model using risk differences ( RD ) or standardized mean differences ( SMD ) with 95% confidence intervals ( CI ). 29 RCT s with 2509 subjects were included. CBT s were superior to controls (waiting list, attention control, treatment as usual, other active non‐pharmacological therapies) in pain relief of 50% or greater ( RD 0.05 [95% CI 0.02–0.07] (high‐quality evidence), improvement of HRQoL of 20% or greater ( RD 0.13 [95% CI 0.00–0.26], (moderate quality evidence), and in reducing negative mood ( SMD −0.43 [95% CI −0.62 to −0.24]) (high‐quality evidence), disability ( SMD −0.30 [95% CI −0.52 to −0.08]) (high‐quality evidence) and fatigue ( SMD – 0–27 [95% CI −0.50 to −0.03]) (high‐quality evidence). There were no statistically significant differences between CBT s and controls in acceptability and safety (high‐quality evidence). The update did not change the major findings of the previous review. CBT s provided a clinically relevant benefit over control interventions in reducing some key symptoms of FMS and disability at the end of treatment. Significance This updated systematic review with meta‐analysis on cognitive behavioural therapies ( CBT s) including acceptance‐based CBT s endorse the efficacy and tolerability of CBT s in reducing key symptoms and disability in FMS in the short‐ and long‐term if compared to waiting list, treatment as usual, attention controls and active non‐pharmacological therapies. CBT s did not differ in efficacy except superiority for coping with pain and tolerability from recommended drug therapy (pregabalin and/or duloxetine).