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Pain in chronic fatigue syndrome: response to rehabilitative treatments in the PACE trial

Published online by Cambridge University Press:  23 August 2013

J. H. Bourke ,
A. L. Johnson ,
M. Sharpe ,
T. Chalder  and
P. D. White
J. H. Bourke*
Affiliation:
Centre for Psychiatry, Wolfson Institute for Preventive Medicine, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, UK
A. L. Johnson
Affiliation:
MRC Biostatistics Unit, University of Cambridge Institute of Public Health MRC Clinical Trials Unit, London, UK
M. Sharpe
Affiliation:
Department of Psychiatry, University of Oxford, Oxford, UK
T. Chalder
Affiliation:
Academic Department of Psychological Medicine, King's College London, UK
P. D. White
Affiliation:
Centre for Psychiatry, Wolfson Institute for Preventive Medicine, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, UK
*
* Address for correspondence: Dr J. H. Bourke, Centre for Psychiatry, Wolfson Institute for Preventive Medicine, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, Dominion House, 59 Bartholomew Close, London EC1A 7ED, UK. (Email: [email protected])
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Abstract

Background

Pain is a common symptom of chronic fatigue syndrome (CFS). We investigated the effects of the treatments used in the PACE trial [cognitive behavioural therapy (CBT), graded exercise therapy (GET), adaptive pacing therapy (APT) and specialist medical care (SMC)] on pain in CFS.

Method

We compared pain outcomes including individual painful symptoms, taken from the CDC criteria for CFS and co-morbid fibromyalgia. We modelled outcomes adjusting for baseline variables with multiple linear regression.

Results

Significantly less frequent muscle pain was reported by patients following treatment with CBT compared to SMC (mean difference = 0.38 unit change in frequency, p = 0.02), GET versus SMC (0.42, p = 0.01) and GET versus APT (0.37, p = 0.01). Significantly less joint pain was reported following CBT versus APT (0.35, p = 0.02) and GET versus APT (0.36, p = 0.02). Co-morbid fibromyalgia was less frequent following GET versus SMC (0.03, p = 0.03). The effect sizes of these differences varied between 0.25 and 0.31 for muscle pain and 0.24 and 0.26 for joint pain. Treatment effects on pain were independent of ‘change in fatigue’.

Conclusions

CBT and GET were more effective in reducing the frequency of both muscle and joint pain than APT and SMC. When compared to SMC, GET also reduced the frequency of co-morbid fibromyalgia; the size of this effect on pain was small.

Keywords

Adaptive pacing therapy (APT)chronic fatigue syndrome (CFS)chronic paincognitive behavioural therapy (CBT)fibromyalgiagraded exercise therapy (GET)PACE trialrehabilitation
Type
Original Articles
Information
Psychological Medicine , Volume 44 , Issue 7 , May 2014 , pp. 1545 - 1552
Copyright
Copyright © Cambridge University Press 2013 

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References

Andrews, NE, Strong, J, Meredith, PJ (2012). Activity pacing, avoidance, endurance, and associations with patient functioning in chronic pain: a systematic review and meta-analysis. Archives of Physical Medicine and Rehabilitation 93, 2109–2121.Google Scholar
Bryant, TN (2000). Computer software for calculating confidence intervals (CIA). In: Statistics with Confidence (ed. Altman, D. G., Machin, D., Bryant, T. N. and Gardner, J. G.). BMJ Books: London.Google Scholar
Cairns, R, Hotopf, M (2005). A systematic review describing the prognosis of chronic fatigue syndrome. Occupational Medicine (London) 55, 20–31.Google Scholar
Castell, BD, Kazantis, N, Moss-Morris, RE (2011). Copgnitive behavioral therapy and graded exercise for chronic fatigue syndrome: a meta-analysis. Clinical Psychology: Science and Practice 18, 311–324.Google Scholar
Chambers, D, Bagnall, AM, Hempel, S, Forbes, C (2006). Interventions for the treatment, management and rehabilitation of patients with chronic fatigue syndrome/myalgic encephalomyelitis: an updated systematic review. Journal of the Royal Society of Medicine 99, 506–520.Google Scholar
Cohen, J (1988). Statistical Power Analysis for the Behavioural Sciences. Lawrence Erlbaum Associates.Google Scholar
Edmonds, M, McGuire, H, Price, J (2004). Exercise therapy for chronic fatigue syndrome. Cochrane Database of Systematic Reviews. Issue no. 3, Art. no. CD003200.Google Scholar
Ellingson, LD, Shields, MR, Stegner, AJ, Cook, DB (2012). Physical activity, sustained sedentary behavior, and pain modulation in women with fibromyalgia. Journal of Pain 13, 195–206.Google Scholar
George, SZ, Wittmer, VT, Fillingim, RB, Robinson, ME (2010). Comparison of graded exercise and graded exposure clinical outcomes for patients with chronic low back pain. Journal of Orthopaedic and Sports Physiotherapy 40, 694–704.Google Scholar
Geraets, JJ, Goossens, ME, de Groot, IJ, de Bruijn, CP, de Bie, RA, Dinant, GJ, van der Heijden, G, van den Heuvel, WJ (2005). Effectiveness of a graded exercise therapy program for patients with chronic shoulder complaints. Australian Journal of Physiotherapy 51, 87–94.CrossRefGoogle ScholarPubMed
Glombiewski, JA, Sawyer, AT, Gutermann, J, Koenig, K, Rief, W, Hofmann, SG (2010). Psychological treatments for fibromyalgia: a meta-analysis. Pain 151, 280–295.Google Scholar
Kindermans, HP, Huijnen, IP, Goossens, ME, Roelofs, J, Verbunt, JA, Vlaeyen, JW (2011). ‘Being’ in pain: the role of self-discrepancies in the emotional experience and activity patterns of patients with chronic low back pain. Pain 152, 403–409.CrossRefGoogle ScholarPubMed
King, C, Jason, LA (2005). Improving the diagnostic criteria and procedures for chronic fatigue syndrome. Biological Psychology 68, 87–106.CrossRefGoogle ScholarPubMed
Knoop, H, Stulemeijer, M, Prins, JB, van der Meer, JW, Bleijenberg, G (2007). Is cognitive behaviour therapy for chronic fatigue syndrome also effective for pain symptoms? Behaviour Research and Therapy 45, 2034–2043.Google Scholar
Lohnberg, JA (2007). A review of outcome studies on cognitive-behavioral therapy for reducing fear-avoidance beliefs among individuals with chronic pain. Journal of Clinical Psychology in Medical Settings 14, 113–122.Google Scholar
Malouff, JM, Thorsteinsson, EB, Rooke, SE, Bhullar, N, Schutte, NS (2008). Efficacy of cognitive behavioral therapy for chronic fatigue syndrome: a meta-analysis. Clinical Psychology Review 28, 736–745.CrossRefGoogle ScholarPubMed
McKay, PG, Duffy, T, Martin, CR (2009). Are chronic fatigue syndrome and fibromyalgia the same? Implications for the provision of appropriate mental health intervention. Journal of Psychiatric and Mental Health Nursing 16, 884–894.CrossRefGoogle ScholarPubMed
Meeus, M, Nijs, J, Meirleir, KD (2007). Chronic musculoskeletal pain in patients with the chronic fatigue syndrome: a systematic review. European Journal of Pain 11, 377–386.Google Scholar
Morley, S, Eccleston, C, Williams, A (1999). Systematic review and meta-analysis of randomized controlled trials of cognitive behaviour therapy and behaviour therapy for chronic pain in adults, excluding headache. Pain 80, 1–13.Google Scholar
NICE (2007). Chronic fatigue syndrome/myalgic encephalomyelitis (or encephalopathy): diagnosis and management, clinical guideline CG53 (http://guidance.nice.org.uk/CG53). National Institute for Health and Clinical Excellence. Accessed 17 September 2012.Google Scholar
Ostelo, RWJG, van Tulder, MW, Vlaeyen, JWS, Linton, SJ, Morley, S, Assendelft, WJJ (2005). Behavioural treatment for chronic low-back pain. Cochrane Database of Systematic Reviews. Issue no. 1, Art. no. CD002014.CrossRefGoogle ScholarPubMed
Price, JR, Mitchell, E, Tidy, E, Hunot, V (2008). Cognitive behaviour therapy for chronic fatigue syndrome in adults. Cochrane Database of Systematic Reviews. Issue no. 3, Art. no. CD001027.Google Scholar
Prins, JB, van der Meer, JW, Bleijenberg, G (2006). Chronic fatigue syndrome. Lancet 367, 346–355.Google Scholar
Reeves, WC, Lloyd, A, Vernon, SD, Klimas, N, Jason, LA, Bleijenberg, G, Evengard, B, White, PD, Nisenbaum, R, Unger, ER (2003). Identification of ambiguities in the 1994 chronic fatigue syndrome research case definition and recommendations for resolution. BMC Health Services Research 3, 25.CrossRefGoogle ScholarPubMed
Sharpe, MC, Archard, LC, Banatvala, JE, Borysiewicz, LK, Clare, AW, David, A, Edwards, RH, Hawton, KE, Lambert, HP, Lane, RJ (1991). A report – chronic fatigue syndrome: guidelines for research. Journal of The Royal Society of Medicine 84, 118–121.Google Scholar
Stulemeijer, M, de Jong, LW, Fiselier, TJ, Hoogveld, SW, Bleijenberg, G (2005). Cognitive behaviour therapy for adolescents with chronic fatigue syndrome: randomised controlled trial. British Medical Journal 330, 14.Google Scholar
Vercoulen, JH, Swanink, CM, Fennis, JF, Galama, JM, van der Meer, JW, Bleijenberg, G (1994). Dimensional assessment of chronic fatigue syndrome. Journal of Psychosomatic Research 38, 383–392.Google Scholar
White, PD, Goldsmith, K, Johnson, AL, Chalder, T, Sharpe, M; PACE Trial Management Group (2013). Recovery from chronic fatigue syndrome after treatments given in the PACE trial. Psychological Medicine. Published online: 31 01 2013 . doi:S0033291713000020.Google Scholar
White, PD, Goldsmith, KA, Johnson, AL, Potts, L, Walwyn, R, DeCesare, JC, Baber, HL, Burgess, M, Clark, LV, Cox, DL, Bavinton, J, Angus, BJ, Murphy, G, Murphy, M, O'Dowd, H, Wilks, D, McCrone, P, Chalder, T, Sharpe, M (2011). Comparison of adaptive pacing therapy, cognitive behaviour therapy, graded exercise therapy, and specialist medical care for chronic fatigue syndrome (PACE): a randomised trial. Lancet 377, 823–836.Google Scholar
White, PD, Sharpe, MC, Chalder, T, DeCesare, JC, Walwyn, R (2007). Protocol for the PACE trial: a randomised controlled trial of adaptive pacing, cognitive behaviour therapy, and graded exercise, as supplements to standardised specialist medical care versus standardised specialist medical care alone for patients with the chronic fatigue syndrome/myalgic encephalomyelitis or encephalopathy. BMC Neurology 7, 6.Google Scholar
Whiting, P, Bagnall, AM, Sowden, AJ, Cornell, JE, Mulrow, CD, Ramirez, G (2001). Interventions for the treatment and management of chronic fatigue syndrome: a systematic review. Journal of the American Medical Association 286, 1360–1368.Google Scholar
Wolfe, F, Clauw, DJ, Fitzcharles, MA, Goldenberg, DL, Katz, RS, Mease, P, Russell, AS, Russell, IJ, Winfield, JB, Yunus, MB (2010). The American College of Rheumatology preliminary diagnostic criteria for fibromyalgia and measurement of symptom severity. Arthritis Care and Research (Hoboken) 62, 600–610.CrossRefGoogle ScholarPubMed