Testing an Intervention to Decrease Catastrophizing in Persons with Fibromyalgia

Abstract

Problem statement. The purpose of this study was to test the effectiveness of a brief psychoeducational nursing intervention to alter catastrophizing and improve coping with fibromyalgia, a syndrome of chronic, widespread pain. Catastrophizing is defined as a negative way of thinking about pain that interferes with the development of pain coping self-efficacy, the confidence a person has in their ability to manage pain. In fibromyalgia, catastrophizing has demonstrated a strong relationship to pain severity and daily functioning, but brief interventions targeting catastrophizing have not been tested.

Theoretical framework. Bandura's social cognitive model emphasizing self-efficacy as a determinant of behavior was used as the framework for the study.

Subjects. Participants in a 1.5 day fibromyalgia evaluation and treatment program in a tertiary health care facility in the Midwest completed the study (total N = 124).

Methodology. In this two-group experimental study, a control group (N=95) randomized by block assignment received treatment as usual, a fibromyalgia evaluation/treatment program which included a discussion of self-care management strategies. An intervention group (N=29) received an additional pilot-tested psycho educational 2.5 hour program to alter catastrophic thinking, plus 3 weekly phone calls and 3 weekly homework assignments. Pre- and 1-month post-treatment measures of pain intensity, pain catastrophizing, pain coping self-efficacy, depressive symptoms, and the impact of fibromyalgia on daily psychological and physical functioning, were collected.

Results. No significant differences in treatment effect between the control and experimental groups were found for altering catastrophizing. ANCOVA, adjusting for age, gender, education level, duration of pain, history of depression and level of depressive symptoms, was used to make the comparison. Dosage of treatment did have an impact on select outcome measures, however. No mediating effect of catastrophizing on the outcome measures was present.

Implications. The lack of a difference in treatment effect may relate to treatment brevity, short I month follow-up, a need to alter the brief catastrophizing intervention, or lack of participant adherence to the entire treatment protocol. Longer follow-up intervals to examine treatment outcomes changes over time and strategies to improve adherence to treatment recommendations are in need of further study.