Brief intervention curbs fibromyalgia’s impact
Interdisciplinary program only 1½ days
The most effective treatment of chronic diseases such as fibromyalgia must, like the diseases themselves, be implemented over a period of months, or even years . . . Right? Not necessarily. A brief interdisciplinary program at the Mayo Clinic in Rochester, MN, has achieved meaningful improvement in patients in terms of how they were affected by their symptoms.
On follow-up, for example, 70% showed improvement in their score on the Fibromyalgia Impact Questionnaire (FIQ), including bad days per week, pain severity, fatigue, "awaken refreshed," stiffness, and nervousness and anxiety. MPI (Multidimensional Pain Inventory) scores also demonstrated significant improvement in the areas of pain severity, interference, and general activity level.
How can such significant improvement be achieved with a program of relatively brief duration? "I think one reason why brief intervention is helpful is that many patients, and for that matter doctors, don’t have a clear idea of what fibromyalgia is," says Lois E. Krahn, MD, of Mayo’s department of psychiatry and psychology. "There are many forms and symptoms, and a core component of our program is education, to provide the patients with more scientifically based knowledge than many of them, unfortunately, have had in the past."
For example, she notes, some people with fibromyalgia feel they should be more sedentary to prevent pain, and they don’t know that moderate exercise actually can be beneficial. "This may induce them to lead lifestyles that would exacerbate their symptoms," she explains. "By being better informed, they hopefully will make better choices."
In addition, even this brief intervention can make a big difference in the ability of the patient to provide optimal self-care, which is very important in fibromyalgia patients. "They learn what kind of exercise is best; they learn stress management techniques, how best to function in the employment sphere. All of this is addressed," Krahn explains. "What’s sad for me is that in many cases, no one had ever talked to them, for example, about what to do at work."
The program crammed a lot of activity into a brief period of time. During the first half-day, patients were evaluated by a nurse and a physician. This included medical, physical, psychological, educational, and pharmacological assessments. The second half-day consisted of a nurse-led course emphasizing self-management. This included written materials, lectures, and group discussions about these topics:
- what fibromyalgia is and is not;
- the cycle of pain;
- stress management;
- planning for difficult days;
- sleep hygiene;
- anger management;
- communication skills;
- coping skills;
- personal responsibility.
The third segment included both occupational and physical therapy components led by physical and occupational therapists. Written materials, lectures, group discussions, and interactive demonstrations were used to teach the patients how to manage their condition. In the physical therapy component, exercise, stretching, and moderation specifically were emphasized. In the occupational therapy component, proper body mechanics and energy conservation were emphasized, Krahn says.
Follow-up is critical
Because the post-treatment outcome measures and other follow-up information were mailed to the patients one month after the intervention, patient compliance after the intervention clearly was critical to the success of the program. In the case of the Mayo program, the more severely affected patients showed the most improvement, which surprised even Krahn. Why was the program so successful?
"One important piece was the people involved with it," she offers. "One reason we established the program was that patients had been less than satisfied with their care; but the physicians who were treating them were also less than satisfied. Now, we’ve identified staff who enjoy working with these issues, and they have volunteered to work in our center."
In effect, she says, fibromyalgia patients are no longer seen exclusively by rheumatologists; they are seen by the whole volunteer staff. "Beforehand, patients might have been seen by health care professionals who actually were experts in other diseases. Now, we have very talented nurses, rheumatologists, and physiatrists who want to treat fibromyalgia patients." In addition, she notes, with this multidisciplinary approach, "we are better able to meet the needs of any individual patient."
Krahn feels the results of this program should give hope both to fibromyalgia patients and to those who care for them. "Sometimes with a disease like this, people get very pessimistic; they feel nothing can be effective in relieving its symptoms," Krahn observes. "The basic take-home from this study is that these patients not only deserve attention, but that there are treatments that are effective. These patients are very high utilizers of health care, and there is great potential for this kind of intervention to reduce their need for ongoing medical care."
Need more information?
For more on fibromyalgia program, contact:
• Lois E. Krahn, MD, Department of Psychiatry and Psychology, Mayo Clinic, 200 First St. S.W., Rochester, MN. Telephone: (507) 284-3789.