Department of Pain Medicine, BG University Hospital Bergmannsheil GmbH, Ruhr University, Bochum, Germany.
Department Internal and Integrative Medicine, Kliniken Essen-Mitte, Faculty of Medicine, University of Duisburg-Essen, Germany.
Eur J Pain. 2018 Feb;22(2):242-260. doi: 10.1002/ejp.1121. Epub 2017 Oct 6.
This updated systematic review aimed at evaluating the efficacy, acceptability and safety of cognitive behavioural therapies (CBTs) in fibromyalgia syndrome (FMS). Clinicaltrials.gov, Cochrane Library, MEDLINE, PsycINFO and SCOPUS were searched from September 2013 to May 2017. Randomized controlled trials (RCTs) comparing CBTs 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 RCTs with 2509 subjects were included. CBTs 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 CBTs and controls in acceptability and safety (high-quality evidence). The update did not change the major findings of the previous review. CBTs provided a clinically relevant benefit over control interventions in reducing some key symptoms of FMS and disability at the end of treatment.
This updated systematic review with meta-analysis on cognitive behavioural therapies (CBTs) including acceptance-based CBTs endorse the efficacy and tolerability of CBTs 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. CBTs did not differ in efficacy except superiority for coping with pain and tolerability from recommended drug therapy (pregabalin and/or duloxetine).
本更新的系统评价旨在评估认知行为疗法（CBT）在纤维肌痛综合征（FMS）中的疗效、可接受性和安全性。2013 年 9 月至 2017 年 5 月，在临床试验.gov、Cochrane 图书馆、MEDLINE、PsycINFO 和 SCOPUS 中进行了检索。分析了比较 CBT 与对照组的随机对照试验（RCT）。主要结局是治疗结束时和 6 个月随访时≥50%的疼痛缓解、≥20%的健康相关生活质量（HRQoL）改善、负面情绪、疲劳、残疾、可接受性和安全性。采用风险差异（RD）或标准化均数差异（SMD）和 95%置信区间（CI），采用随机效应模型汇总效应。纳入了 29 项 RCT 和 2509 例受试者。CBT 在 50%或更大程度的疼痛缓解（RD 0.05 [95% CI 0.02-0.07]（高质量证据）、20%或更大程度的 HRQoL 改善（RD 0.13 [95% CI 0.00-0.26]（中等质量证据）、以及减轻负面情绪（SMD -0.43 [95% CI -0.62 至 -0.24]）（高质量证据）、残疾（SMD -0.30 [95% CI -0.52 至 -0.08]）（高质量证据）和疲劳（SMD -0.27 [95% CI -0.50 至 -0.03]）（高质量证据）方面优于对照组（等待名单、注意力对照、常规治疗、其他积极的非药物治疗）。CBT 在可接受性和安全性方面与对照组无统计学差异（高质量证据）。更新并没有改变之前综述的主要发现。CBT 在治疗结束时与对照干预相比，在减少 FMS 的一些关键症状和残疾方面提供了有临床意义的益处。
本项包括基于接受度的 CBT 的更新的系统评价和荟萃分析支持 CBT 在减少 FMS 的关键症状和残疾方面的疗效和耐受性，与等待名单、常规治疗、注意力对照和积极的非药物治疗相比，CBT 在短期和长期内均有效。除了在疼痛处理方面优于推荐的药物治疗（普瑞巴林和/或度洛西汀）外，CBT 在疗效上没有差异。
