Hedman-Lagerlöf Maria, Hedman-Lagerlöf Erik, Axelsson Erland, Ljótsson Brjánn, Engelbrektsson Johanna, Hultkrantz Sofia, Lundbäck Karolina, Björkander Daniel, Wicksell Rikard K, Flink Ida, Andersson Erik
Department of Clinical Neuroscience, Division of Psychology.
Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet.
Clin J Pain. 2018 Jun;34(6):532-542. doi: 10.1097/AJP.0000000000000566.
Fibromyalgia (FM) is a common and disabling chronic pain disorder, for which existing pharmacological and psychological treatments have yet yielded insufficient effects. Previous literature has shown that exposure therapy may be an effective treatment for chronic pain. This study constitutes the first randomized controlled trial evaluating exposure therapy for FM.
A total of 140 participants with diagnosed FM were randomized to a 10-week Internet-delivered exposure treatment (iExp; n=70) or a waitlist control condition (WLC; n=70). Primary outcome measure were FM symptoms and impact, and secondary outcome measures were fatigue, disability, quality of life, pain-related distress and avoidance behaviors, insomnia, depression, and anxiety.
Data retention was high (100% data completion at posttreatment for primary outcome, 96% at 6-month follow-up and 94% at 12-month follow-up). Results showed that participants in the iExp group made large and superior improvements compared with WLC on FM symptoms and impact (B, -1.93; z, -10.14; P<0.001, between-group Cohen d=0.90), as well as all secondary outcomes (between-group Cohen d ranging from 0.44 to 1.38) with sustained results.
We conclude that iExp seems to be an efficacious treatment for FM compared with no treatment, and the results also highlight the potential increase of accessibility by using the Internet format to deliver psychological treatments for these patients. Future trials with active control conditions are warranted.
纤维肌痛（FM）是一种常见的、导致功能障碍的慢性疼痛疾病，现有的药物和心理治疗效果仍不充分。以往文献表明，暴露疗法可能是治疗慢性疼痛的有效方法。本研究是评估暴露疗法治疗纤维肌痛的首个随机对照试验。
总共140名确诊为纤维肌痛的参与者被随机分为接受为期10周的互联网提供的暴露治疗组（iExp；n = 70）或等待名单对照组（WLC；n = 70）。主要结局指标是纤维肌痛症状及影响，次要结局指标是疲劳、功能障碍、生活质量、疼痛相关困扰及回避行为、失眠、抑郁和焦虑。
数据保留率很高（主要结局在治疗后数据完成率为100%，6个月随访时为96%，12个月随访时为94%）。结果显示，与等待名单对照组相比，iExp组参与者在纤维肌痛症状及影响方面有显著且更大的改善（B，-1.93；z，-10.14；P < 0.001，组间Cohen d = 0.90），以及在所有次要结局方面（组间Cohen d范围为0.44至1.38），且结果持续存在。
我们得出结论，与不治疗相比，iExp似乎是治疗纤维肌痛的有效方法，结果还凸显了通过互联网形式为这些患者提供心理治疗可能会增加可及性。未来有必要进行有积极对照条件的试验。
