Fibromyalgia Symptom Reduction by Online Behavioral Self-monitoring, Longitudinal Single Subject Analysis and Automated Delivery of Individualized Guidance

William Collinge, Paul Yarnold, Robert Soltysik, William Collinge, Paul Yarnold, Robert Soltysik

Abstract

Background: Fibromyalgia (FM) is a complex chronic pain condition that is difficult to treat. The prevailing approach is an integration of pharmacological, psycho-educational, and behavioral strategies. Information technology offers great potential for FM sufferers to systemically monitor symptoms as well as potential impacts of various management strategies.

Aims: This study aimed to evaluate effects of a web-based, self-monitoring and symptom management system (SMARTLog) that analyzes personal self-monitoring data and delivers data-based feedback over time.

Materials and methods: Subjects were self-referred, anonymous, and recruited via publicity on FM advocacy websites. Standardized instruments assessed health status, self-efficacy, and locus of control at baseline and monthly during participation. Subjects were encouraged to complete the SMARTLog several times weekly. Within-subject, univariate, and multivariate analyses were used to derive classification trees for each user associating specific behavior variables with symptom levels over time.

Results: Moderate use (3 times weekly x 3 months) increased likelihood of clinically significant improvements in pain, memory, gastrointestinal problems, depression, fatigue, and concentration; heavy use (4.5 times weekly x five months) produced the above plus improvement in stiffness and sleep difficulties.

Conclusions: Individualized, web-based behavioral self-monitoring with personally-tailored feedback can enable FM sufferers to significantly reduce symptom levels over time.

Keywords: Behavioral medicine; Chronic fatigue syndrome; Fibromyalgia; Self-management; Self-monitoring; Single-subject analysis; Symptom reduction; internet.

Conflict of interest statement

Conflict of Interest: None declared.

References

    1. Yunus MB. Fibromyalgia and overlapping disorders: The unifying concept of central sensitivity syndromes. Semin Arthritis Rheum. 2007;36:339–56.
    1. Winfield JB. Fibromyalgia and related central sensitivity syndromes twenty-five years of progress. Semin Arthritis Rheum. 2007;36:335–8.
    1. Yunus MB. Central sensitivity syndromes: A new paradigm and group nosology for fibromyalgia and overlapping conditions, and the related issue of disease versus illness. Semin Arthritis Rheum. 2008;37:339–52.
    1. Kindler LL, Bennett RM, Jones KD. Central sensitivity syndromes: Mounting pathophysiologic evidence to link fibromyalgia with other common chronic pain disorders. Pain Manag Nurs. 2011;12:15–24.
    1. Woolf CJ. Central sensitization: Implications for the diagnosis and treatment of pain. Pain. 2011;152:S2–15.
    1. Wood PB, Schweinhardt P, Jaeger E, Dagher A, Hakyemez H, Rabiner EA, et al. Fibromyalgia patients show an abnormal dopamine response to pain. Eur J Neurosci. 2007;25:3576–82.
    1. Wood PB, Patterson JC, 2nd, Sunderland JJ, Tainter KH, Glabus MF, Lilien DL. Reduced presynaptic dopamine activity in fibromyalgia syndrome demonstrated with positron emission tomography: A pilot study. J Pain. 2007;8:51–8.
    1. Riva R, Mork PJ, Westgaard RH, Rø M, Lundberg U. Fibromyalgia syndrome is associated with hypocortisolism. Int J Behav Med. 2010;17:223–33.
    1. Behm FG, Gavin IM, Karpenko O, Lindgren V, Gaitonde S, Gashkoff PA, et al. Unique immunologic patterns in fibromyalgia. BMC Clin Pathol. 2012;12:25.
    1. Muzammil S, Cooper HC. Acute pancreatitis and fibromyalgia: Cytokine link. N Am J Med Sci. 2011;3:206–8.
    1. Omoigui S. The biochemical origin of pain: The origin of all pain is inflammation and the inflammatory response. Part 2 of 3 – Inflammatory profile of pain syndromes. Med Hypotheses. 2007;69:1169–78.
    1. Bazzichi L, Rossi A, Massimetti G, Giannaccini G, Giuliano T, De Feo F, et al. Cytokine patterns in fibromyalgia and their correlation with clinical manifestations. Clin Exp Rheumatol. 2007;25:225–30.
    1. Üçeyler N, Häuser W, Sommer C. Systematic review with meta-analysis: Cytokines in fibromyalgia syndrome. BMC Musculoskelet Disord. 2011;12:245.
    1. Ablin JN, Buskila D. Fibromyalgia syndrome - Novel therapeutic targets. Maturitas. 2013;75:335–40.
    1. Brown MM, Jason LA. Functioning in individuals with chronic fatigue syndrome: Increased impairment with co-occurring multiple chemical sensitivity and fibromyalgia. Dyn Med. 2007;6:6.
    1. Friedberg F, Jason LA. Chronic fatigue syndrome and fibromyalgia: Clinical assessment and treatment. J Clin Psychol. 2001;57:433–55.
    1. Moldofsky H. Fibromyalgia, sleep disorder and chronic fatigue syndrome. Ciba Found Symp. 1993;173:262–79.
    1. Niazi AK, Niazi SK. Mindfulness-based stress reduction: A non-pharmacological approach for chronic illnesses. N Am J Med Sci. 2011;3:20–3.
    1. Friedberg F, Williams DA, Collinge W. Lifestyle-oriented non-pharmacological treatments for fibromyalgia: A clinical overview and applications with home-based technologies. J Pain Res. 2012;5:425–35.
    1. American College of Rheumatology. [Accessed July 9, 2013]. at .
    1. Leslie M. Fibromyalgia syndrome: A comprehensive approach to identification and management. Clin Excell Nurse Pract. 1999;3:165–71.
    1. Glombiewski JA, Sawyer AT, Gutermann J, Koenig K, Rief W, Hofmann SG. Psychological treatments for fibromyalgia: A meta-analysis. Pain. 2010;151:280–95.
    1. Bernardy K, Füber N, Köllner V, Häuser W. Efficacy of cognitive-behavioral therapies in fibromyalgia syndrome: A systematic review and meta-analysis of randomized controlled trials. J Rheumatol. 2010;37:1991–2005.
    1. Häuser W, Arnold B, Eich W, Felde E, Flügge C, Henningsen P, et al. Management of fibromyalgia syndrome - an interdisciplinary evidence-based guideline. Ger Med Sci. 2008;6:Doc14.
    1. Mengshoel AM, Heggen K. Recovery from fibromyalgia - previous patients’ own experiences. Disabil Rehabil. 2004;26:46–53.
    1. Henriksson CM. Living with continuous muscular pain - patient perspectives. Part II: Strategies for daily life. Scand J Caring Sci. 1995;9:77–86.
    1. Mossavar-Rahmani Y, Henry H, Rodabough R, Bragg C, Brewer A, Freed T, et al. Additional self-monitoring tools in the dietary modification component of The Women's Health Initiative. J Am Diet Assoc. 2004;104:76–85.
    1. Lorig KR, Ritter PL, Laurent DD, Plant K. The internet-based arthritis self-management program: A one-year randomized trial for patients with arthritis or fibromyalgia. Arthritis Rheum. 2008;59:1009–17.
    1. Williams DA, Kuper D, Segar M, Mohan N, Sheth M, Clauw DJ. Internet-enhanced management of fibromyalgia: A randomized controlled trial. Pain. 2010;151:694–702.
    1. Menga G, Dupre BJ, Gauthier C, Davis WE, Webb-Detiege TA, Scopelitis E. Fibromyalgia: Can online cognitive behavioral therapy help? Arthritis Rheum. 2011;63(Suppl10):937.
    1. Collinge W, Soltysik RC, Yarnold PR. An internet-based intervention for fibromyalgia self-management: Initial design and alpha test. Optim Data Anal. 2010;1:163–75.
    1. Dunkl PR, Taylor AG, McConnell GG, Alfano AP, Conaway MR. Responsiveness of fibromyalgia clinical trial outcome measures. J Rheumatol. 2000;27:2683–91.
    1. Ware J, Turner-Bowker DM, Kosinski M, Gandek B. SF-12v2 Health Survey User's Manual. Lincoln, RI: Quality Metric, Inc; 2003. p. 250.
    1. Lorig K, Stewart A, Ritter P, González V, Laurent D, Lynch J . Outcome Measures for Health Education and other Health Care Interventions. Thousand Oaks, CA: Sage Publications; 1996. .Thousand Oaks, CA: Sage Publications; 1996; pp. 24–45.
    1. Wallston KA, Stein MJ, Smith CA. Form C of the MHLC scales: A condition-specific measure of locus of control. J Pers Assess. 1994;63:534–53.
    1. Yarnold PR, Soltysik RC, Bennett CL. Predicting in-hospital mortality of patients with AIDS-related pneumocystis carinii pneumonia: An example of hierarchically optimal classification tree analysis. Stat Med. 1997;16:1451–63.
    1. Optimal Data Analysis. [Accessed June 23, 2013]. at .
    1. Yarnold PR, Soltysik RC. Optimal Data Analysis: Guidebook with Software for Windows. Washington, DC: APA Books; 2005.
    1. Fitzcharles MA, Ste-Marie PA, Goldenberg DL, Pereira JX, Abbey S, Choinière M, et al. National Fibromyalgia Guideline Advisory Panel.2012 Canadian guidelines for the diagnosis and management of fibromyalgia syndrome: Executive summary. Pain Res Manag. 2013;18:119–26.
    1. Lami MJ, Martinez MP, Sanchez AI. Systematic review of psychological treatment in fibromyalgia. Curr Pain Headache Rep. 2013;17:345.
    1. Nijs J, Roussel N, Van Oosterwijck J, De Kooning M, Ickmans K, Struyf F, et al. Fear of movement and avoidance behaviour toward physical activity in chronic-fatigue syndrome and fibromyalgia: State of the art and implications for clinical practice. Clin Rheumatol. 2013;32:1121–9.

Source: PubMed

스폰서 및 공동 작업자

건강 상태

약물 개입

3
구독하다