Cognitive behavior therapy, exercise, or both for treating chronic widespread pain

John McBeth, Gordon Prescott, Graham Scotland, Karina Lovell, Philip Keeley, Phil Hannaford, Paul McNamee, Deborah P. M. Symmons, Steve Woby, Chrysa Gkazinou, Marcus Beasley, Gary J. Macfarlane

Research output: Contribution to journalArticlepeer-review

108 Citations (Scopus)


Background The clinical impact of telephone-delivered cognitive behavioral therapy (TCBT), exercise, or a combined intervention in primary care patients with chronic widespread pain (CWP) is unclear.

Methods A total of 442 patients with CWP (meeting the American College of Rheumatology criteria) were randomized to receive 6 months of TCBT, graded exercise, combined intervention, or treatment as usual (TAU). The primary outcome, using a 7-point patient global assessment scale of change in health since trial enrollment (range: very much worse to very much better), was assessed at baseline and 6 months (intervention end) and 9 months after randomization. A positive outcome was defined as “much better” or “very much better.” Data were analyzed using logistic regression according to the intention-to-treat principle.

Results The percentages reporting a positive outcome at 6 and 9 months, respectively, were TAU group, 8% and 8%; TCBT group, 30% and 33%; exercise group, 35% and 24%; and combined intervention group, 37% and 37% (P < .001). After adjustment for age, sex, center, and baseline predictors of outcome, active interventions improved outcome compared with TAU: TCBT (6 months: odds ratio [OR], 5.0 [95% CI, 2.0-12.5]; 9 months: OR, 5.4 [95% CI, 2.3-12.8]), exercise (6 months: OR, 6.1 [95% CI, 2.5-15.1]; 9 months: OR, 3.6 [95% CI, 1.5-8.5]), and combined intervention (6 months: OR, 7.1 [95% CI, 2.9-17.2]; 9 months: OR, 6.2 [95% CI, 2.7-14.4]). At 6 and 9 months, combined intervention was associated with improvements in the 36-Item Short Form Health Questionnaire physical component score and a reduction in passive coping strategies. Conclusions on cost-effectiveness were sensitive to missing data.

Conclusion TCBT was associated with substantial, statistically significant, and sustained improvements in patient global assessment.

Original languageEnglish
Pages (from-to)48-57
Number of pages10
JournalJAMA Internal Medicine
Issue number1
Early online date14 Nov 2011
Publication statusPublished - 9 Jan 2012


  • randomized controlled-trial
  • low-back-pain
  • style physical-activity
  • fibromyalgia syndrome
  • social desirability
  • self-report
  • scale
  • recommendations
  • classification
  • metaanalysis


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