Long-term effects of cognitive behaviour therapy and exercise for chronic widespread pain

Background
Cognitive behaviour therapy (CBT) and exercise have been shown to improve short-term outcomes for chronic widespread pain (CWP) patients. There is little data on whether improvement maintains long-term.

Methods or theme
The MUSICIAN Trial was a 2 x 2 factorial randomised controlled trial. A survey of general practitioner (GP)-registers identified CWP patients consulting their GP in the last year. Random assignation was to four study arms: the Cognitive Behavior Therapist (tCBT), exercise, combined treatment, or treatment as usual (TAU). tCBT participants had eight weekly telephone sessions and three and six month follow-up calls. Exercise group participants followed an individual fitness-instructor designed program over six months with monthly review. Combined treatment participants received both interventions. TAU participants received usual care. Follow-up by postal questionnaire or telephone was 24 months post-treatment. Positive outcome was patient-reported change in health of ‘much’ or ‘very much’ better. Analysis was by logistic regression and odds ratios (ORs) with 95% confidence intervals (CIs) are reported.

Results
Totally 442 persons participated (median age 57 years, 69% female) – 361 had 24-month follow-up. Of 94 respondents, 12 (12.8%) in TAU reported positive outcomes, 29 of 82 in tCBT (35.4%), 27 of 92 in exercise (29.3%) and 29 of 93 in combined treatment (31.2%). ORs compared to TAU were: tCBT, OR 4.0 (95% CI, 1.8–8.7); exercise, 2.9 (1.4–6.3); combined, 3.5 (1.6–7.5). Improvement odds did not differ across active treatments – there was no advantage in receiving both interventions.

Conclusions
tCBT and/or exercise for CWP are associated with long-term patient-reported health improvements. These are amongst the largest, longest-term benefits reported for CWP and offer potential management strategies.