Abstract
This study's aim was to assess the efficacy of 2 forms of activity pacing in patients
with fibromyalgia syndrome (FMS). Treatment-related changes in activity management
patterns were also examined. Patients with FMS (n = 178) were randomly assigned to
an operant learning (OL; delayed [n = 36] or immediate [n = 54] groups) or an energy
conservation (EC; delayed [n = 35] or immediate [n = 53] groups) treatment condition.
Of these, 32 OL and 37 EC patients completed treatment. Forty-three patients were
allocated to the delayed treatment condition (control group). Repeated measures analyses
of variance were used to examine the effects of OL and EC treatments on primary (average
pain and usual fatigue), secondary (pain and fatigue interference, physical and psychological
function, sleep quality, depressive symptoms, and anxiety symptoms), and tertiary
(pain-related activity patterns) outcomes. Neither treatment was effective in reducing
average pain or usual fatigue symptoms. Relative to EC, OL patients showed greater
improvements in depressive symptoms, whereas nonsignificant trends (P values ranging between .05 and .06) were observed for pain interference, fatigue
interference, and psychological function. Both treatments were associated with improvements
in sleep quality and physical function, increases in pacing, and decreases in overdoing
activity patterns. Reductions in activity avoidance were only found in OL. These findings
suggest that OL may be more beneficial than EC and that it could potentially be viewed
as an effective stand-alone activity pacing treatment for patients with FMS. Research
to determine the extent to which these preliminary findings replicate is warranted.
Perspective
This article examines the efficacy of 2 forms of activity pacing in patients with
fibromyalgia syndrome. The results suggest the possibility that operant learning may
be more beneficial than energy conservation and could potentially be viewed as an
effective stand-alone activity pacing treatment for patients with fibromyalgia syndrome.
Key words
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Article info
Publication history
Published online: October 13, 2018
Accepted:
September 7,
2018
Received in revised form:
July 23,
2018
Received:
October 30,
2017
Footnotes
All authors reviewed and provided comments on drafts and subsequent revisions of this article and approved the final version for submission and publication. W.R.N. was responsible for initially defining the research questions and research objectives. M.R. developed the study protocol and treatment manuals, participated in the design of the analyses, provided input in the data analysis plan, conducted part of the statistical analyses, and prepared the first draft of the manuscript; M.P.J., M.H., P.M.-F., and W.R.N. provided input into the research protocol, the data analysis plan, and feedback on multiple drafts of the manuscript.
Financial support for this project included a bequest from the estate of Mrs. Beryl Ivey to Dr. Warren R. Nielson and an Earl Russell Trainee Grant from Western University, London, Ontario to Dr. Mélanie Racine.
The authors have no conflicts of interest to declare.
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© 2018 by the American Pain Society
