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Operant Learning Versus Energy Conservation Activity Pacing Treatments in a Sample of Patients With Fibromyalgia Syndrome: A Pilot Randomized Controlled Trial

  • Mélanie Racine
    Correspondence
    Address reprint requests to Mélanie Racine, PhD, Department of Clinical and Neurological Sciences, Schulich School of Medicine & Dentistry, University of Western Ontario (London), 1635 Megantic St., Saint-Hubert (Quebec), J3Y 7H7.
    Affiliations
    Lawson Health Research Institute, London, Ontario, Canada

    Department of Clinical Neurological Sciences, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada

    Beryl & Richard Ivey Rheumatology Day Programs, St. Joseph's Health Care, London, Ontario, Canada
    Search for articles by this author
  • Mark P. Jensen
    Affiliations
    Department of Rehabilitation Medicine, University of Washington, Seattle, Washington
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  • Manfred Harth
    Affiliations
    Lawson Health Research Institute, London, Ontario, Canada
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  • Patricia Morley-Forster
    Affiliations
    Department of Anaesthesia and Perioperative Medicine, Western University, London, Ontario, Canada
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  • Warren R. Nielson
    Affiliations
    Lawson Health Research Institute, London, Ontario, Canada

    Beryl & Richard Ivey Rheumatology Day Programs, St. Joseph's Health Care, London, Ontario, Canada

    Department of Psychology, Western University, London, Ontario, Canada
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Published:October 13, 2018DOI:https://doi.org/10.1016/j.jpain.2018.09.013

      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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