MUSICIAN: Managing Unexplained Symptoms (Chronic widespread pain) In primary Care: Involving traditional and Accessible New approaches
Chronic widespread pain (CWP) has a population prevalence of approximately 10% and is amongst the most common reasons for referral to a rheumatologist. Such patients use health services extensively, with one study estimating average 6-month direct costs of approximately £1,000. There is currently a lack of evidence regarding how best to manage patients who frequently present with CWP. A 2×2 factorial-design randomised controlled study was used to assess the effectiveness and cost-effectiveness of the alternative regimes.
Outcome and Translation
The study provided evidence to practitioners and policy makers on the best approach for the management of CWP. At six and nine months after intervention, active interventions were associated with non-significant increases in QALYs. Applying a cost-effectiveness ceiling ratio of £30,000 per QALY gained, telephone-based CBT had the highest probability of being the preferred option at nine months, with about a 70% chance of being cost-effective compared with treatment as usual. Importantly, patient-reported improvements in health were recently found to be maintained at two years after treatment, suggesting sustained effectiveness, and providing evidence that the treatment is very cost-effective.
External collaborators: G Macfarlane, G Prescott (Population Health, University of Aberdeen); P Hannaford, A El-Metwally (Academic Primary Care, University of Aberdeen) and J Norrie (HSRU, University of Aberdeen)
McBeth, J., Prescott, G., Scotland, G., Lovell, K., Keeley, P., Hannaford, P., McNamee, P., Symmons, D.P.M., Woby, S., Gkazinou, C., Beasley, M. and Macfarlane, G.J. (2012) 'Cognitive behavior therapy, exercise, or both for treating chronic widespread pain', Archives of Internal Medicine, 172(1), 48-57.
Coretti, S., Ruggeri, M. and McNamee, P. (2014) 'The minimum clinically important difference for EQ-5D index: a critical review', Expert Review of Pharmacoeconomics & Outcomes Research, 14(2), 221-233.
Beasley, M., Prescott, G. J., Scotland, G., McBeth, J., Lovell, K., Keeley, P., Hannaford, P. C., Symmons, D. P. M., MacDonald, R. I. R., Woby, S. and Macfarlane, G. J. (2015) 'Patient-reported improvements in health are maintained 2 years after completing a short course of cognitive behaviour therapy, exercise or both treatments for chronic widespread pain: long-term results from the MUSICIAN randomised controlled trial', RMD Open,1, e000026.
Beasley, M., Prescott, G., McBeth, J., Scotland, G., Lovell, K., Keeley, P., Hannaford, P., McNamee, P., Symmons, D. P. M., Woby, S., Gkazinou, C. and Macfarlane, G. J. (2013) 'Long-term effects of cognitive behaviour therapy and exercise for chronic widespread pain', EULAR (European League Against Rheumatism), Madrid, 12-15 June 2013.
Beasley, M., Prescott, G., Scotland, G., McBeth, J., Keeley, P., Lovell, K., Hannaford, P., McNamee, P., Symmons, D. P. M., Woby, S. and Macfarlane, G. (2014) 'Long-term results from a randomised controlled trial of cognitive behaviour therapy and exercise for chronic widespread pain [poster]', British Pain Society Annual Scientific Meeting, Manchester, 29 April - 1 May 2014.
Coretti, S. and McNamee, P. (2014) 'What size of difference matters in EQ-5D? Comparison of methods to estimate the minimum clinically important difference', Society for Medical Decision Making, 15th Biennial European Meeting, Special Focus on Clinical Decision Making in the Era of Personalized Medicine, Antwerp, Belgium, 8-10 June 2014.