What was the background to this study?
We had previously undertaken a study where we randomly allocated people with chronic widespread pain (a key feature of the condition called fibromyalgia) to receive either a 6 week course of cognitive behaviour therapy (also known as “talking therapy”) by telephone or to receive normal care. That study showed us that the group who received the talking therapy were much more likely to tell us that their health had improved, and this benefit was still evident 2 years after the course had finished.
What did we do?
We wanted to test whether the same approach could actually prevent people developing chronic widespread pain in the first place. We knew from previous work that we could identify people who were at high risk of developing chronic widespread pain – these were people who had consulted their GP with a local pain (such as knee, shoulder or back pain) and had sleep problems, reported other bodily symptoms and held specific beliefs about their symptoms. We used this knowledge to identify approximately 1000 such people, and randomly allocated them to receive either talking therapy or whatever management their GP recommended. We then contacted them 3 months, 1 year and 2 years later and asked them to complete a short questionnaire on topics including pain, sleep quality, and general quality of life.
What did we find?
What we found was that approximately the same number of people in both groups had developed chronic widespread pain at each time point. However, there were a number of aspects of health which we noticed had improved much more in the talking therapy group. They reported less fatigue, better sleep and lower levels of distress; they were much more likely to report that they considered their health to be improved and their reported quality of life was better.
What does this mean?
It is important to weigh the clinical benefits of any treatment against the costs. In the UK the NHS is usually willing to pay for treatments if they deliver an extra year of high quality life provided they don’t cost more than around £20,000-£30,000. In fact this course of talking therapy cost less than £2000 – which makes it very cost-effective.
The results of this study suggest that talking therapy may be beneficial for a much wider group of patients with pain than previously considered.
Who funded this work?
The study was funded by Versus Arthritis and in addition NHS Grampian, NHS Highland and NHS Greater Glasgow and Clyde paid for the costs of the talking therapy. It was conducted by a team of researchers principally based at the Universities of Aberdeen and Manchester.
The research team acknowledges the financial support of the NRS Primary Care Network (formerly known as SPCRN).
We would like to thank the managers and coordinators who assisted with the project: Dr Alison Hinds and Tracy Ibbotson (NHS Greater Glasgow & Clyde), Amanda Cardy (NHS Grampian), and Samantha Holden (NHS Highland).
Thanks also to the following GP practices, who helped us to recruit participants:
- Mount Florida Medical Centre, Midlock Medical Centre, Buckingham Terrace Medical Practice, Levern Medical Group, Bridgeton Health Centre, and Cardonald Medical Centre in (NHS Greater Glasgow & Clyde)
- Denburn Medical Practice, Ellon Medical Group, and Laurencekirk Healthcare Centre (NHS Grampian)
- Aultbea and Gairloch Medical Practice, The Pearson Practice, Cairn Medical Practice, Grantown on Spey Medical Practice, Strathpeffer Medical Practice, Fairfield Medical Practice, and Fortrose Medical Practice (NHS Highland)
Where can I read more?
To view the full scientific paper, click here.