SUBGROUPS OF FMS--SYMPTOMS, BELIEFS & TAILORED TREATMENT

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Fibromyalgia syndrome (FMS) is a prevalent, chronic musculoskeletal pain disorder. Despite extensive research the etiology and pathophysiologic mechanisms of FMS are not well understood, and no treatment has been shown to be universally effective. In this project, we propose that FMS is a complex disorder involving multiple factors, both physical and psychosocial-behavioral. In our previous research, we have demonstrated that FMS patients are heterogeneous in the psychosocial-behavioral axis and can be classified into 3 distinct subgroups on a basis of their psychosocial adaptation to symptoms. In this application we will extend our previous research and attempt to match treatments to patients psychosocial-behavioral characteristics. Specifically, we will test the efficacy of uniquely tailored treatment for each psychosocial subgroup. Three groups of FMS patients will be treated with one of the 3 treatment protocols with standard physical therapy and varying psychological treatments. A total of 312 FMS patients will undergo a 6 half-day interdisciplinary treatment sessions consisting of physical therapy and psychological treatments. All protocols include a standardized physical therapy but include either cognitive-behavioral pain management therapy, interpersonal skill training, or supportive counseling. In addition to the treatment outcome study, various symptoms of FMS will be assessed prospectively in the patients natural habitats to better understand covariations of FMS symptoms. The repeated daily monitoring using the palm-top computer (ecological momentary assessment) will permit us to evaluate the value of process ratings compared to retrospective reports. Overall, the results of these studies should establish the benefit of matching treatments to subject characteristics, and enhance our understanding of the roles of cognitive-affective-behavioral adaptation of FMS patients.