Internet Enhanced Treatment

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There is unfortunately no known cure for fibromyalgia, and effectively treating its signs and symptoms can be extremely difficult. Although there are many suspected causes of fibromyalgia, definitive answers remain elusive. The variations in the way fibromyalgia presents itself among individuals makes identifying and ruling out other similar conditions very difficult. Nevertheless, experts agree (and research supports) that the most effective way to manage fibromyalgia is through a multifaceted, multidisciplinary approach. While individual treatment regimens will vary greatly between patients, the most effective regimens will include a combination of drug therapies, dietary modifications and supplementation, alternative therapies (such as acupuncture and massage), and regular exercise.

In addition to these conventional and alternative therapies, the Internet is becoming an increasingly utilized tool for those living with chronic disease. Though research in this field is still relatively in its infancy, emerging data show that an internet-based management system, like FibroTrack, can be useful to enhance the effectiveness of conventional treatment efforts. A number of recent studies have demonstrated the usefulness of internet-enhanced treatment for depression and anxiety (Wade, 2010; Berger et al., 2011), as well as chronic pain (Buhrman et al., 2004; Devineni & Blanchard, 2005; Buhrman et al., 2011). Specific research regarding Internet-enhanced treatment for fibromyalgia is also limited, however compelling evidence is available from one recent study, which demonstrated that fibromyalgia patients who used an Internet-based self-management program as part of their treatment regimen experienced significant improvements in pain and physical function.

This study, authored by Williams and colleagues (2010), reports the findings of a randomized controlled trial (the “gold standard” for research study design) in which 188 fibromyalgia patients were randomly assigned to one of two intervention arms: 1) usual care from their primary care physician, or 2) usual care plus access to an Internet-enhanced self-management program over a six month study period. This Internet-based program translated content from conventional face-to-face cognitive behavioral therapy designed for fibromyalgia patients into an online, self-help medium. Cognitive behavioral therapy is a type of psychological therapy that helps individuals understand how their thoughts and feelings impact their behaviors.

The online program was titled “Living Well with Fibromyalgia” and consisted of a website that contained 13 educational modules divided among three groups: a) background knowledge about fibromyalgia; b) education, behavioral, and thinking skills useful for managing symptoms; and c) behavioral and thinking skills useful for adapting lifestyle changes that promote improved management of fibromyalgia. Each of the 13 educational modules contained a video lecture, a corresponding written summary of the lecture, homework assignments, and forms for self-monitoring while applying the strategies discussed in the videos. Those fibromyalgia patients who were assigned to the usual care plus Internet self-management program were asked to explore the website on their own and review and implement the modules that they felt were most relevant to their particular disease status. No further instructions or coaching regarding use of the website was given to those patients.

At the beginning of the study, both groups of participants completed a series of questionnaires designed to assess their physical function status and degree of pain severity, as well as their fatigue, sleep disturbances and sleep quality, anxiety, and depression. These questionnaires were repeated at the end of the six month period in order to detect changes in these variables among participants in both groups over time. With regard to pain, the participants in the Internet-enhanced self-management program showed significant reductions in pain intensity when compared to those who simply received their usual care. In fact, 29% of those in the Internet-enhanced group reported a 30% decrease in pain versus only 8% in the standard care group. In terms of physical function, those in the Internet-enhanced group also showed a 31% improvement in physical function status versus only 6% in the usual care group. This study did not, however, detect differences between the two groups with regard to sleep quality and disturbances, fatigue, depression, and anxiety.

Although this study failed to show that an Internet-enhanced self-management program can effectively improve measures of sleep, fatigue, and mood, it did demonstrate that such programs can be useful in helping patients improve pain severity and physical functioning. The authors of this study also note that these findings are of particular importance in the treatment of fibromyalgia, which has historically been difficult to administer effectively for a majority of patients. Citing the significant improvements in pain and physical function gained by those participants in the Internet-enhanced program, Williams et al. suggest that Internet-based self-management programs have great potential to increase the effectiveness of fibromyalgia treatment efforts.

FibroTrack

The software utilized in the study by Williams et al. (2010) was quite basic and provided participants with basic educational modules, homework assignments, and simple tracking tools. It did not allow users to track detailed symptoms and integrated treatment efforts. However, despite its simplicity, those who were assigned to this arm of the study experienced measurable and significant improvements in their pain intensity and measures of physical functioning – gains that were not achieved to the same extent by those participants who received only standard care. These findings underscore the importance and utility of Internet-based management tools such as FibroTrack.

Unlike the system from the Williams study, FibroTrack is a much more comprehensive and tailored system. It is specifically designed with the individual user in mind and is not intended to serve as a one-size-fits-all tool for multiple users. It is highly customizable and specifically designed for the sole purpose of improving the effectiveness of fibromyalgia treatment. FibroTrack offers users the ability to track not only symptoms, but to validate those symptoms against ongoing treatment efforts in order to provide a detailed view of treatment efficacy and success. It has been designed from the ground up, with the explicit purpose of enabling users to manage all aspects of their fibromyalgia.

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References

1.        Williams DA, Kuper D, Segar M, Mohan N, Sheth M, Clauw DJ. Internet-enhanced management of fibromyalgia: a randomized controlled trial. Pain. 2010;151(3):694-702.

2.        Wade AG. Use of the internet to assist in the treatment of depression and anxiety: a systematic review. Prim Care Companion J Clin Psychiatry. 2010;12(4):pii:PCC.09r00876.

3.        Berger T, Hammerli K, Gubser N, Andersson G, Caspar F. Internet-based treatment of depression: a randomized controlled trial comparing guided with unguided self-help. Cogn Behav Ther. 2011;40(4):251-266.

4.        Buhrman M, Faltenhag S, Strom L, Andersson G. Controlled trial of Internet-based treatment with telephone support for chronic back pain. Pain. 2004;111(3):368-377.

5.        Devineni T, Blanchard EB. A randomized controlled trial of an internet-based treatment for chronic headache. Behav Res Ther. 2005;43(3):277-292.

Buhrman M, Nilsson-Ihrfeldt E, Jannert M, Strom L, Andersson G. Guided internet-based cognitive behavioural treatment for chronic back pain reduces pain catastrophizing: a randomized controlled trial. J Rehabil Med. 2011;43(6):500-505.

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