A pilot study of the effects of behavioral weight loss treatment on fibromyalgia symptoms☆
Introduction
Fibromyalgia syndrome (FMS) is a condition that is characterized by widespread pain in 11 of 18 tender points experienced for at least 3 months [1]. In addition to pain, patients commonly report fatigue, sleep disturbance, depression and anxiety, cognitive difficulties, and other symptoms and illnesses such as headache, irritable bowel syndrome, rheumatoid arthritis, systemic lupus erythematosus, low back pain, Sjogren's, and osteoarthritis [1]. FMS has an enormous impact on the quality of life (QOL) of patients diagnosed with the condition; for example, the activities of daily living are more time consuming and difficult for women diagnosed with FMS than for normal controls [2].
As there is currently no cure for FMS, the only way to treat its symptoms is via clinical management. A recent meta-analysis found that treatment either with medication (e.g., antidepressants and muscle relaxants) or nonpharmacological treatments (e.g., cognitive–behavioral treatment, exercise, or biofeedback) led to improved FMS symptomatology; however, nonpharmacological treatment had a larger effect on symptoms reduction relative to medication [3]. Thus, there is a pressing need for further clinical interventions to reduce the pain and distress of FMS patients.
FMS symptoms have shown to improve after a change in diet [4]. Specifically, participants who consumed a vegan diet for 3 months showed greater improvements in FMS symptoms when compared with participants in a control condition. However, individuals also lost weight while on this diet, which may have mediated the relationship between adhering to a vegan diet and decreased symptomatology. Furthermore, after the 3-month study, not one member of the intervention group continued to maintain the vegan diet. As a result, pain levels regressed and improvements were not maintained.
Several studies have demonstrated the benefits of exercise in the improvement of FMS symptoms [5], [6], [7], [8], [9], [10], [11], [12], [13], [14]. Collectively, these studies have found that exercise, regardless of type (aerobic, walking, strength training, or aquatic), decreases FMS symptoms. However, many studies of exercise have been limited by low adherence and high attrition.
Although both exercise and a vegan diet have shown to be effective, more research is needed to determine if the relation between pain with specific diet and/or exercise regimen is actually mediated by weight loss. While there is little research on the relation between FMS and weight loss, a preliminary study demonstrated that there may be a correlation between the two [15]. This study found that the majority of women with FMS were overweight/obese compared with normal weight women (61% vs. 38%, respectively), had a significantly higher overall body mass index (BMI; 27.9 kg/m2) than the general population, and BMI was negatively correlated with physical functioning. Similarly, several previous studies found a positive association between BMI and other chronic pain conditions such as low back pain [16] and headaches [17]. Thus, obesity appears to be related to pain and may perhaps worsen the symptomatology. However, to date, there are no longitudinal studies that have investigated the effects of weight loss on FMS symptoms. Therefore, a first step in the process of investigating the relationship between weight loss and FMS symptoms is to develop a pilot study.
The primary purpose of the present study was to develop such a pilot treatment program specifically to explore the relationship between BMI and FMS symptoms (e.g., fatigue and pain). Specifically, this pilot study was designed to generate hypotheses regarding weight and FMS and to examine variables that might be related for further study. It was first hypothesized that BMI would be positively related to depression, anxiety, pain, and an overall lower QOL. Second, given that a modest weight loss of 5–10% reduces other obesity-related comorbidities (e.g., diabetes, hyperlipidemia, and hypertension; [18]), it was predicted that this modest amount of weight loss would result in improved FMS symptoms. Finally, it was also predicted that weight loss would improve affective status, QOL, and body satisfaction.
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Participants
A total of 52 participants were screened and enrolled in the study. Forty-two actually began the program, and 31 completed the entire treatment program and provided postdata (60% of entire screened sample; 74% of those who began treatment). Reasons for attrition included the following: life stress, difficulty driving to the hospital, and upcoming unrelated surgery. No adverse effects associated with the research project were reported. Patients were recruited primarily through referral from
Participants
One-way analyses of variance (ANOVA) showed that there were no significant differences in demographic variables between those who completed the program (n=31) versus those who did not complete the program (n=21). Therefore, demographic data are only presented for the treatment completers. All participants were Caucasian. The average age was 54.48±8.08 years (range, 38–75 years). Participants, on average, reported that their pain began 12.69±9.43 years ago (range, 2–45 years). A total of 22
Discussion
This pilot study is the first study to examine the effects of weight loss on FMS symptoms. Consistent with previous research on pain [15], [16], [17], at baseline, weight was positively correlated with multiple pain measures, including functional disability and pain interference. In addition, pain was positively correlated with depression, anxiety, and body concerns and negatively related to QOL [31], [32], [33], [34], [35], [36], [37].
After weight loss treatment, the participants lost an
Acknowledgments
The authors would like to thank James Strosberg, MD, for assistance with recruitment and use of facility and Sharon Alger-Meyer, MD, for help with the study design.
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Preparation of this manuscript was supported, in part, by an award from the American Psychological Association (Doctoral Dissertation Award).