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• McBeth and colleagues compared the impact of cognitive behavioral therapy (CBT) delivered via phone, exercise, or a combination of the two interventions among subjects with chronic widespread pain.
• Subjects (N=442) with chronic widespread pain (as per American College of Rheumatology criteria) were randomized to one of the following interventions over a 6-month study period:
  • CBT via phone
  • Graded exercise
  • CBT via phone + graded exercise
  • Treatment as usual
• Primary outcome: change in health status
  • Assessed via seven-point scale (range: “very much worse” to “very much better”)
  • Assessed at baseline, 6 months, and 9 months post-randomization
  • Positive outcome defined as “much better” or “very much better”
• Positive outcomes were observed as follows (P<0.001):
  • Treatment as usual: 6 months: 8%; 9 months: 8%
  • CBT via phone: 6 months: 30%; 9 months: 33% Graded exercise: 6 months: 35%; 9 months: 24%
  • CBT via phone + graded exercise: 6 months: 37%; 9 months: 37%
• When adjusted for variables including age, baseline predictors of outcome, and sex, active interventions demonstrated improved outcomes vs treatment as usual
  • CBT via phone: 6 months: odds ratio (OR), 5.0 (95% confidence interval [CI], 2.0–12.5); 9 months: OR, 5.4 (95% CI, 2.3–12.8)
  • Graded exercise: 6 months: OR, 6.1 (95% CI, 2.5–15.1); 9 months: OR, 3.6 (95% CI, 1.5–8.5)
  • CBT via phone + graded exercise: 6 months: OR, 7.1 (95% CI, 2.9–17.2); 9 months: OR, 6.2 (95% CI, 2.7–14.4)

McBeth J, Prescott G, Scotland G, et al. Cognitive behavior therapy, exercise, or both for treating chronic widespread pain. Arch Intern Med. 2012;172(1):48-57.

April 2012