Susan P. Buckelew’s research while affiliated with University of Missouri and other places

Twenty-five subjects with primary fibromyalgia syndrome and 22 subjects with rheumatoid arthritis were compared on measures of psychological distress, pain, health status, life stress, sleep disturbance, and coping strategies. Higher levels of psychological distress were found in the primary fibromyalgia syndrome group, but the degree of life stress was shown to be a significant covariate.

Objective: To provide a concise overview of behavioral interventions and fibromyalgia. Findings: This review describes behavioral theory, behavioral treatment interventions, applications of these behavioral techniques to the fibromyalgia population, and directions for future research. Conclusions: Behavioral theory can be used to understand some of the patterns associated with pain. Behavioral treatment suggestions and cognitive behavioral treatment programs provide options for improving the quality of life associated with fibromyalgia. Preliminary data from one treatment intervention study is presented. Future directions for research are addressed.

To evaluate and compare the efficacy of pharmacological and nonpharmacological treatments of fibromyalgia syndrome (FMS). This meta-analysis of 49 fibromyalgia treatment outcome studies assessed the efficacy of pharmacological and nonpharmacological treatment across four types of outcome measures-physical status, self-report of FMS symptoms, psychological status, and daily functioning. After controlling for study design, antidepressants resulted in improvements on physical status and self-report of FMS symptoms. All nonpharmacological treatments were associated with significant improvements in all four categories of outcome measures with the exception that physically-based treatment (primarily exercise) did not significantly improve daily functioning. When compared, nonpharmacological treatment appears to be more efficacious in improving self-report of FMS symptoms than pharmacological treatment alone. A similar trend was suggested for functional measures. The optimal intervention for FMS would include nonpharmacological treatments, specifically exercise and cognitive-behavioral therapy, in addition to appropriate medication management as needed for sleep and pain symptoms.

Objective. To develop a protocol for determining when an individual is adequately trained to locate the tender points relative to fibromyalgia in an exam. Methods. The error distance for each tender point was established by polling individuals with experience in conducting tender point exams. Bayesian statistical methods were employed to form a protocol for determining an individual's proficiency in locating the tender points. A predictive distribution was utilized to find the probability of remaining trained at locating tender points. Also, the probability of classifying at least 11 tender points as tender (mild) under different 'locating' criteria and different number of points that are truly tender was computed. Results. Critical values indicating the number of tender points needed in the qualification process for various standards of reliability - 80%, 85%, and 90% - are presented. To be certified after 3 subjects have been examined in the 80%, 85%, and 90% criteria, one has to correctly identify 48, 50, and 52, respectively, out of the 54 possible tender points. Conclusion. We believe that at least 3 subjects should be examined before certification is granted using any of the 3 criteria - 80%, 85%, and 90%. In our example, when using the 85% criterion, the qualification process required 7 subjects to certify an individual.

To develop a protocol for determining when an individual is adequately trained to locate the tender points relative to fibromyalgia in an exam. The error distance for each tender point was established by polling individuals with experience in conducting tender point exams. Bayesian statistical methods were employed to form a protocol for determining an individual's proficiency in locating the tender points. A predictive distribution was utilized to find the probability of remaining trained at locating tender points. Also, the probability of classifying at least 11 tender points as tender (mild) under different "locating" criteria and different number of points that are truly tender was computed. Critical values indicating the number of tender points needed in the qualification process for various standards of reliability--80%, 85%, and 90%--are presented. To be certified after 3 subjects have been examined in the 80%, 85%, and 90% criteria, one has to correctly identify 48, 50, and 52, respectively, out of the 54 possible tender points. We believe that at least 3 subjects should be examined before certification is granted using any of the 3 criteria--80%, 85%, and 90%. In our example, when using the 85% criterion, the qualification process required 7 subjects to certify an individual.

To compare the effectiveness of biofeedback/relaxation, exercise, and a combined program for the treatment of fibromyalgia. Subjects (n = 119) were randomly assigned to one of 4 groups: 1) biofeedback/relaxation training, 2) exercise training, 3) a combination treatment, or 4) an educational/attention control program. All 3 treatment groups produced improvements in self-efficacy for function relative to the control condition. In addition, all treatment groups were significantly different from the control group on tender point index scores, reflecting a modest deterioration by the attention control group rather than improvements by the treatment groups. The exercise and combination groups also resulted in modest improvements on a physical activity measure. The combination group best maintained benefits across the 2-year period. This study demonstrates that these 3 treatment interventions result in improved self-efficacy for physical function which was best maintained by the combination group.

Objective. To compare the effectiveness of biofeedback/relaxation, exercise, and a combined program for the treatment of fibromyalgia. Methods. Subjects (n = 119) were randomly assigned to one of 4 groups: 1) biofeedback/relaxation training 2) exercise training 3) a combination treatment, or 4) an educational/attention control program. Results. All 3 treatment groups produced improvements in self-efficacy for function relative to the control condition. In addition, all treatment groups were significantly different from the control group on tender point index scores, reflecting a modest deterioration by the attention control group rather than improvements by the treatment groups. The exercise and combination groups also resulted in modest improvements on a physical activity measure. The combination group best maintained benefits across the 2-year period. Conclusion. This study demonstrates that these 3 treatment interventions result in improved self-efficacy for physical function which was best maintained by the combination group.

Examined treatment adherence of 87 Ss (mean age 43.96 yrs) with fibromyalgia syndrome enrolled in a rehabilitation clinical trial study and randomly assigned to 1 of 3 treatment groups: (1) biofeedback, (2) exercise, (3) combination (biofeedback and exercise) or to an attention control condition. Ss completed a 6-wk training program, questionnaires, and a physical exam. Between-group differences on an adherence measure were examined, and multiple regression analyses were used to determine the best model for predicting adherence. Results show that adherence among people with fibromyalgia is multidetermined. Those in the biofeedback intervention were more adherent, suggesting that treatment factors impact adherence. Furthermore, the best model for predicting adherence suggests that subject characteristics like age and education also influence adherence. (PsycINFO Database Record (c) 2012 APA, all rights reserved)

To examine relationships among changes in self-efficacy and changes in other clinically relevant outcome measures. Subjects (n = 44) were participants in a prospective, randomized stress-management study followed over 15 months. Outcome measures included self-efficacy, depression, pain, health status, and disease activity. Correlational analyses revealed significant associations between changes in self-efficacy (particularly total self-efficacy) and changes in selected measures of depression, pain, health status, and disease activity. The observed associations were not due to changes in medication regimen or to nonadherence to the stress-management program. Evidence is provided that induced changes in self-efficacy following a stress-management program were significantly related to other clinically important outcome measures.