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The process of change in pain during cognitive-behavior therapy for chronic fatigue syndrome.

Bloot, L., Heins, M.J., Donders, R., Bleijenberg, G., Knoop, H. The process of change in pain during cognitive-behavior therapy for chronic fatigue syndrome. Clinical Journal of Pain: 2015, 31(10), 914-921
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Background: Cognitive-behavior therapy (CBT) leads to a reduction of fatigue and pain in chronic fatigue syndrome. The processes underlying the reduction in pain have not been investigated. Recently, it was shown that increased self-efficacy, decreased focusing on symptoms, increased physical functioning, and a change in beliefs about activity contribute to the decrease in fatigue. Objectives: The present study has 2 objectives: (1) to determine the relationship between the reduction of fatigue and pain during CBT; (2) test to what extent the model for change in fatigue is applicable to the reduction in pain. Materials and Methods: One hundred forty-two patients meeting United States centers for Disease Control and Prevention criteria for chronic fatigue syndrome, currently reporting pain, and starting CBT were included. A cross-lagged analysis was performed to study the causal direction of change between pain and fatigue. Pain and process variables were assessed before therapy, 3 times during CBT, and after therapy. Actual physical activity was also assessed. The model was tested with multiple regression analyses. Results: The direction of change between pain and fatigue could not be determined. An increase in physical functioning and
decrease in focusing on symptoms explained 4% to 14% of the change in pain. Conclusions: Pain and fatigue most probably decrease simultaneously during CBT. Pain reduction can partly be explained by a reduction of symptom focusing and increased physical functioning.
Additional, yet unknown cognitive-behavioral factors also play a role in the reduction of pain. (aut. ref.)