Brazilian Journal of Pain
Brazilian Journal of Pain
Original Article

Effectiveness of the interactional and interdisciplinary school of fibromyalgia: a long-term randomized control study

Eficácia da escola interrelacional e interdisciplinar de fibromialgia: estudo randomizado controlado em longo prazo

Juliana Barcellos de Souza; Patricia Bourgault; Jacques Charest; Serge Marchand

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BACKGROUND AND OBJECTIVES: This study assessed long-term efficacy of an interdisciplinary group intervention of patients with fibromyalgia as compared with standard medical care.

METHODS: A partially randomized controlled study with two groups and repeated measures. Variables were measured at baseline; immediately after the program; 4 months and 1 year later. Fibromyalgia patients were recruited by newspaper ads or physician references from two Quebec regions. Sixty women suffering from fibromyalgia were randomized to the experimental group (ISF) or the control group CG. The program, called Interactional School of Fibromyalgia (ISF), consists of nine sessions with eight participants and two clinicians. Five variables were measured: Fibromyalgia Impact Questionnaire (FIQ), Physical and Mental components summary of Short Form Health Survey 36 (SF-36), Clinical pain, and pressure pain threshold at tender points.

RESULTS: Efficacy analyses from completers, as well as intent-to-treat analyses, showed a treatment effect on measures even one year after the end of the program. The experimental group experienced lower FIQ scores (p<0.01), less clinical pain (p<0.05), higher pressure-pain thresholds (p<0.01), and higher physical component summary scores on the SF-36 (p<0.05).

CONCLUSION: This interdisciplinary group intervention of patients with fibromyalgia demonstrated better long-term outcomes compared with standard medical care.


Coping, Exercise therapy, Fibromyalgia, Pain management


JUSTIFICATIVA E OBJETIVOS: Este estudo avaliou a eficácia em longo prazo de uma intervenção interdisciplinar em grupo de pacientes com fibromialgia, comparando-a ao atendimento médico padrão.

MÉTODOS: O estudo foi realizado randomicamente com dois grupos e coleta de dados de repetição. As variáveis foram medidas antes do início do programa; imediatamente após o programa; 4 meses e 1 ano depois. Os pacientes com fibromialgia foram recrutados por anúncios em jornais ou referências médicas, de duas regiões de Quebec. Sessenta mulheres que sofriam de fibromialgia foram randomizadas para o grupo experimental (EIF) ou o grupo controle (GC). O programa, denominado Escola Interrelacional de Fibromialgia (EIF), consiste em nove sessões com oito participantes e dois clínicos. Cinco variáveis de resultados foram medidas: Questionário de Impacto da Fibromialgia (QIF), resumo de componentes físicos e mentais do Short Form Health Survey 36 (SF-36), dor clínica e limiar de dor por pressão em pontos sensíveis.

RESULTADOS: As análises de eficácia dos que completaram o programa, bem como as análises de intenção de tratar, mostraram um efeito de tratamento nas medições mesmo um ano após o término do programa. O grupo experimental apresentou pontuações mais baixas do QIF (p<0,01), menos dor clínica (p<0,05), os mais altos limiares de dor por pressão (p<0,01) e as mais altas pontuações do resumo de componente físico no SF-36 (p<0,05).

CONCLUSÃO: Esta intervenção interdisciplinar em grupo de pacientes com fibromialgia demonstrou melhores resultados em longo prazo em comparação com os cuidados médicos padrão.


Adaptação psicológica, Fibromialgia, Manejo da dor, Terapia por exercício


Wolfe F, Clauw DJ, Fitzcharles MA, Goldenberg DL, Häuser W, Katz RL. Revisions to the 2010/2011 fibromyalgia diagnostic criteria. Semin Arthritis Rheum. 2016;46(3):319-29.

Wolfe F, Smythe HA, Yunus MB, Bennett RM, Bombardier C, Goldenberg DL. The American College of Rheumatology 1990 Criteria for the Classification of Fibromyalgia. Report of the Multicenter Criteria Committee. Arthritis Rheum. 1990;33(2):160-72.

McNally JD, Matheson DA, Bakowsky VS. The epidemiology of self-reported fibromyalgia in Canada. Chronic Dis Can. 2006;27(1):9-16.

Russell IJ, Orr MD, Littman B, Vipraio GA, Alboukrek D, Michalek JE. Elevated cerebrospinal fluid levels of substance P in patients with the fibromyalgia syndrome. Arthritis Rheum. 1994;37(11):1593-601.

Moldofsky HK. Disordered sleep in fibromyalgia and related myofascial facial pain conditions. Dent Clin North Am. 2001;45(4):701-13.

Chalaye P, Lafrenaye S, Goffaux P, Marchand S. The role of cardiovascular activity in fibromyalgia and conditioned pain modulation. Pain. 2014;155(6):1064-9.

Julien N, Goffaux P, Arsenault P, Marchand S. Widespread pain in fibromyalgia is related to a deficit of endogenous pain inhibition. Pain. 2005;114(1-2):295-302.

Wigers SH. Fibromyalgia outcome: the predictive values of symptom duration, physical activity, disability pension, and critical life events--a 4.5 year prospective study. J Psychosom Res. 1996;41(3):235-43.

Macfarlane GJ, Kronisch C, Dean LE, Atzeni F, Häuser W, Flub E. EULAR revised recommendations for the management of fibromyalgia. Ann Rheum Dis. 2017;76(2):318-28.

Bennett RM, Burckhardt CS, Clark SR, O'Reilly CA, Wiens AN, Campbell SM. Group treatment of fibromyalgia: a 6-month outpatient program. J Rheumatol. 1996;23(3):521-8.

Lemstra M, Olszynski WP. The effectiveness of multidisciplinary rehabilitation in the treatment of fibromyalgia: a randomized controlled trial. Clin J Pain. 2005;21(2):166-74.

Bourgault P, Lacasse A, Marchand S, Courtemanche-Harel R, Charest J, Gaumond I. Multicomponent interdisciplinary group intervention for self-management of fibromyalgia: a mixed-methods randomized controlled trial. PLoS One. 2015;10(5).

Jacobs H, Bockaert M, Bonte J, D'Haese M, Degrande J, Descamps L. The impact of a group-based multidisciplinary rehabilitation program on the quality of life in patients with fibromyalgia: results from the QUALIFIBRO Study. J Clin Rheumatol.. 2019;19.

Briones-Vozmediano E, Vives-Cases C, Goicolea I. "I'm not the woman I was": Women's perceptions of the effects of fibromyalgia on private life. Health Care Women Int. 2016;37(8):836-54.

Ollevier A, Vanneuville I, Carron P, Baetens T, Goderis T, Gabriel L. A 12-week multicomponent therapy in fibromyalgia improves health but not in concomitant moderate depression, an exploratory pilot study. Disabil Rehabil.. 2019;29:1-8.

Ericsson A, Mannerkorpi K. How to manage fatigue in fibromyalgia: nonpharmacological options. Pain Manag.. 2016;6(4):331-8.

Malfliet A, Van Oosterwijck J, Meeus M, Cagnie B, Danneels L, Dolphens M. Kinesiophobia and maladaptive coping strategies prevent improvements in pain catastrophizing following pain neuroscience education in fibromyalgia/chronic fatigue syndrome: an explorative study. Physiother Theory Pract. 2017;33(8):653-60.

Dobkin PL, Sita A, Sewitch MJ. Predictors of adherence to treatment in women with fibromyalgia. Clin J Pain. 2006;22(3):286-94.

Charest J, Lavignolle B, Chenard J-R, Provencher M, Marchand S. École interactionnelle du dos. Rhumatologie. 1994;48(8):221-37.

Fisch R, Schlanger K. Brief therapy with intimidating cases. 1999.

Jones KD, Adams D, Winters-Stone K, Burckhardt CS. A comprehensive review of 46 exercise treatment studies in fibromyalgia (1988-2005). Health Qual Life Outcomes. 2006;4:67-73.

Busch AJ, Schachter CL, Overend TJ, Peloso PM, Barber KA. Exercise for fibromyalgia: a systematic review. J Rheumatol. 2008;35(6):1130-44.

Marchand S, Charest J, Li J, Chenard JR, Lavignolle B, Laurencelle L. Is TENS purely a placebo effect? A controlled study on chronic low back pain. Pain. 1993;54(1):99-106.

Price DD. Psychological mechanisms of pain and analgesia. 1999.

Burckhardt CS, Clark SR, Bennett RM. The fibromyalgia impact questionnaire: development and validation. J Rheumatol. 1991;18(5):728-33.

Bennett R. The Fibromyalgia Impact Questionnaire (FIQ): a review of its development, current version, operating characteristics and uses. Clin Exp Rheumatol. 2005;23(5 Suppl 39):S154-62.

Perrot S, Dumont D, Guillemin F, Pouchot J, Coste J. Quality of life in women with fibromyalgia syndrome: validation of the QIF, the French version of the fibromyalgia impact questionnaire. J Rheumatol. 2003;30(5):1054-9.

Ware Jr JE. SF-36 health survey update. Spine. 2000;25(24):3130-9.

Leplege A, Ecosse E, Verdier A, Perneger TV. The French SF-36 Health Survey: translation, cultural adaptation and preliminary psychometric evaluation. J Clin Epidemiol. 1998;51(11):1013-23.

McHorney CA, Ware Jr JE, Raczek AE. The MOS 36-Item Short-Form Health Survey (SF-36): II. Psychometric and clinical tests of validity in measuring physical and mental health constructs. Med Care. 1993;31(3):247-63.

Tabachnick BG, Fidell LS. Using Multivariate Statistics. 2007.

Wang C, Schimd CH, Fielding RA, Harvey WF, Reid KF, Price LL. Effect of tai chi versus aerobic exercise for fibromyalgia: comparative effectiveness randomized controlled trial. BMJ. 2018;21(360):k851.

Mannerkorpi K, Ahlmen M, Ekdahl C. Six- and 24-month follow-up of pool exercise therapy and education for patients with fibromyalgia. Scand J Rheumatol. 2002;31(5):306-10.

Gowans SE, Dehueck A, Voss S, Silaj A, Abbey SE. Six-month and one-year follow-up of 23 weeks of aerobic exercise for individuals with fibromyalgia. Arthritis Rheum.. 2004;51(6):890-8.

Chalaye P, Goffaux P, Lafrenaye S, Marchand S. Respiratory effects on experimental heat pain and cardiac activity. Pain Med. 2009;10(8):1334-40.

Niederstrasser NG, Slepian PM, Mankovsky-Arnold T, Larivière C, Vlaeyen JW, Sullivan MJL. An experimental approach to examining psychological contributions to multisite musculoskeletal pain. J Pain. 2014;15(11):1156-65.

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