Fibromyalgia with Pain-Related Depression, Anxiety, or Catastrophizing

Clinical Scenario

This protocol addresses fibromyalgia in patients who present with pain-related depression, anxiety, catastrophizing, or overly passive or overly active coping strategies. These psychological features commonly accompany the chronic pain of fibromyalgia and can substantially affect functional outcomes if not directly addressed.

Why This Sub-Population Matters

Mood disorders and unhelpful coping patterns — including catastrophizing, passive avoidance, or excessive activity despite pain — represent specific targets that inform which therapeutic approach is prioritised. Psychological therapies should be considered for patients presenting with these features.

Treatment Approach (Partial)

A structured psychological therapy — cognitive behavioural in nature, delivered face to face over a course of multiple weeks — forms the core of this first-line recommendation. The complete session structure, delivery details, and sequencing are in the full protocol.

Treatment Goals

Reduction in fibromyalgia pain
Reduction in functional disability
Improvement in mood

Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.1136/annrheumdis-2016-209724

Psychological therapies ('weak for') should be considered for those with mood disorder or unhelpful coping strategies: CBT was effective at producing modest, long-term reductions in pain, disability and improving mood.

Median duration of therapy=10 weeks, with a median number of 10 sessions, and median total hours=18 hours.

All but two studies delivered therapy face to face.

CBTs were effective in reducing pain (−0.29; −0.49 to −0.17) and disability (−0.30; −0.51 to −0.08) at the end of treatment compared with a variety of controls groups, and results were sustained long term.

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