Fibromyalgia syndrome (FMS) is a prevalent, chronic musculoskeletal pain disorder. Although no treatment has been shown to be universally effective, research suggests that a multimodal rehabilitative approach including active physical exercise and coping skill training reduces various symptoms of FMS. Nevertheless, there is large variability in treatment response. Since the rehabilitative approach requires patients to adopt a set of new perspectives and behaviors, the clinical benefit of such approach largely depends upon patient readiness and willingness to comply with the regimen. Past research suggests that successful outcomes require patient intent to change, efficacious beliefs about change, and ability to undertake process of change. In this amended application, we propose to evaluate the clinical efficacy of coping skill training and motivation enhancement therapy to prepare sedentary FMS patients to a rehabilitative approach. A total of 300 patients will be screened. Eligible patients will undergo a 10 2-hour weekly treatment sessions consisting of active exercise, physical therapy education, and one of the three behavioral preparation programs: Coping Skill Training program (CST), Motivation Enhancement program (MET), or Educational Lectures (EDS). Ten hours of the therapy hours across the first 6 weeks and one additional hour at the end of the program will be dedicated to behavioral preparation. All patients will receive one hour active physical exercise from Week 5 to Week10 and one hour physical education in Week 7 through Week 9. A comprehensive evaluation including medical, physical, and psychological assessments at the clinic and a home assessment protocol examining daily symptoms, activity levels, and sleep quality for one week will be performed at pre-treatment, post-treatment, and 6 month follow-up phases. At 12 month follow-up, each patient will undergo the home assessment protocol and questionnaire assessment. We will also delineate factors associated with clinically meaningful outcomes for each preparation program and to test mediation paths to better understand the mechanisms of clinical improvement via rehabilitation. We expect that results from this study will facilitate better understanding of how motivation enhancement augments clinical benefit of rehabilitative approach for many chronic pain conditions.
