FİBROMİYALJİ SENDROMUNDA BİLİŞSEL DAVRANIŞÇI TERAPİ VE TENS TEDAVİLERİNİN ETKİNLİĞİ
Günümüzde fibromiyalji sendromu (FMS) için farklı tedavi yöntemleri vardır, ancak standart bir tedavi
yöntemi konusunda fikir birliği yoktur. Randomize kontrollü çalışmamızda, FMS’de TENS (Transcutaneous
Electrical Nerve Stimulation), hasta eğitimi ve bilişsel davranışçı terapinin (BDT) etkinliği
araştırıldı.
Bu amaçla, American College of Rheumatology (ACR) 1990 tanı kriterlerine göre FMS tanısı konan,
18-60 yaş arası, 60 kadın hasta rastgele yöntemle 20’şer kişilik 3 gruba ayrıldı. 1. gruba (n=20) 10
seans plasebo TENS ve 5 seans hasta eğitimi (HE); 2. gruba (n=20) 10 seans TENS ve 5 seans HE; 3.
gruba (n=20) 10 seans TENS ve 8 seans BDT uygulandı.
Olgular tedavi öncesi ve sonrası, tedavi bitiminden 6 hafta sonra ağrı açısından, vizüel analog skala
(VAS), algometrik ölçüm, ağrılı nokta sayısı, haftalık analjezik kullanım sayısı; uyku kalitesi açısından
VAS ve sabah yorgunluğu (5’li Likert tipi skala); depresyon açısından Beck depresyon ölçeği; genel
değerlendirme açısından hasta ve doktorun genel değerlendirmesi (5’li Likert tipi skala); fonksiyonel
değerlendirme açısından FMS etki sorgulaması formu (FIQ); ve yaşam kalitesi açısından Short Form36
(SF-36) ile değerlendirildiler. Hastalar tedavi sonrasında kendilerine uygulanan tedaviyi 5’li Likert
tipi skala ile değerlendirdiler.
Günümüzde FMS tedavisinde çok değişik yöntemler kullanılmaktadır. Ancak FMS tedavisinde kabul
edilmiş ortak bir tedavi yöntemi bulunmamaktadır. Bu çalışmamızda HE, BDT ve TENS tedavilerinin
FMS üzerine olan etkileri incelendi.
Bu çalışmada FMS’li hastalarda TENS’in ağrı üzerine etkili olduğunu ve grup halinde uygulanan BDT
ve HE’nin ağrı, depresyon, hastalığın genel değerlendirmesi ve yaşam kalitesine olumlu etkileri olduğu,
ayrıca BDT’nin depresyon, hastanın kendini genel değerlendirmesi ve uyku parametrelerinde
HE’ye üstün olduğu saptandı. Ancak FMS’de fizik tedavi ajanları ve BDT’yi değerlendiren daha uzun
takipli ve daha çok olgu içeren çalışmalara ihtiyaç vardır.
Anahtar Kelimeler:
Fibromiyalji sendromu, Bilişsel davranışçı terapi, TENS
EFFICACY OF COGNITIVE BEHAVIORAL THERAPY AND TENS THERAPY IN FIBROMYALGIA SYNDROME
At the present time, there are different typeS of treatment methods for fibromyalgia syndrome (FMS),
but there is no consensus on a standart treatment method. In our randomized controlled study, we
researched the efficacy of patient’s education, cognitive behavioral therapy (CBT) along with TENS in
FMS.
Sixty women aged between 18-60, who fullfilled the American College of Rheumatology criteria for
FMS, were separated into three groups. The first group (n=20) received plasebo TENS as 10 sessions
and education as 5 sessions; the second group (n=20) received TENS as 10 sessions and education as 5
sessions whereas the third group received TENS 10 sessions and CBT as 8 sessions.
Our evaluation parameters were intensity of pain with algometer, number of the tender points, VAS index
for pain, VAS index for quality of sleep and morning fatigue (5-point Likert-type scale), Beck depression
inventory, fibromyalgia impact questionnaire, SF-36, patient and physican global assesments at the
beginning, at the end of the theraphy, and 6 weeks after. Each patient evaluated the therapy with a
Likert type scale at the end of therapy as well.
It was found TENS is effective on pain in FMS. Patients education and CBT as group therapy format
were also effective on pain, depression, global assesment of disease and quality of life in FMS. CBT was
found more effective on depression, quality of sleep along with patient and physican global assesment
parameters than education alone.
It is obvious that studies with great number of patients and with longer follow up periods on the
effectiveness of physical therapy agents and CBT both together, or in comparative design will answer
further questions.
Keywords:
Fibromyalgia syndrome, Cognitive behavioral therapy, TENS,
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- ISSN: 2536-5193
- Yayın Aralığı: Yılda 2 Sayı
- Yayıncı: İstanbul Arel Üniversitesi