Patient-reported improvements in health are maintained 2 years after completing a short course of cognitive behaviour therapy, exercise or both treatments for chronic widespread pain: long-term results from the MUSICIAN randomised controlled trial

Objectives: The MUSICIAN study has previously
shown short-term benefit but only marginal costeffectiveness for two non-pharmacological
interventions for chronic widespread pain (CWP). We wished to determine their long-term effectiveness and cost-effectiveness.
Methods: A 2×2 factorial randomised controlled trial based in primary care in the UK. People were eligible if they were aged ≥25 years with CWP for which they had consulted their general practitioner. The interventions were a 6-month telephone cognitive behaviour therapy (tCBT) and/or a tailored exercise programme, in comparison to usual care. The primary outcome was patient-reported change in health.
Results: 884 persons were eligible, 442 were
randomised and 81.7% were followed up 24 months
post-treatment. In comparison to usual care (positive outcome 12.8%), tCBT (35.4%; OR 3.7 95% CI (1.8 to 8.0)), exercise (29.3%; OR 2.8 95% CI (1.3 to 6.0)) and both interventions (31.2%; OR 3.1 95% CI (1.3 to 6.0)) were significantly more effective. There was only a small decrease in effectiveness over time for individual and combined treatments. Those with more
intense/disabling pain, higher distress and those who exhibited passive coping at baseline were more likely to have a positive outcome with tCBT than persons without these characteristics. tCBT was associated with the greatest increase in quality of life and lowest costs.
Cost per quality adjusted life year was £3957–£5917 depending on method of analysis.
Conclusions: A short course of tCBT for people with CWP was effective long-term and was highly costeffective. Exercise was also effective but delivered positive outcome for fewer patients at greater cost, and there was no advantage for patients receiving both interventions.
Trial registration number: ISRCTN67013851.