Please select the eligibility criteria that correspond to the clinical trial below.
Title: Stimulating Self Management in Patients With Fibromyalgia Through Web-based Situational Feedback
Brief Summary: The overall objective of this randomized controlled study (RCT) financed by the Norwegian Research Council (grant no. 182012/V50) is to establish the effectiveness of situational feedback to the self-management of fibromyalgia syndrome (FMS) using innovative means of patient-provider communication in a randomized controlled study (RCT). Thereby this project will contribute to the knowledge of treatment of patients with FMS. The effectiveness of the intervention will be expressed in terms of a) reduced pain, b) psychometric outcomes, c) quality of life, d) improved engagement in daily activities and e) prevented transition to chronic disability. We furthermore aim to 1) determine the effectiveness of providing regular situational feedback in enhancing self-management and, consequently 2) study the effectiveness of enhancing self-management in reducing pain and physical disability.

Self-management of chronic pain is increasingly seen as an important tool in providing adequate care to patients with FMS and other types of Chronic Non-malignant Pain. Enhancing the patient's self-management of her/his condition is thought to be effective in reducing pain and disability. However, sufficient empirical evidence to support this is yet unavailable. This may be due to the non-situational nature of many interventions studied so far: Patients are taught management skills in a clinical setting, and may not be able to successfully use these skills in daily care. Therefore, enhancing self-management of chronic pain, by providing immediate feedback that is directly related to patient's daily life ("situational" feedback) complementary to care-as usual, is thought to be more effective than conventional interventions in a clinical setting. This may even be even more effective when the patient receives quick response feedback using mobile communication technology, i.e. any place any time.


Options:
A: Inclusion Criteria:

* arthritic condition (osteoarthritis, rheumatoid arthritis or fibromyalgia)
* internet access and ability to use computer

Exclusion Criteria:

* active treatment for cancer
* taken small group arthritis self-management program
B: Inclusion Criteria:

Subjects will include those for whom a discontinuation trial of NSAIDs is most appropriate: 1) Veterans with knee pain despite NSAID use and/or 2) Veterans at relatively higher risk of NSAID toxicity 55-59 as ascertained by meeting 1 or more of the following 4 criteria:

* Answer affirmatively to the question: "Do you have some knee pain on most days over the past 3 months?"
* Have 1 or more risk factors for NSAID-induced nephrotoxicity (age greater than 60 years, atherosclerotic cardiovascular disease, current diuretic use, chronic renal insufficiency, congestive heart failure (New York Heart Association class I-II. Note, Class III and IV are excluded).
* Have 1 or more risk factors for NSAID-induced gastrointestinal toxicity (history of peptic ulcer disease, age \> 65 years, concurrent use of daily ASA or corticosteroids), and are currently on a gastro-protective agent.
* Have 1 or more risk factors for NSAID-induced cardiovascular toxicity (prevalent cardiovascular disease, hypertension, hypercholesterolemia, diabetes, smoking, family history of early heart disease or age greater than 55 years for women).

In addition, subjects must:

* Be age 20 years or older. While the usual cut off for knee OA is approximately 40 years, the investigators chose to lower the age cutoff as younger Veterans have a higher than expected risk of OA (see B.1).
* Have radiographic evidence of knee OA reported in the VistA electronic system.
* Be using an NSAID (other than daily ASA) for knee pain on most days of the month for at least the past 3 months.
* Be able to understand and speak English and have a telephone.
* Be willing to engage in a CBT program, to discontinue (or replace) their NSAID, and to restrict co-therapies to acetaminophen for 14 weeks.

Exclusion Criteria:

* Subjects desiring escalation of analgesics for their current level of knee pain as determined by endorsement of the following statement: "Is your knee pain bad enough that you want to talk to your doctor about taking stronger pain medications?"
* Current use of opioids and/or Celebrex.
* Current use of an NSAID (not including ASA) for a painful condition in addition to knee OA.
* Contraindications to chronic NSAID use: current use of warfarin or antiplatelet agent other than ASA, allergy to any NSAID, active upper gastrointestinal ulceration in the previous 30 days, upper gastrointestinal bleeding in the past year, history of gastroduodenal perforation or obstruction, cardiovascular event within the past 6 months (myocardial infarction, cerebrovascular event, coronary-artery bypass graft, invasive coronary revascularisation, or new-onset angina), severe congestive heart failure (New York Heart Association class III-IV), evidence of serious anemia, hepatic, renal (including nephrotic syndrome), or blood coagulation disorders, and pregnancy.

\*\*\*Though the investigators are proposing a RWT - and thus will not be initiating NSAID therapy - it would not be appropriate to continue NSAIDs (even when prescribed) in high-risk patients. The investigators acknowledge that these exclusion criteria limit generalizability, but the investigators feel justified to ensure subjects' safety.\*\*\*

* Previous hyaluronic acid knee injections (within 6 months) or corticosteroid knee injections (within 3 months).
* Scheduled knee hyaluronic acid or corticosteroid injections, arthroscopy, or knee surgery.
* Co-morbid conditions that include the following: known other causes of arthritis (infectious arthritis, rheumatoid arthritis, connective tissue disease, or psoriatic arthritis), gout or pseudogout attack within the last 12 months, peripheral neuropathy or cardiopulmonary disease that limits walking more than knee pain, bone metastases or Paget's disease involving the lower extremities, and history of drug or alcohol abuse within the past 2 years, bilateral knee replacements or knee pain in the replaced knee only.
* Current involvement in litigation or receiving workmen's compensation.
* Hearing, cognitive impairment or mental illness, as determined by chart review that would preclude participation in a CBT program.
* For Women of Childbearing Age: Must not currently be pregnant, agree to avoid getting pregnant during the course of the study and should inform the study team if pregnancy occurs at any time during study participation.
* Previous meloxicam use discontinued due to lack of effective symptom relief
* Contraindications to prolonged NSAID use, per PI discretion.
C: Inclusion Criteria:

* Women with diagnosis of organic and non-organic chronic pelvic pain (CPP) for six months or more
* Age ≥ 18 years
* Be capable of understanding the information provided, with use of an interpreter if required and being able to understand simple English as is used in the app

Exclusion Criteria:

* Males
* Absence of diagnosis of organic and non-organic chronic pelvic pain (CPP)
* Diagnosis of organic and non-organic chronic pelvic pain (CPP) lasting for less than 3 months
* Age \< 18 years
* No access to a Personal computer or smart phone
* Unable to speak / understand English
* Current users of the app content available to the public
D: Inclusion Criteria:

* Female, having wide spread pain like FMS (IPCS codes CD-10, 79.0 - coded) for at least three months ,\> 18 years, able to understand Norwegian; able to use the webenabled mobile phone.

Exclusion Criteria:

* substantial psychological problems in need of treatment with intensive psychotherapy.

Answer: D