Cognitive behavioural therapy effective for fibromyalgia pain

1. This randomized controlled trial found that an 8-week cognitive behavioural therapy (CBT) intervention was more effective than fibromyalgia (FM) education in reducing pain catastrophizing and improving pain interference scores.

2. Functional magnetic resonance imaging (fMRI) demonstrated that pain catastrophization was associated with increased ventral posterior cingulate cortex (vPCC) activation, and that post-CBT, patients showed reduced firing in the somatosensory and salience networks. 

Evidence Rating Level: 1 (Excellent)

Fibromyalgia (FM) is a chronic rheumatic condition causing widespread pain throughout the body, fatigue, and a range of other symptoms, often leading to negative affect and reduced quality of life. While various treatments have been explored, there is no one-size-fits-all solution. The current randomized controlled trial applied neuroimaging in order to better understand CBT’s relative effectiveness compared to conventional fibromyalgia patient education, as well as the underlying neural mechanisms involved in such changes. More specifically, the study assessed the effects of CBT on pain interference and pain catastrophizing. Participants underwent initial fMRI scanning while undergoing an adapted pain catastrophizing task, then were randomized to either an 8-week intervention of CBT or 8 weeks of FM education. At the termination of treatment, a repeat fMRI scan was completed. A total of 114 women with FM were enrolled. The primary outcome, pain interference, was significantly reduced from baseline in the CBT group compared to the education group (p < .05). Pain catastrophizing scores also reduced from baseline to post-treatment in both groups, but more so in the CBT group (p < .05). The study demonstrated that CBT significantly reduced fibromyalgia impact compared to the control group (p < .05) as well. When fMRI was employed, it was found that pain catastrophizing produced increased vPCC activation and that vPCC connectivity during catastrophizing was reduced in the somatomotor network and salience network regions after receiving CBT(p = .03). These findings underscore the potential of CBT as a non-pharmacological option in managing chronic pain secondary to FM, and fMRI-adapted tasks also shed further light on the neural underpinnings of the FM illness experience. This study is limited in that it only included female participants, and that CBT for chronic pain can vary in its protocol. Thus, future studies should include a wider participant pool and seek to elucidate which aspects and skills acquired through CBT specifically are most useful in mitigating the effects of FM. 

Click to read the study in ACR

Image: PD

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