Thérapie cognitivo-comportementale, bénéfice pour la fibromyalgie

The benefits of cognitive behavioral therapy for patients with fibromyalgia

Sep 29, 2023

Patients with fibromyalgia (FM) – a disease that primarily affects women and is characterized by chronic pain , fatigue and “brain fog” – often have limited treatment options and few explanations. to their symptoms.

Reduce the emotional impact of pain

Research by researchers at Mass General Brigham has shown that cognitive behavioral therapy (CBT) can significantly reduce FM disability, including reducing " pain catastrophizing ," a negative cognitive and emotional response that can intensify pain through feelings of helplessness , rumination and intrusive thoughts. This finding is supported by neuroimaging data, which highlights reduced connectivity between brain regions associated with self-awareness, pain, and emotion processing. The results are published September 20 in Arthritis & Rheumatology.

In this study, we examined the interplay between psychological processes and brain connectivity patterns in response to pain. We wanted to explore how CBT, a talking therapy aimed at combating maladaptive thoughts, can improve individuals' daily functioning and change how the brain processes pain-related information."

Robert Edwards, PhD, co-senior author, clinical psychologist in the Department of Anesthesiology, Perioperative Medicine, and Pain Medicine at Brigham and Women's Hospital, a founding member of the Mass General Brigham Health System.

Edwards explains that CBT can reduce negative cognitive and emotional responses to pain . He says while these reactions are normal, they can amplify the disabling effects of chronic pain and make conditions like FM more burdensome.

CBT improves quality of life

Researchers recruited 98 women, randomly assigning 64 to a treatment group receiving CBT and 34 to a control group receiving training on FM and chronic pain, but not receiving specific CBT techniques. TCC. All participants were aged 18 to 75 years and had a confirmed diagnosis of FM for at least six months. To collect baseline data, all participants completed several validated pain and quality of life questionnaires.

Each group participated in eight intervention sessions , consisting of 60- to 75-minute visits with a licensed mental health provider. Participants were assessed primarily on their level of pain interference , or a measure of how their pain interferes with their daily activities, pain catastrophizing, pain severity, and the overall impact that FM has. had on the quality of life of patients.

The results show better apprehension of pain

Results showed that those who underwent CBT experienced significantly greater reductions in pain interference. CBT participants also demonstrated significantly less catastrophizing about pain and reported that their FM symptoms had significantly less impact on their daily lives.

The team found that after undergoing CBT, patients experienced changes in the activities of all three networks that suggest a decrease in attention to pain .

“Before participants underwent CBT, we found that parts of the brain related to self-awareness and sensation were highly connected, suggesting that patients were acutely aware of the sensation of pain they were experiencing. and internalized these symptoms,” says co-author Jeungchan Lee, PhD, an instructor in the Department of Physical Medicine and Rehabilitation at Spaulding Rehabilitation Hospital and the Athinoula A. Martinos Center for Biomedical Imaging at Massachusetts General Hospital. “After CBT, these connections were significantly weaker, suggesting that patients were better able to separate themselves from their pain after therapy.

The study was limited to women, partly because of the high prevalence of the disease and partly to eliminate differences in brain activity between the sexes which could lead to confusion. In the future, researchers hope to collect data from men and non-binary patients with FM. Additionally, CBT includes multiple therapeutic components , and these results cannot be generalized to assess the impact of all forms of CBT on reducing FM-related chronic pain.

Multidisciplinary pain treatment

Lee and Edwards agree that these findings ultimately suggest that complex chronic pain conditions like fibromyalgia should be treated using a multitude of pharmacological and cognitive therapies.

"I hope these results will encourage healthcare providers to consider CBT as an effective treatment option to reduce the impact of pain experienced by patients," Edwards said. "Chronic pain such as fibromyalgia involves long-lasting changes in the central nervous system, and CBT is one of several treatment options, such as medications and physical therapy, that we know can be beneficial for people suffering from FM.

Source :
Mass General Brigham

Journal reference:
Lee, J., et al. (2023) A Randomized, Controlled Neuroimaging Trial of Cognitive-Behavioral Therapy for Fibromyalgia Pain. Arthritis & Rheumatology. .

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