Patients with fibromyalgia (FM) - a condition that primarily affects women and is characterized by chronic pain , fatigue and "brain fog" - often have limited treatment options and few explanations for their symptoms.
Reducing the emotional impact of pain
Research from Mass General Brigham researchers has shown that cognitive behavioral therapy (CBT) can significantly reduce FM disability, including by 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 show reduced connectivity between brain regions associated with self-awareness, pain, and emotional processing. The findings are published September 20 in Arthritis & Rheumatology.
In this study, we examined the interaction between psychological processes and brain connectivity patterns in response to pain. We wanted to explore how CBT, a talk therapy aimed at combating maladaptive thoughts, can improve individuals' daily functioning and change the brain's processing of 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 that while these reactions are normal, they can amplify the disabling effects of chronic pain and make conditions like FM more difficult to bear.
CBT improves quality of life
The researchers recruited 98 women, randomly assigning 64 to a treatment group that received CBT and 34 to a control group that received training on FM and chronic pain but did not receive specific CBT techniques. All participants were between the ages of 18 and 75 and had a confirmed diagnosis of FM for at least six months. To collect baseline data, all participants completed several validated questionnaires about pain and quality of life.
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 much their pain disrupts their daily activities, pain catastrophizing, pain severity, and the overall impact that FM had on patients' quality of life.
The results show a better understanding of pain
Results showed that those who received CBT experienced significantly greater reductions in pain interference. CBT participants also demonstrated significantly less pain catastrophizing and reported that their FM symptoms had significantly less impact on their daily lives.
The team found that after receiving CBT, patients experienced changes in activity in all three networks that suggested a decrease in attention to pain .
“Before participants received 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 internalizing those 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 rule out confounding gender differences in brain activity. In the future, the researchers hope to collect data from men and nonbinary patients with FM. Additionally, CBT includes multiple treatment components , and these results cannot be generalized to assess the impact of all forms of CBT on reducing chronic FM pain.
Multidisciplinary pain treatment
Lee and Edwards agree that these findings ultimately suggest that complex chronic pain conditions like fibromyalgia should be treated with a multitude of pharmacological and cognitive therapies.
“I hope these findings will encourage healthcare providers to consider CBT as an effective treatment option to reduce the impact of pain patients experience,” Edwards said. “Chronic pain conditions such as fibromyalgia involve long-term changes in the central nervous system, and CBT is one of many treatment options, such as medications and physical therapy, that we know can benefit people with 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.
