The fibromyalgia (FM) is a chronic disease that mainly affects women and manifests itself with generalized musculoskeletal pain, or excessive sensitivity to painful stimuli, in addition to excessive tiredness for no reason, or fatigue. In addition, it is often accompanied by other problems, such as sleep disorders, mental confusion, anxiety or depression, which seriously interferes with daily activities.
In a new attempt to better understand how to manage this disease, a study led by researchers at Mass General Brigham has discovered that cognitive behavioral therapy (CBT) may counteract the burden of fibromyalgia alleviating the way the brain experiences fibromyalgia pain, since a negative cognitive and emotional response can intensify pain through feelings of helplessness, rumination, and intrusive thoughts. This finding is supported by neuroimaging data showing reduced connectivity between brain regions associated with self-awareness, pain, and emotional processing.
“In this study, we observed the interaction between psychological processes and brain connectivity patterns in response to pain,” said co-senior author Robert Edwards, clinical psychologist in the Department of Anesthesiology, Perioperative and Pain Medicine at Brigham and Women’s Hospital. “We wanted to explore how CBT, a talk therapy aimed at combating maladaptive thoughts, can improve people’s daily functioning and alter the brain’s processing of pain-related information.”.
After cognitive-behavioral therapy, certain connections in the brain were significantly less strong, suggesting that fibromyalgia patients were better able to isolate themselves from their pain after therapy.
Edwards has explained that CBT can reduce negative cognitive and emotional responses to pain and states that although these responses are normal, they can amplify the disabling effects of chronic pain and worsen the disability caused by conditions such as fibromyalgia. The results have been published in Arthritis & Rheumatology.
Multidisciplinary treatment of fibromyalgia symptoms
98 women between 18 and 75 years old with a confirmed diagnosis of fibromyalgia for at least six months and who suffered from chronic pain participated in the research. All of them responded to validated questionnaires on pain and quality of life. They were divided into two groups at random: 64 were included in a group that received cognitive behavioral therapy, while the 34 in the control group received education about fibromyalgia and chronic pain, but were not taught specific CBT techniques.
Both groups participated in eight intervention sessions, which consisted of 60- to 75-minute visits with a licensed mental health professional. Participants were assessed primarily on their levels of pain interference, or the extent to which their pain disrupted their daily activities, pain catastrophe, pain severity, and the overall impact fibromyalgia had on their quality of life.
The results demonstrated that those treated with CBT experienced significantly greater reductions in pain interference, and also showed significantly less catastrophic pain and stated that their fibromyalgia symptoms had significantly less impact on their daily life.
The researchers found that, after undergoing cognitive-behavioral therapy, the patients experienced changes in the activities of three brain networks – the somatosensory/motor and salience processing brain regions and the default mode network in chronic pain – that suggested a less attention to pain.
“Before the participants underwent cognitive behavioral therapy, we saw that certain parts of the brain related to self-awareness and sensation were highly connected, suggesting that the patients were aware of the sensation of pain they were experiencing and internalized these symptoms. “, highlighted the co-author Jeungchan Lee, instructor in the Department of Physical Medicine and Rehabilitation at Spaulding Rehabilitation Hospital and the Athinoula A. Martinos Biomedical Imaging Center at Massachusetts General Hospital. “After CBT these connections were significantly less strong, suggesting that patients were better able to isolate themselves from their pain after therapy.”
Both scientists agree that these findings suggest that complex chronic pain conditions such as fibromyalgia should be addressed with various pharmacological and cognitive therapies. “I hope these findings motivate medical professionals to consider cognitive behavioral therapy as an effective treatment option to reduce the impact of pain patients experience,” Edwards said. “Chronic pain conditions, such as fibromyalgia, involve long-lasting patterns of changes in the central nervous system, and CBT is one of many treatment options, such as medications and physical therapy, that we know can be beneficial for those living with fibromyalgia.” , he concludes.