Promising psychological treatments for fibromyalgia

Pérez-Aranda, A., et al. (2017). Description and narrative review of well-established and promising psychological treatments for fibromyalgia. Mindfulness & Compassion, http://www.sciencedirect.com/science/article/pii/S2445407917300319

Abstract. Fibromyalgia (FMS) is a prevalent, disabling syndrome characterized by chronic widespread musculoskeletal pain and symptoms such as sleep disturbance, fatigue, stiffness, distress, cognitive impairments and a high comorbidity with anxiety and depressive disorders. Although no curative treatment has yet been found, various therapeutic approaches have been developed in the fields of pharmacology and psychology.

The present paper aims to offer a narrative review and a description for clinicians and researchers of psychological therapies that have been applied in a format group in FMS with strong or promising empirical support: i.e., Cognitive Behavioral Therapy (CBT), Acceptance and Commitment Therapy (ACT), Mindfulness-Based Stress Reduction (MBSR), Psychoeducational program for FMS (FibroQoL), Amygdala Retraining Therapy (ART), and Attachment-Based Compassion Therapy (ABCT).

This review will offer a brief practical summary of each therapy protocol (session-by-session), their rationale and available evidence of their effectiveness.

Fibromyalgia

Adler-Neal, Adrienne L., and Fadel Zeidan. “Mindfulness Meditation for Fibromyalgia: Mechanistic and Clinical Considerations.” Current Rheumatology Reports, vol. 19, no. 9, 2017, pp. 59. Full text.

Summary. Fibromyalgia is a disorder characterized by widespread pain and a spectrum of psychological comorbidities, rendering treatment difficult and often a financial burden. Fibromyalgia is a complicated chronic pain condition that requires a multimodal therapeutic approach to optimize treatment efficacy. Thus, it has been postulated that mind-body techniques may prove fruitful in treating fibromyalgia.

Mindfulness meditation, a behavioral technique premised on non-reactive sensory awareness, attenuates pain and improves mental health outcomes. However, the impact of mindfulness meditation on fibromyalgia-related outcomes has not been comprehensively characterized.

The present review delineates the existing evidence supporting the effectiveness and hypothesized mechanisms of mindfulness meditation in treating fibromyalgia-related outcomes.

Does mindfulness reduce symptoms of fibromyalgia?

Tobin, J. (2014). Effect of mindfulness-based interventions on symptoms of fibromyalgia: A meta-analysis (Doctoral dissertation, California State University, Fullerton). 

From the Abstract. Mindfulness provides an alternative or supplement to traditional pharmacological treatment of fibromyalgia, but it is not yet clear how effective it is in reducing symptoms. The purpose of this meta-analysis was to explore the efficacy of mindfulness-based interventions on fibromyalgia impact, pain severity, and psychological distress in adults diagnosed with fibromyalgia. A total of 11 randomized controlled trials were included in the analysis, all of which measured at least one of the designated outcomes.

Studies’ data was pooled and standardized mean differences were calculated. Results showed a moderate to large intervention effect for each outcome. Subgroup analyses were conducted for each outcome based on control group type (active versus wait list), and for each outcome, all subgroups’ SMD significantly favored the experimental condition, with the exception of the active controls for psychological distress.

… While this analysis yielded results suggesting the efficacy of mindfulness in reducing symptoms of fibromyalgia, future meta-analyses may consider including studies of more diverse methodological quality to create more robust and powerful effect sizes, while exploring methodology as a potential moderator.

MBI and somatization disorders

Lakhan, S. E., & Schofield, K. L. (2013). Mindfulness-based therapies in the treatment of somatization disorders: a systematic review and meta-analysis. PloS one, 8(8), e71834. Full Text.

Mindfulness-based therapy (MBT) has been used effectively to treat a variety of physical and psychological disorders, including depression, anxiety, and chronic pain. Recently, several lines of research have explored the potential for mindfulness-therapy in treating somatization disorders, including fibromyalgia, chronic fatigue syndrome, and irritable bowel syndrome.

Thirteen studies were identified as fulfilling the present criteria of employing randomized controlled trials to determine the efficacy of any form of MBT in treating somatization disorders. A meta-analysis of the effects of mindfulness-based therapy on pain, symptom severity, quality of life, depression, and anxiety was performed to determine the potential of this form of treatment.

Preliminary evidence suggests that MBT may be effective in treating at least some aspects of somatization disorders. Further research is warranted.

Chronic pain and the role of home meditation practice

Rosenzweig, S., et al. (2010). Mindfulness-based stress reduction for chronic pain conditions: Variation in treatment outcomes and role of home meditation practice. Journal of Psychosomatic Research, 68 (1), 29. Full text.

From the Abstract: This study compared changes in bodily pain, health-related quality of life (HRQoL), and psychological symptoms during an 8-week mindfulness-based stress reduction (MBSR) program among groups of participants with different chronic pain conditions.

Outcomes differed in significance and magnitude across common chronic pain conditions. Diagnostic subgroups of patients with arthritis, back/neck pain, or two or more comorbid pain conditions demonstrated a significant change in pain intensity and functional limitations due to pain following MBSR.

Participants with arthritis showed the largest treatment effects for HRQoL and psychological distress. Patients with chronic headache/migraine experienced the smallest improvement in pain and HRQoL. Patients with fibromyalgia had the smallest improvement in psychological distress.

Greater home meditation practice was associated with improvement on several outcome measures, including overall psychological distress, somatization symptoms, and self-rated health, but not pain and other quality of life scales.

Reduces depressive symptoms in women diagnosed with fibromyalgia

Parra-Delgade, M., & Latorre-Postigo, J. M. (2013). Effectiveness of Mindfulness-Based Cognitive Therapy in the Treatment of Fibromyalgia: A Randomised Trial. Cognitive Therapy and Research. Online DOI: 10.1007/s10608-013-9538-z.   

Abstract: Fibromyalgia syndrome has a strong clinical and social impact affecting the personal, family and working life of the sufferer. The presence of depressive symptoms is associated with decreased quality of life and an increase in the intensity of pain. The aim of this study is to demonstrate the effectiveness of Mindfulness-Based Cognitive Therapy (MBCT) in reducing the impact of fibromyalgia, the depressive symptoms and the intensity of pain in women with fibromyalgia.

An experimental pre-post treatment design with a 3-month follow-up was carried out. Female patients (N = 33) were randomised to MBCT or to a control group condition. MBCT is an 8-week group intervention. … Substantial differences were found in the reduction of the impact of fibromyalgia after treatment and in the decrease in depressive symptoms decrease in the follow-up. A slight decrease was observed in intensity of pain in different body areas although there were no significant differences between the groups.

The study findings suggest that depressive symptoms and the impact of the illness were reduced in the MBCT group of women diagnosed with fibromyalgia. These changes were maintained during the 3-month follow up. No significant changes were found in the reduction of intensity of pain. The limitations of this study were analysed and possible improvements for future research were considered.