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• Posted September 25, 2023

Psychotherapy May Help Ease Fibromyalgia Pain

"Talk therapy" may help people with fibromyalgia manage their chronic pain -- and alter the brain's pain-processing circuitry along the way, a new study shows.

Researchers found that after eight sessions of cognitive behavioral therapy (CBT), patients with fibromyalgia felt less burdened by their pain and other symptoms in daily life. And that was related, in part, to changes in areas of the brain related to self-awareness and pain processing.

Experts stressed that the findings do not mean that people's fibromyalgia symptoms are "all in their head." But they are, at their root, in the brain.

"All pain is in the brain, and CBT can help your brain feel less pain," said Robert Edwards, a senior researcher on the study and a clinical psychologist at Mass General Brigham in Boston.

Fibromyalgia is a chronic disorder that causes pain and tenderness throughout the body, as well as other problems like fatigue, trouble sleeping and "brain fog."

"It's not just pain. It's a panoply of symptoms," said Dr. Lenore Brancato, a rheumatologist at NYU Langone Health in New York City.

Because of that, she said, people with fibromyalgia typically need multiple therapies, including medications to relieve pain and improve sleep, physical therapy, and "mind-body" practices like tai chi and mindfulness meditation.

CBT, Brancato said, is another important tool.

"People can become so consumed by their pain that their natural pathway is, 'It's so bad, I can't do anything,'" said Brancato, who was not involved in the new study. "They end up ruminating, and they can feel isolated because no one understands."

CBT, Brancato said, "authenticates the pain," but also teaches people how to change their responses to it.

When that happens, both experts said, any other therapies people are trying may work better: Physical therapy or gentle exercise at home, for example, may become more doable because the negative thoughts are no longer standing as obstacles.

For the new study -- published Sept. 20 in the journal Arthritis & Rheumatology -- Edwards and his colleagues recruited 98 fibromyalgia patients, all women. (The condition is more common in women than men.)

Each patient was randomly assigned to one of two groups: In one, patients attended a CBT session once a week for eight weeks; those in the other group received education about fibromyalgia. All patients continued on any medications they'd already been prescribed.

By the end of the study, both groups were faring better, on average -- saying their pain and other symptoms had less hold on them day to day.

But the CBT group showed a bigger improvement, and their gains largely stemmed from a reduction in "pain catastrophizing" -- that cycle of rumination and anxiety that can worsen the experience of pain.

Other research has indicated that CBT has such benefits. The additional "twist" in this study, Edwards said, is that patients also underwent specialized MRI scans before and after treatment.

Those scans showed that for CBT patients, improvements in pain catastrophizing correlated with changes in brain activity. Before therapy, those patients typically showed heightened connectivity in brain areas linked to self-awareness and sensation -- suggesting they were hyperaware of their pain.

After the CBT sessions ended, however, that overactive brain circuitry was quieter.

Having brain imaging findings like these "could be a very helpful tool in building acceptance around the reality of this pain syndrome," said Dr. Micaela Bayard, assistant professor of medicine at Mount Sinai Queens Rheumatology in New York City. She believes the study also argues for “increased access to psychological interventions like CBT.”

For his part, Edwards said the CBT used in the study was specifically designed for people with chronic pain. It aimed to help them alter their thinking around their symptoms and taught them "coping strategies" to manage their pain.

The approach does take effort. The CBT sessions were each 60 to 75 minutes, and then patients have to practice the techniques at home.

"It's not immediate gratification," Brancato said. "It takes some work."

But once you learn CBT techniques, she added, "you'll have them for a lifetime."

As for access, the good news is, insurance plans do typically cover CBT, Brancato said. The bad news is, finding a therapist can be difficult depending on where you live.

Even in those cases, though, Edwards said that people may be able to learn CBT techniques through online or app-based programs.

More information

The National Fibromyalgia Association has more on treatment options.

SOURCES: Robert Edwards, PhD, clinical psychologist, Department of Anesthesiology, Perioperative & Pain Medicine, Brigham and Women's Hospital, Boston; Lenore Brancato, MD, rheumatologist, clinical assistant professor, medicine, NYU Grossman School of Medicine, New York City; Micaela Bayard, MD, assistant professor, medicine, Mount Sinai Queens Rheumatology, New York City; Arthritis & Rheumatology, Sept. 20, 2023, online