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Effects of Cognitive-Behavioral Therapy (CBT) on Brain Connectivity Supporting Catastrophizing in Fibromyalgia.
Clin J Pain. 2017 03; 33(3):215-221.CJ

Abstract

OBJECTIVE(S)

Fibromyalgia (FM) is a chronic, common pain disorder characterized by hyperalgesia. A key mechanism by which cognitive-behavioral therapy (CBT) fosters improvement in pain outcomes is via reductions in hyperalgesia and pain-related catastrophizing, a dysfunctional set of cognitive-emotional processes. However, the neural underpinnings of these CBT effects are unclear. Our aim was to assess CBT's effects on the brain circuitry underlying hyperalgesia in FM patients, and to explore the role of treatment-associated reduction in catastrophizing as a contributor to normalization of pain-relevant brain circuitry and clinical improvement.

METHODS

In total, 16 high-catastrophizing FM patients were enrolled in the study and randomized to 4 weeks of individual treatment with either CBT or a Fibromyalgia Education (control) condition. Resting state functional magnetic resonance imaging scans evaluated functional connectivity between key pain-processing brain regions at baseline and posttreatment. Clinical outcomes were assessed at baseline, posttreatment, and 6-month follow-up.

RESULTS

Catastrophizing correlated with increased resting state functional connectivity between S1 and anterior insula. The CBT group showed larger reductions (compared with the education group) in catastrophizing at posttreatment (P<0.05), and CBT produced significant reductions in both pain and catastrophizing at the 6-month follow-up (P<0.05). Patients in the CBT group also showed reduced resting state connectivity between S1 and anterior/medial insula at posttreatment; these reductions in resting state connectivity were associated with concurrent treatment-related reductions in catastrophizing.

DISCUSSION

The results add to the growing support for the clinically important associations between S1-insula connectivity, clinical pain, and catastrophizing, and suggest that CBT may, in part via reductions in catastrophizing, help to normalize pain-related brain responses in FM.

Authors+Show Affiliations

Departments of *Anesthesiology §Medicine, Division of Rheumatology, Harvard Medical School, Brigham & Women's Hospital, Chestnut Hill †MGH/MIT/HMS Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA ‡Clinical Research Division, Korea Institute of Oriental Medicine, Daejeon, Korea.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

27518491

Citation

Lazaridou, Asimina, et al. "Effects of Cognitive-Behavioral Therapy (CBT) On Brain Connectivity Supporting Catastrophizing in Fibromyalgia." The Clinical Journal of Pain, vol. 33, no. 3, 2017, pp. 215-221.
Lazaridou A, Kim J, Cahalan CM, et al. Effects of Cognitive-Behavioral Therapy (CBT) on Brain Connectivity Supporting Catastrophizing in Fibromyalgia. Clin J Pain. 2017;33(3):215-221.
Lazaridou, A., Kim, J., Cahalan, C. M., Loggia, M. L., Franceschelli, O., Berna, C., Schur, P., Napadow, V., & Edwards, R. R. (2017). Effects of Cognitive-Behavioral Therapy (CBT) on Brain Connectivity Supporting Catastrophizing in Fibromyalgia. The Clinical Journal of Pain, 33(3), 215-221. https://doi.org/10.1097/AJP.0000000000000422
Lazaridou A, et al. Effects of Cognitive-Behavioral Therapy (CBT) On Brain Connectivity Supporting Catastrophizing in Fibromyalgia. Clin J Pain. 2017;33(3):215-221. PubMed PMID: 27518491.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Effects of Cognitive-Behavioral Therapy (CBT) on Brain Connectivity Supporting Catastrophizing in Fibromyalgia. AU - Lazaridou,Asimina, AU - Kim,Jieun, AU - Cahalan,Christine M, AU - Loggia,Marco L, AU - Franceschelli,Olivia, AU - Berna,Chantal, AU - Schur,Peter, AU - Napadow,Vitaly, AU - Edwards,Robert R, PY - 2016/8/16/pubmed PY - 2017/12/15/medline PY - 2016/8/13/entrez SP - 215 EP - 221 JF - The Clinical journal of pain JO - Clin J Pain VL - 33 IS - 3 N2 - OBJECTIVE(S): Fibromyalgia (FM) is a chronic, common pain disorder characterized by hyperalgesia. A key mechanism by which cognitive-behavioral therapy (CBT) fosters improvement in pain outcomes is via reductions in hyperalgesia and pain-related catastrophizing, a dysfunctional set of cognitive-emotional processes. However, the neural underpinnings of these CBT effects are unclear. Our aim was to assess CBT's effects on the brain circuitry underlying hyperalgesia in FM patients, and to explore the role of treatment-associated reduction in catastrophizing as a contributor to normalization of pain-relevant brain circuitry and clinical improvement. METHODS: In total, 16 high-catastrophizing FM patients were enrolled in the study and randomized to 4 weeks of individual treatment with either CBT or a Fibromyalgia Education (control) condition. Resting state functional magnetic resonance imaging scans evaluated functional connectivity between key pain-processing brain regions at baseline and posttreatment. Clinical outcomes were assessed at baseline, posttreatment, and 6-month follow-up. RESULTS: Catastrophizing correlated with increased resting state functional connectivity between S1 and anterior insula. The CBT group showed larger reductions (compared with the education group) in catastrophizing at posttreatment (P<0.05), and CBT produced significant reductions in both pain and catastrophizing at the 6-month follow-up (P<0.05). Patients in the CBT group also showed reduced resting state connectivity between S1 and anterior/medial insula at posttreatment; these reductions in resting state connectivity were associated with concurrent treatment-related reductions in catastrophizing. DISCUSSION: The results add to the growing support for the clinically important associations between S1-insula connectivity, clinical pain, and catastrophizing, and suggest that CBT may, in part via reductions in catastrophizing, help to normalize pain-related brain responses in FM. SN - 1536-5409 UR - https://www.unboundmedicine.com/medline/citation/27518491/Effects_of_Cognitive_Behavioral_Therapy__CBT__on_Brain_Connectivity_Supporting_Catastrophizing_in_Fibromyalgia_ L2 - http://dx.doi.org/10.1097/AJP.0000000000000422 DB - PRIME DP - Unbound Medicine ER -