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In Patients With Fibromyalgia, CBT Reduces Pain Catastrophizing, Alters Brain Connectivity
Cognitive behavioral therapy (CBT) was superior to a matched education treatment for decreasing pain-related catastrophizing and improving function in patients with fibromyalgia. The study, published in Arthritis & Rheumatology, also showed that CBT altered the connectivity of specific regions in the brain.
“These findings contribute to a growing literature highlighting the benefits of nonpharmacologic treatments — including CBT — for chronic pain conditions such as fibromyalgia,” said corresponding author Jeungchan Lee, PhD, Spaulding Rehabilitation Hospital and Harvard Medical School in Charlestown, Massachusetts. “Identifying the multiple biopsychosocial mechanisms by which these treatments help to alleviate pain may help to facilitate the practice of precision pain medicine and improve treatment outcomes for the many patients suffering from chronic pain.”
The study included 98 patients with fibromyalgia who underwent neuroimaging and were randomized to 8 weeks of individual CBT or a fibromyalgia education control condition.
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Decreases in pain-related catastrophizing, a set of pain-amplifying cognitive and emotional processes, were larger in patients who received CBT compared with the education control, according to the study. Through reduced pain-related catastrophizing, pain interference and symptom impact in patients also improved.
Before CBT, patients showed increased functional connectivity between the ventral posterior cingulate cortex, a key node of the default mode network, and the somatomotor and salience network regions during catastrophizing thoughts, the study found. After CBT, that functional connectivity lessened.
“Our results suggest clinically important and CBT-specific associations between somatosensory/motor- and salience-processing brain regions and the default mode network in chronic pain. These patterns of connectivity may contribute to individual differences (and treatment-related changes) in somatic self-awareness,” researchers wrote. “CBT appears to provide clinical benefits at least partially by reducing pain-related catastrophizing and producing adaptive alterations in default mode network functional connectivity.”
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