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Randomized Controlled Trial
. 2017 Mar;33(3):215-221.
doi: 10.1097/AJP.0000000000000422.

Effects of Cognitive-Behavioral Therapy (CBT) on Brain Connectivity Supporting Catastrophizing in Fibromyalgia

Asimina Lazaridou  1 , Jieun Kim, Christine M Cahalan, Marco L Loggia, Olivia Franceschelli, Chantal Berna, Peter Schur, Vitaly Napadow, Robert R Edwards
Affiliations
Randomized Controlled Trial

Effects of Cognitive-Behavioral Therapy (CBT) on Brain Connectivity Supporting Catastrophizing in Fibromyalgia

Asimina Lazaridou et al. Clin J Pain. 2017 Mar.

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.

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Conflict of interest statement

The authors of the article declare that they have no competing financial interests.

Figures

Figure 1
Figure 1
Study Flow
Figure 2
Figure 2
Pain Catastrophizing Scale scores at baseline, post and 6 month follow-up
Figure 3
Figure 3
BPI Pain Interference scores at baseline, post and 6 month follow-up
Figure 4
Figure 4
Functional connectivity effects, with group differences in pre- to post-treatment changes in S1-a/mINS connectivity and a scatterplot of the association between pre- to post-treatment changes in PCS and pre- to post-treatment changes in S1-a/mINS connectivity
See this image and copyright information in PMC

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