Personal construct therapy improves symptoms of depression in women with fibromyalgia CREDIT Chronic Joy Ministry

Fibromyalgia is a rheumatic disease of unknown origin, which is characterized by chronic pain and often accompanied by symptoms of depression. It mainly affects women, and there is no cure, but various treatments can help relieve the symptoms.

Cognitive-behavioural psychological therapy has proven to be a useful tool in this area. Now, a multicentre study involving researchers at the Universitat Oberta de Catalunya (UOC), the University of Barcelona (UB) and the Universidad de Las Américas (UDLA) in Ecuador, and published in open access format in the journal International Journal of Clinical and Health Psychology, has recently proven that another form of psychological therapy, called personal construct therapy, is just as effective in reducing depressive symptoms and improving patients’ quality of life. According to Mari Aguilera, a researcher belonging to the GRECIL interuniversity group, as well as a professor in the Faculty of Psychology and Education Sciences at the UOC and the UB and the co-lead author of the study with the researcher at the Universidad de Las Américas in Ecuador Clara Paz, these results make it possible to “expand the range of effective therapies and increase the flexibility to adapt to each patient’s particular characteristics and needs“.

106 women in a pioneering multicentre study

The study, which was coordinated by the UB full professor of Psychology faculty and the Institute of Neurosciences Guillem Feixas, included 106 women with fibromyalgia and depressive symptoms who were treated in ten different places: two mental health centres and eight primary healthcare centres. The association between fibromyalgia and depression is common in these patients, and appears to work both ways: each one increases the risk and aggravates the characteristics of the other.

The volunteers followed a weekly course of psychological therapy for approximately four months. Half of them received standard cognitive-behavioural therapy, which has already been shown to be moderately effective in this type of patient. The other half followed a treatment based on personal construct therapy – a different approach “focused on people’s identity, how they see themselves, how they see what happens to them and how they see others,” explained Joan Carlos Medina, a member of the Faculty of Psychology and Education Sciences at the UOC, and a researcher at the UB.

The results of the study show that both the therapies reduced symptoms of depression in approximately 60% of the women taking part, and that there were no significant differences between the treatments. Furthermore, they also showed improvements in terms of the disease’s impact on their daily functioning and in terms of pain. In specific terms, approximately one in four patients who received personal construct therapy significantly improved their functioning in the medium term, and one in six experienced reduced pain.

More tools for personalization

“Fibromyalgia has no specific known cause and there is no cure, but a psychological improvement has an impact on physical health,” explained Aguilera. This is particularly important in a disease “which is still questioned by some doctors, and which is often considered less important due to the fact that it mainly affects women,” she added.

The standard cognitive-behavioural therapy “is more interested in how to change behaviour than the reason behind it,” said Aguilera, while personal construct therapy is focused in particular “on how you build your world and what you give meaning to. But it’s not so much about setting them against each other, as seeing whether the two of them can be useful from a different perspective.”

Some studies have shown that personal construct therapy could be useful in treating depression, for example, but apart from a small pilot study, “this is the first time that this type of therapy has been studied and shown to be helpful for fibromyalgia patients,” explained Medina. Having more proven resources means that they can be adapted to the patients’ preferences. “It helps us to personalize treatments, and adapt them better. We have more tools for listening, learning and proposing strategies,” he concluded.

Queen’s University researcher Ian Gilron has uncovered a more effective way of treating fibromyalgia, a medical condition characterized by chronic widespread pain typically accompanied by fatigue, as well as sleep, mood and memory problems.

The results of the trial suggest that combining pregabalin, an anti-seizure drug, with duloxetine, an antidepressant, can safely improve outcomes in fibromyalgia, including not only pain relief, but also physical function and overall quality of life. Until now, these drugs have been proven, individually, to treat fibromyalgia pain.

“Previous evidence supports added benefits with some drug combinations in fibromyalgia,” says, Dr. Gilron (Anesthesiology, Biomedical Sciences). “We are very excited to present the first evidence demonstrating superiority of a duloxetine-pregabalin combination over either drug alone.”

Fibromyalgia was initially thought to be a musculoskeletal disorder. Research now suggests it’s a disorder of the central nervous system – the brain and spinal cord. Researchers believe that fibromyalgia amplifies painful sensations by affecting the level and activity of brain chemicals responsible for processing pain signals.

“The condition affects about 1.5 to 5 per cent of Canadians – more than twice as many women as men. It can have a devastating on the lives of patients and their families,” explains Dr. Gilron. “Current treatments for fibromyalgia are either ineffective or intolerable for many patients.”

This study is the latest in a series of clinical trials – funded by the Canadian Institutes of Health Research (CIHR) – that Dr. Gilron and his colleagues have conducted on combination therapies for chronic pain conditions. By identifying and studying promising drug combinations, their research is showing how physicians can make the best use of current treatments available to patients.

“The value of such combination approaches is they typically involve drugs that have been extensively studied and are well known to health-care providers,” says Dr. Gilron.

This new research was published in the journal Pain.

Dr. Gilron and his research team at Queen’s are members of the SPOR Network on Chronic Pain. The national network, funded under Canada’s Strategy for Patient-Oriented Research, directs new research, trains researchers and clinicians, increases access to care for chronic pain sufferers, and speeds up the translation of the most recent research into practice.

 Evidence suggests acupuncture reduces the symptoms of fibromyalgia, according to a Mayo Clinic study.

Fibromyalgia is a disorder considered disabling by many, and is characterized by chronic, widespread musculoskeletal pain and symptoms such as fatigue, joint stiffness and sleep disturbance. No cure is known and available treatments are only partially effective.

Mayo’s study involved 50 fibromyalgia patients enrolled in a randomized, controlled trial to determine if acupuncture improved their symptoms. Symptoms of patients who received acupuncture significantly improved compared with the control group, according to the study published in the June issue of Mayo Clinic Proceedings.

“The results of the study convince me there is something more than the placebo effect to acupuncture,” says David Martin, M.D., Ph.D., lead author of the acupuncture article and a Mayo Clinic anesthesiologist. “It affirms a lot of clinical impressions that this complementary medical technique is helpful for patients.”

Increasingly, patients are interested in pursuing complementary medicine techniques in conjunction with their mainstream medical care, Dr. Martin says. But often, such techniques lack scientific evidence to justify a patient’s expense and time.

The study lends credence to patients’ belief that nontraditional methods may improve their health. In Mayo’s trial, patients who received acupuncture to counter their fibromyalgia symptoms reported improvement in fatigue and anxiety, among other symptoms. Acupuncture was well tolerated, with minimal side effects.

Mayo’s acupuncture study is one of only three randomized and controlled studies involving fibromyalgia patients. Of the other studies, one found acupuncture to be helpful, while the other reported it was ineffective for pain relief.

Dr. Martin says Mayo’s study demonstrates that acupuncture is helpful, and also proves physicians can conduct a rigorous, controlled acupuncture study. Future research could help physicians understand which medical conditions respond best to acupuncture, how to apply it to best relieve symptoms, and how long patients can expect to their symptoms to decrease after each treatment.

People who have the common chronic pain condition fibromyalgia often report that they don’t respond to the types of medication that relieve other people’s pain. New research from the University of Michigan Health System helps to explain why that might be: Patients with fibromyalgia were found to have reduced binding ability of a type of receptor in the brain that is the target of opioid painkiller drugs such as morphine.

The study included positron emission tomography (PET) scans of the brains of patients with fibromyalgia, and of an equal number of sex- and age-matched people without the often-debilitating condition. Results showed that the fibromyalgia patients had reduced mu-opioid receptor (MOR) availability within regions of the brain that normally process and dampen pain signals – specifically, the nucleus accumbens, the anterior cingulate and the amygdala.

“The reduced availability of the receptor was associated with greater pain among people with fibromyalgia,” says lead author Richard E. Harris, Ph.D., research investigator in the Division of Rheumatology at the U-M Medical School’s Department of Internal Medicine and a researcher at the U-M Chronic Pain and Fatigue Research Center.

“These findings could explain why opioids are anecdotally thought to be ineffective in people with fibromyalgia,” he notes. The findings appear in The Journal of Neuroscience. “The finding is significant because it has been difficult to determine the causes of pain in patients with fibromyalgia, to the point that acceptance of the condition by medical practitioners has been slow.”

Opioid pain killers work by binding to opioid receptors in the brain and spinal cord. In addition to morphine, they include codeine, propoxyphene-containing medications such as Darvocet, hydrocodone-containing medications such as Vicodin, and oxycodone-containing medications such as Oxycontin.

The researchers theorize based on their findings that, with the lower availability of the MORs in three regions of the brains of people with fibromyalgia, such painkillers may not be able to bind as well to the receptors as they can in the brains of people without the condition.

Put more simply: When the painkillers cannot bind to the receptors, they cannot alleviate the patient’s pain as effectively, Harris says. The reduced availability of the receptors could result from a reduced number of opioid receptors, enhanced release of endogenous opioids (opioids, such as endorphins, that are produced naturally by the body), or both, Harris says.

The research team also found a possible link with depression. The PET scans showed that the fibromyalgia patients with more depressive symptoms had reductions of MOR binding potential in the amygdala, a region of the brain thought to modulate mood and the emotional dimension of pain.

The study subjects were 17 women with fibromyalgia and 17 women without the condition.

 

Areas of the brain responsible for pain processing and cognitive performance changed in fibromyalgia patients who exercised following a medication holiday, say researchers from Georgetown University Medical Center. They say the changes indicate brain functioning is more streamlined after an exercise intervention because less of the brain’s resources are devoted to processing bothersome fibromyalgia perceptions such as pain.

The study, presented at the Society of Neuroscience’s annual meeting, Neuroscience 2011, used functional MRI scans to assess changes in the brain. Researchers observed a decrease in brain activity in areas responsible for memory and pain control after fibromyalgia patients took part in an exercise regimen.

“The decreased brain activity we see in the area of cognition suggests that the brain is working more efficiently,” explains Brian Walitt, M.D. M.P.H., director of the Fibromyalgia Evaluation and Research Center at Georgetown University Medical Center and senior study author. “We also see less brain activity in areas responsible for pain processing which might be aiding that efficiency.” Walitt cautions that more research needs to be conducted before suggesting a change in clinical care for fibromyalgia.

Fibromyalgia is a medical disorder characterized by widespread pain, fatigue, disordered sleep, and cognitive changes. It is regarded as an interoceptive disorder in that it has no apparent cause, Walitt says. “In conditions like this, the body perceives something by mistake.” The pain is not psychosomatic, but is real and likely produced by the central nervous system, he says.

To that end, the research team used fMRI to “provide a definitive measure of cognitive functioning, so that we can more scientifically measure the effect of exercise,” says Manish Khatiwada, M.S., who will be presenting the results. “This is a novel approach to the study of fibromyalgia.” (Khatiwada is working in the laboratory of co-author John VanMeter, Ph.D., director of the Center for Functional and Molecular Imaging.)

For this study, the researchers enrolled eighteen women with fibromyalgia, and gave them a baseline fMRI to assess working memory and questionnaires about their well-being and pain while they were on medication. They then were told not to use their medications for a “washout” period, and had a second fMRI and memory testing. After six weeks, they had another assessment. The final scan was taken after the volunteers engaged in a six-week period of exercise, which involved three 30-minute sessions of aerobic exercise each week with a trainer.

Memory and pain typically worsen in patients after stopping their medication — which was the experience of patients in this study. After six weeks of exercise, however, patients reported an improvement in overall well-being. However, their performance in the memory task did not change significantly when compared to their baseline study measurements. Despite a change in memory test performance, brain activity in the memory task and pain processing areas of the brain decreased.

“What we see is a less interference by pain activity which could be contributing to the decrease in activity in the memory section. Basically, the brain is using less energy for the same task,” Walitt says.