Posted on Fibromyalgia, Pain Management

CBT eases how fibromyalgia pain is experienced by the brain

A randomized, controlled trial led by Mass General Brigham researchers demonstrates that cognitive behavioral therapy can significantly reduce the impact of fibromyalgia pain
A randomized, controlled trial led by Mass General Brigham researchers demonstrates that cognitive behavioral therapy can significantly reduce the impact of fibromyalgia pain

Individuals with fibromyalgia often face limited treatment options and struggle to find explanations for their symptoms. Researchers at Mass General Brigham have discovered that cognitive behavioural therapy (CBT) can significantly alleviate the burden of fibromyalgia by reducing pain-catastrophizing, a negative cognitive and emotional response that can intensify pain. Neuroimaging data showing decreased connectivity between brain regions associated with self-awareness, pain, and emotional processing support this finding.

“In this study, we examined how psychological processes and the brain’s connectivity patterns respond to pain,” stated co-senior author Robert Edwards, PhD, a clinical psychologist in the Department of Anesthesiology, Perioperative & Pain Medicine at Brigham and Women’s Hospital, a founding member of the Mass General Brigham healthcare system. “We sought to investigate how cognitive behavioral therapy (CBT), a type of talk therapy aimed at addressing maladaptive thoughts, can improve daily functioning and change the brain’s processing of pain-related information.”

Edwards explains that cognitive behavioral therapy (CBT) can reduce negative cognitive and emotional responses to pain. He says that while these responses are normal, they can amplify the disabling effects of chronic pain and make conditions like fibromyalgia (FM) more burdensome.

The research team for the study included researchers from three members of Mass General Brigham: Spaulding Rehabilitation Hospital, Brigham and Women’s Hospital, and Massachusetts General Hospital. Mass General Brigham brings together 16 member institutions, including academic medical centres, top-tier speciality hospitals, community hospitals, and more. Research that involves multiple entities within Mass General Brigham provides unique insights and perspectives from different settings and areas of expertise, making it more impactful than individual research efforts.

:Researchers recruited 98 women, randomly assigning 64 to a treatment group receiving CBT and 34 to a control group that received education about FM and chronic pain but was not taught specific CBT techniques. All participants were between 18 and 75 years old and had a confirmed diagnosis of fibromyalgia for at least six months. To collect baseline data, all participants completed several validated pain and quality of life questionnaires.

During the study, each group took part in eight intervention sessions, which involved 60-75 minute visits with a licensed mental health provider. The participants were mainly evaluated based on their pain interference levels, which measures the extent to which their pain affected their daily activities, as well as their pain catastrophizing, pain severity, and the overall impact of fibromyalgia on their quality of life.

Results demonstrated that those who underwent CBT experienced significantly greater reductions in pain interference. CBT participants also exhibited significantly less pain catastrophizing and reported that their FM symptoms had significantly less impact on their daily lives.

The team saw evidence that after undergoing CBT, patients experienced changes in the activities of all three networks that suggested a diminished focus on pain.

“Before undergoing cognitive behavioral therapy (CBT), we observed strong connections in certain parts of the brain related to self-awareness and sensation, indicating that patients were highly attuned to the pain they were feeling and internalized these symptoms,” said co-first author Jeungchan Lee, PhD, an instructor in the Department of Physical Medicine and Rehabilitation at Spaulding Rehabilitation Hospital and the Athinoula A. Martinos Center for Biomedical Imaging at Massachusetts General Hospital. “After CBT, these connections were significantly weaker, suggesting that patients were better able to separate themselves from their pain after therapy.”

This study was limited to women, partly because of its high prevalence, and partly to eliminate confounding gender differences in brain activity. In the future, the researchers hope to collect data from men and non-binary patients with FM. Additionally, CBT includes several therapeutic components, and these results cannot be generalized to assess the impact across all forms of CBT on reducing FM chronic pain.

Both Lee and Edwards agree that these findings ultimately suggest that complex chronic pain conditions like fibromyalgia should be addressed with a multitude of pharmacological and cognitive therapies.

“I hope that these findings motivate healthcare providers to consider CBT as an effective treatment option to reduce the impact of pain patients experience,” explained Edwards. “Chronic pain conditions like fibromyalgia involve long-standing patterns of changes in the central nervous system, and CBT is one among many treatment options, such as medication and physical therapy, that we know can be beneficial for those living with FM.”

Posted on Diabetes

The number of Type 2 diabetes cases more than doubled seven decades after exposure to famine.

A study conducted by researchers at Columbia University Mailman School of Public Health, the University of North Carolina at Chapel Hill, and the National Academy of Sciences of Ukraine investigated the link between prenatal famine and adult Type 2 diabetes mellitus (T2DM) using the Ukrainian Holodomor famine of 1932-1933 as a case study. They examined 128,225 cases of Type 2 diabetes diagnosed between 2000-2008 among 10,186,016 Ukrainian males and females born between 1930 and 1938.

A study led by Columbia University Mailman School of Public Health found that individuals who were exposed to famine early in their gestation had a more than two-fold likelihood of developing Type 2 diabetes compared to those who were not exposed to the famine. The results of this study have been published in the journal Science.

The famine resulted in 4 million excess deaths in a short period, with the most significant losses occurring within a 6-month period. The Holodomor far surpassed other famines in its severity. In 1933, life expectancies at birth were only 7.2 years for females and 4.3 years for males.

“The setting in Ukraine provided a unique opportunity to study the long-term effects of the Holodomor, a famine that resulted in widespread hunger and death, on Type 2 Diabetes Mellitus (T2DM) cases diagnosed seven decades after prenatal exposure to the famine,” explained Dr. L.H. Lumey, a professor of Epidemiology at Columbia Public Health. “The famine occurred over a six-month period in early 1933, allowing us to determine the timing of the famine and the varying severity across different regions.”

Stalin used famine as a weapon of terror against Ukrainian farmers, leading to a devastating concentration. When Ukraine could not meet its grain quotas for the Soviet Central Government, drastic measures were taken under the pretext of countering sabotage by counter-revolutionary elements. A widespread campaign involved searching peasants’ homes for “hidden” or “stolen” grain, leading to food confiscation and leaving families without supplies for the winter. Additionally, measures were put in place to restrict Ukrainian peasants’ ability to seek out food elsewhere.

Sure, here is the revised text for clarity and correctness:These measures led to a devastating situation. Many rural families were left without any food, as avenues to search for food were closed and grain reserve funds were depleted. As a result, thousands of rural families were condemned to a slow death by starvation in their villages. The impact was a remarkable increase in excess deaths during the Holodomor between January and June 1933. At the peak of the famine in June 1933, there were an average of 28,000 famine-related deaths per day, equivalent to 1,167 deaths per hour or 19 per minute.

“Our research on the long-term health effects of the Holodomor famine highlights important lessons for addressing health challenges caused by national disasters,” says Lumey. “It emphasizes the need for a thorough healthcare and policy framework that considers the enduring impact of early-life adversities on population health and their potential long-term consequences on chronic diseases and mental health.”

Individuals diagnosed with T2DM between 2000 and 2008 may have been overweight or obese and had other risk factors for the disease. However, the research team found that the specific relationship between adult T2DM risk and the location and date of birth during the famine suggests that famine exposure in early gestation is the dominant factor that outweighs all others.

“This awareness should prompt a proactive approach among policymakers and public health officials to anticipate the increased healthcare needs among populations affected by national disasters. It also highlights the importance of raising awareness about the potential long-term health effects of early-life adversities,” observed Lumey.

“Developing policies to address long-term health challenges after a national disaster is crucial. Our study highlights the need for policies to prevent events like the Holodomor from recurring. Dr. Wolowyna of the University of North Carolina at Chapel Hill points out that Russia’s invasion of Ukraine in 2022 is a grim reminder of history repeating itself. The three-month siege of the city of Mariupol to starve the population into surrender during the current war in Ukraine serves as a stark reminder of the current and real danger. Furthermore, the blockade of Ukrainian ports to prevent the export of Ukrainian grain to developing countries in Africa and Asia has increased the risk of starvation for millions of people in these regions.”

Posted on Multiple Sclerosis

Great news for people with multiple sclerosis – the COVID-19 vaccine is not associated with an increased risk of relapse.

Researchers identified immune cells as a potential key factor for protection against MS disease

“People with multiple sclerosis (MS) are at higher risk of severe coronavirus infection. However, there has been concern about potential relapse after vaccination. A recent study discovered that people with MS may not face a greater risk of relapse after receiving the COVID-19 vaccine. This study was published in the online issue of Neurology®,

“People with MS face a higher risk of severe COVID infection due to their level of motor disability or exposure to treatments that suppress their immune systems,” said study author Xavier Moisset, MD, PhD, of Clermont Auvergne University in Clermont-Ferrand, France. “Some previous studies have shown relapses after vaccination, causing some people to skip the recommended booster doses. The good news is that our study found no increased risk of relapse after COVID-19 vaccination for nearly all participants.”

Researchers discovered a small increase in relapse risk after a booster dose for patients with high MS activity. This was particularly evident in individuals who experienced at least two relapses in the previous two years, especially those who were not taking any MS medications.

The study included 124,545 individuals with MS in France. They had been living with MS for an average of 14 years and were monitored for 45 days after receiving the vaccine. This period was chosen because potential vaccine-induced relapses typically occur within 28 days after vaccination.

During the study, 102,524 individuals, representing 82% of the participants, received at least one dose of a COVID-19 vaccine. Among them, 95% completed the full vaccination regimen by receiving a second dose, and 59% received an additional booster dose.

In the 45 days following vaccination, researchers examined relapses that required treatment with high-dose corticosteroids.

“After adjusting for other factors that could affect the likelihood of a relapse, such as the time of year and the effect of disease-modifying therapy, researchers found that COVID-19 vaccination did not increase the risk of severe relapse. These results remained consistent after each dose.”

To confirm the findings, researchers compared people who had relapses with those who did not. Once again, they found no increased risk of vaccine exposure. Instead, they identified a slight decrease in relapse risk following vaccination.

“Our findings are reassuring: these vaccines can be used without any worry about the risk of relapse,” Moisset said. “The absence of such a risk is encouraging for people with MS. They may receive booster shots when needed, especially if booster shots are to be repeated in the future.”

“Moisset emphasized extra caution when considering booster vaccinations for patients with high inflammatory activity. It’s important for these patients to first receive disease-modifying treatment. Undertreated individuals and those with highly active disease showed a slightly increased risk after receiving the third vaccine dose. The risk was highest when both factors were combined.”

Posted on autoimmune conditions, Diabetes

“Tiny particles could be used to deliver therapeutics that prevent diabetes.”

Inside each of us, there is a group of cells that work to protect us from outside germs and internal dangers like cancer. However, these cells can sometimes mistakenly attack the body, leading to autoimmune diseases such as type 1 diabetes.

Texas A&M researchers have recently been awarded an RO1 grant from the National Institutes of Health. The grant is intended to support the development of a strategy to deliver immune-suppressing proteins that are typically produced by specialized stem cells. This approach has the potential to reduce the immune system’s attack on the insulin-producing beta-cells in the pancreas, paving the way for a new treatment for type 1 diabetes.

“We are thrilled that the NIH will support our research in this area, which has implications not only for type 1 diabetes but also for other autoimmune diseases,” said Dr. Roland Kaunas, associate professor in the biomedical engineering department and recipient of the grant award.

The National Diabetes Statistics Report states that 35 out of 10,000 youths in the United States have diabetes, with 304,000 of them having type 1 diabetes. Currently, the only approved treatment for this condition is lifelong insulin therapy. However, ongoing research is exploring new therapeutics and approaches for treating this and other autoimmune diseases. For instance, cell-based therapies, where immune cells or stem cells are genetically modified to produce immune-suppressing substances, are being actively investigated. Nevertheless, these interventions face challenges such as toxicity and difficulties in transplanting gene-edited cells.

“Mēsĕnchȳmal stem cells are valuable as a therapy because they can dampen the immune response. However, they are not FDA approved,” said Kaunas. “This is a strong motivation for developing cell-free versions of stem cell therapies that could represent a lower hurdle to getting approval by the FDA.”

TAMU researchers have focused on delivering therapeutic products produced by stem cells, rather than the cells themselves. For example, mesenchymal stem cells (MSCs) produce extracellular vesicles – tiny cargo-carrying packets containing RNA, DNA, and other proteins. Some of these proteins, such as cytokines and chemokines, can reduce immune activity. Dr. Ryang Hwa Lee, the principal investigator and associate professor at the Texas A&M School of Medicine, has previously shown the therapeutic potential of both MSCs and the extracellular vesicles they produce in preclinical models.

Lee and Kaunas are currently researching whether extracellular vesicles can be modified to deliver extra immune-suppressing proteins, with the goal of better preventing the immune system from attacking insulin-producing beta-cells. They also aim to show whether these modified extracellular vesicles can stop or even reverse the development of type 1 diabetes. Lastly, the team plans to study how the modified EVs, in combination with existing immune therapies, can work together to suppress the immune system.

“We hope that our research will lead to an additional therapeutic avenue that can improve the efficacy and safety of existing immune therapy for type 1 diabetes,” said Lee. “Although ours is preclinical work, its success will facilitate the development of robust and ready-to-use extracellular vesicle-based therapeutics for type 1 diabetes and other autoimmune diseases.”

Posted on Autism

“Integrating Positive Psychology and Autism: A Roundtable Discussion” What makes life worth living?

A new Roundtable Discussion in the peer-reviewed journal Autism in Adulthood examines the potential integration and mutual benefits of positive psychology and autism and its impact on the autism community. Click here to read the Roundtable.

The Roundtable was co-moderated by Patricia Wright, PhD, MPH, Executive Director of Proof Positive: Autism Wellbeing Alliance, and Rachel Moseley, PhD, from Bournemouth University. Expert panelists included Dan Tomasulo, PhD, from Teachers College, Columbia University; Hari Srinivasan, a PhD neuroscience student at Vanderbilt University; Jodie Wilson, BVSc, MAPP, from Latrobe University; Sara Woods, PhD, University of Washington; and Tayyab Rashid, PhD, a licensed clinical and school psychologist in Toronto.

“Positive psychology seeks to explore what brings meaning and fulfilment to life. In addition to reducing suffering, it focuses on developing tools to increase positive emotions, such as fostering meaningful relationships, discovering how to engage with life, and achieving a sense of purpose. Positive psychology can offer significant benefits to the autism community by recognizing and leveraging individual strengths. By appreciating these strengths, it can positively influence interpersonal interactions, communication dynamics, and an individual’s overall response framework.”

Rather than only addressing weaknesses, positive psychology focuses on enhancing and amplifying strengths by providing tools, techniques, and processes to leverage those strengths.