Sustained Pain Reduction Through Affective Self-awareness in Fibromyalgia: A Randomized Controlled Trial

Hsu, Mei‐Yu; Schubiner, Howard; Lumley, Mark A.; Stracks, John; Clauw, Daniel J.; Williams, David A.

doi:10.1007/s11606-010-1418-6

Cited by 94 publications

(81 citation statements)

References 49 publications

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“…This version of EAET was modified from previous trials [10,23,30,41] and presented FM as an amplification of CNS pain and sensory processes due to stress or conflict that is followed by emotional avoidance. Becoming aware of and then experiencing and expressing more adaptive emotions, which is then ideally followed by more direct and honest interpersonal interactions, reduces CNS amplification and improves symptoms.…”

Section: Methodsmentioning

confidence: 99%

“…One small trial found that psychodynamic therapy led to some improvement, but not more than a “high-standard” intervention involving health behavior advice and medication [49]. Another small trial of a group intervention found that emotional awareness and written expression techniques led to substantial pain reduction, compared to wait-list controls [30]. …”

Section: Introductionmentioning

confidence: 99%

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Emotional awareness and expression therapy, cognitive behavioral therapy, and education for fibromyalgia: a cluster-randomized controlled trial

Lumley

Schubiner

Lockhart

et al. 2017

Pain

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177

102

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Patients with FM experience increased lifetime levels of psychosocial adversity, trauma, and emotional conflict. To address these risk factors, we developed Emotion Awareness and Expression Therapy (EAET) and tested its benefits against an active control condition, FM Education, and against the field's gold standard intervention for FM, cognitive-behavioral therapy (CBT) for symptom management. Adults with FM (n = 230) formed 40 treatment groups, which were randomized to EAET, CBT, or Education and given eight, 90-min sessions. Patient-reported outcomes were assessed at baseline, post-treatment, and 6-month follow-up (primary endpoint). Retention of patients to follow-up was excellent (90.4%). Intent-to-treat analyses indicated that, although EAET did not differ from FM Education on pain severity (primary outcome), EAET had significantly better outcomes than FM Education on overall symptoms, widespread pain, physical functioning, cognitive dysfunction, anxiety, depression, positive affect, and life satisfaction (between-condition d's ranging from 0.29 to 0.45 SD), and the percentage of patients improving “much/very much” (34.8% vs. 15.4%). EAET did not differ from CBT on the primary or most secondary outcomes, but compared to CBT, EAET led to significantly lower FM symptoms (d = 0.35) and widespread pain (d = 0.37), and a higher percentage of patients achieving 50% pain reduction (22.5% vs. 8.3%). In summary, an intervention targeting emotional awareness and expression related to psychosocial adversity and conflict was well-received, more effective than a basic educational intervention, and had some advantages over CBT on pain. We conclude that EAET should be considered as an additional treatment option for FM.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Emotional awareness and expression therapy, cognitive behavioral therapy, and education for fibromyalgia: a cluster-randomized controlled trial

Lumley

Schubiner

Lockhart

et al. 2017

Pain

Self Cite

177

102

View full text Add to dashboard Cite

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“…On the other hand, alternative explanations are more convincing, as it has been shown that individuals with fibromyalgia are more likely than controls to have deficits in emotional awareness, and difficulty in distinguishing positive from negative emotions. 30,31 Alternatively, although concordance rates between self and clinician ratings of depression are usually acceptable, significantly discordant ratings have been documented in a substantial number of patients, leading researchers to explore the potential role of other factors in determining the observed discrepancies between self and observer ratings of depression. Personality traits such as higher levels of neuroticism, low extraversion and low agreeableness, younger age, and the nonendogenous subtype of depression were associated with greater endorsement of self-reported depressive symptoms relative to observer ratings.…”

Section: Discussionmentioning

confidence: 99%

Agomelatine in the Treatment of Fibromyalgia

Bruno¹,

Micò²,

Lorusso³

et al. 2013

Journal of Clinical Psychopharmacology

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Pharmacological therapy for fibromyalgia syndrome (FMS) is actually unsatisfactory; analgetic and nonsteroidal anti-inflammatory drugs are not very effective. On the other hand, it is opportune to underline that antidepressant drugs produce positive response on pain in patients with FMS. Furthermore, many studies showed that using variable doses of melatonin (3-6 mg/d) in subjects affected from FMS had significantly been effective on pain, sleep, daytime fatigue, and depression. This study was aimed to evaluate the efficacy of agomelatine on depression, anxiety, cognition, and pain in a sample of drug-free FMS patients. Agomelatine was administered at the single daily dose of 25 mg/d to 15 fibromyalgia "drug-free" female subjects during 12 weeks. Outcome measures included the Hamilton Rating Scale for Depression, the Hamilton Rating Scale for Anxiety, the Zung Self-Rating Depression Scale, the Zung Self-Rating Anxiety Scale, the Visual Analog Scale of Pain, the Quality of Life Index, the Wisconsin Card Sorting Test, the Verbal Fluency Task-Controlled Oral Word Association Test, and the Stroop Color-Word Test. Treatment with agomelatine significantly improved depression, anxiety, and pain in patients with FMS. Regarding executive/cognitive symptoms, treatment with agomelatine did not have a significant impact on the explored neuropsychological domains, although there was a trend toward the improvement of performances. The findings showed that agomelatine was effective and well tolerated in patients with FMS. Further research is needed to fully evaluate the role of agomelatine as a potential pharmacological strategy for the treatment of FMS.

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“…A distinction is made between primary emotional states (essentially biologically determined drives, motives and impulses), which are adaptive (from an evolutionary point of view), and secondary emotional states (such depression, anxiety and fear), which develop as a consequence of failure to recognize and deal effectively with the primary emotional states, and are essentially maladaptive [35]. In this model emotional processes are seen as essential mediators of the response to pain, and chronic pain is effectively the consequence of emotional dysregulation, solutions for which might include training in mindfulness [36] or emotional disclosure [37,38]. Although these approaches appear promising, further research is needed into their influence on clinical outcome [18].…”

Section: Management Perspective Main Emotional Process-pain Modelmentioning

confidence: 99%

The Importance of Psychosocial Influences On Chronic Pain

Main

2013

Pain Manage.

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SUMMARY Recent experimental and clinical studies into the nature of chronic pain and its development have highlighted the importance of psychosocial factors on the perception of pain and response to it. There have been advances in the understanding of not only the biological substrate, but also the nature and influence of specific psychological and social factors in particular. A range of new explanatory models have stimulated new approaches to treatment directed not only at the reduction of pain and its impact, but also at the identification of early indicators or risk factors for the development of chronicity. The purpose of this paper is to attempt a summary and integration of these diverse research findings and identify the next set of research challenges that might serve as a basis for more clearly focused and targeted approaches to multifaceted pain management and perhaps c ontribute to reduction in the burden of chronic pain.*Arthritis Care UK National Primary Care Centre, Keele University, North Staffordshire, ST5 5BG, UK; profcmain@gmail.com Complete cures for chronic pain are often unachievable, so we need to help the patient develop more realistic expectations, with a focus on the impact of pain in terms of function and emotional wellbeing.In meeting this challenge adoption of an evidence-based biopsychosocial framework is required.For most patients, identifying the relevant psychosocial factors will increase the range of therapeutic options and maximize the opportunity to assist the patient to gain/regain control of their symptoms and their impact.Many chronic patients have been ill-served by their encounters with healthcare professionals. The first objective of treatment therefore must be to identify and address possible iatrogenic confusion and distress, and offer appropriate reassurance as a precursor to exploring treatment options.Restructuring clinical assessment specifically to begin with a careful elicitation of the patient's understanding, expectations, beliefs and concerns offers a framework within which to facilitate self-disclosure, identify need for reassurance and embark on the planning of effective interventions.In chronic pain patients, it is important to recognize that many psychosocial factors, which may be perceived as obstacles to recovery, may in fact by repositioned as opportunities to develop more effective interventions. Practice PointsThe importance of psychosocial influences on chronic pain MANAGEMENT PERSPECTIVEChris J Main* Any attempt to treat chronic pain necessitates consideration not only of the nature of chronic pain but also why and how it persists. The gate control theory of pain [1] has spawned a plethora of investigations into peripheral and central pain mechanisms. New techniques such as imaging [2] have supported sophisticated and wide-ranging investigations of its neurobiological substrate [3] holding the promise of further enhancing our understanding of fundamental pain mechanisms. However the experience of pain is ultimately perceptual and the nature a...

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Sustained Pain Reduction Through Affective Self-awareness in Fibromyalgia: A Randomized Controlled Trial

Cited by 94 publications

References 49 publications

Emotional awareness and expression therapy, cognitive behavioral therapy, and education for fibromyalgia: a cluster-randomized controlled trial

Emotional awareness and expression therapy, cognitive behavioral therapy, and education for fibromyalgia: a cluster-randomized controlled trial

Agomelatine in the Treatment of Fibromyalgia

The Importance of Psychosocial Influences On Chronic Pain

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