New Therapy Targets Fibromyalgia Pain-induced Fear of Exercise

New Therapy Targets Fibromyalgia Pain-induced Fear of Exercise

Use of a novel virtual reality therapy program led to physiological changes in the brains of fibromyalgia syndrome (FMS) patients that may help in the management and alteration of pain catastrophization related to exercise. The study, titled “Targeting pain catastrophization in patients with fibromyalgia using virtual reality exposure therapy: a proof-of-concept study,” was published in the Journal of Physical Therapy Science.

Clinical evidence from several studies supports exercise therapy as a key aspect in the management of chronic pain conditions like FMS, essential to the physical and psychological well-being of patients. Poor exercise compliance is seen as a main obstacle to these benefits. One of the predictors of poor compliance is pain catastrophization, generally defined as “an exaggerated negative orientation towards actual or anticipated pain experiences,” and believed to be more pronounced and damaging in FMS patients than in individuals with other rheumatologic chronic pain conditions. Cognitive behavioral therapy (CBT) has been suggested to alter pain catastrophization in FMS patients. CBT relies on either in vivo exposure therapy, where real situations are experienced by the patient, or imagined exposure therapy. A recent development, however, has pointed to the potential of virtual reality exposure therapy (VRET), especially in situations where it is difficult or costly to expose patients to real-life situations or where imagined scenarios are ineffective. VRET has been previously used successfully to treat phobias, but never against the fear of exercise in chronic pain conditions.

Researchers tested a virtual reality exposure program as treatment to reduce pain catastrophization and exercise avoidance. The study enrolled 13 FMS patients and 9 matched controls and exposed them to two types of stimuli, active visuals (clips of different exercise activities) and passive visuals (clips of various relaxing/sedentary activities), interrupted by rest periods with no stimuli. The neurophysiological alterations were observed by functional magnetic resonance imaging (fMRI).

The results showed that during exercise visuals there was a significant activation in the FMS group of certain brain areas, such as the inferior frontal gyrus, posterior cerebellum, and middle frontal gyrus, previously associated with pain catastrophization processing and fear. Such identification might allow physiotherapists to identify those patients likely to have poor exercise compliance and more successfully manage their fears.

“Although it may be many years before an adequate management strategy for treating pain catastrophization in response to exercise therapy in FMS is successfully implemented in clinical practices across the globe, the findings of this research significantly add to the current body of knowledge regarding the possibility of objectively identifying cognitive behavioural strategies like pain catastrophization often observed among chronic pain patients within the physiotherapy practice scope. The results of this study also provide a rather promising suggestion that a program like VRET aimed at reducing pain catastrophization related to exercise activities among patients with FMS may be worth further investigation,” the authors concluded.