A health education program that includes deep breathing, aerobic exercise, and relaxation methods, seems to stabilize cortisol levels and increase production of anti-inflammatory molecules, improving the condition of fibromyalgia patients, a small trial study shows.
Fibromyalgia is characterized by widespread muscle pain, fatigue, sleep disturbance, and memory and mood issues. Chronic pain, a hallmark of the condition, is brought on by alterations in the brain and the central nervous system, which cause the body to overreact to pain and other external stimuli, such as noise, smell, and bright lights.
Current pharmacological and non-pharmacological treatments for fibromyalgia try to ease chronic pain as much as possible. There has been some success using health education programs (HEP).
“[HEP’s] can induce healthy habits, coping strategies and empowerment, and their benefits have been demonstrated through clinical progress evaluations, that consider subjective variables such as pain level, fatigue, sleep quality, anxiety and depression,” the study researchers wrote.
At this point, it is still unclear whether these benefits are subjective, or can be reflected objectively from a biological and clinical point of view.
Researchers with the Universidade Federal de Minas Gerais in Brazil assessed the impact of an HEP, which they based on the Inter-relational School of Fibromyalgia (ISF) program. They used objective clinical parameters, including immune and neuroendocrine (hormonal and nervous) systems’ involvement in patients.
The HEP participants were required to spend 45 minutes a day, six days a week, on relaxation techniques, diaphragmatic breathing, stretching, strengthening and aerobic exercise. Each patient could choose a specific exercise, such as yoga, and practice it three times a week for 15 to 20 minutes.
The trial (ReBEC – RBR-5tdnbr) included 58 women with fibromyalgia, who were divided into two groups: the experimental group — 27 of 58 — that participated in the HEP for 11 weeks; and the control group —the other 31 — that did not take part.
All data, including the levels of cytokines (molecules that mediate and regulate immune and inflammatory response) and cortisol (a hormone involved in stress response, usually decreased in fibromyalgia patients) and the self-administered Fibromyalgia Impact Questionnaire (FIQ, a survey to assess patients’ health status), were gathered at the beginning and the end of the study.
A total of 44 women (21 from the experimental group, and 23 from the control group) completed the study.
Results showed that the HEP significantly increased the levels of interleukin-4 (IL-4) and interleukin-10 (IL-10), two anti-inflammatory cytokines, as well as the ratio of anti-inflammatory/inflammatory cytokines present in the plasma. There was more cortisol in the saliva of patients from the experimental group.
The scientists also found the self-administered FIQ scores were much lower in patients who participated in HEP.
“The HEP-like ISF program significantly improved the health status of the participants [who] underwent intervention. Despite the limited sample size, we recommend the use of HEP-like ISF to treat [fibromyalgia] patients and we expect that this study may serve as a starting point for further investigations to clarify issues that were not addressed here,” they concluded.