After undergoing cognitive behavioral therapy, fibromyalgia patients reported improvements in general health and pain scores, a small study shows.
Moreover, the psychological therapy correlated with a significant reduction in the two most relevant pro-inflammatory cytokines in fibromyalgia, interleukin (IL)-6 and IL-8.
The study, “The effect of cognitive behavioral therapy on the circulating proinflammatory cytokines of fibromyalgia patients: A pilot controlled clinical trial,” was published in the journal General Hospital Psychiatry.
While the mechanisms behind fibromyalgia are far from clear, studies suggest that psychological factors play a major role in the predisposition, onset, and perpetuation of the disease.
Cognitive behavioral therapy (CBT) is considered one the main psychological treatments for fibromyalgia. The goal of the intervention is to change negative thought patterns and introduce modifications to patients’ behavior to help them cope with the pain.
However, the effectiveness of CBT has relied on patients’ self-reporting, which is a subjective method.
Given the increasing evidence of systemic (whole-body) inflammation in fibromyalgia, a group of Iranian researchers evaluated the effects of CBT on the levels of proinflammatory cytokines (signaling molecules) relevant in fibromyalgia, including IL-6, IL-8, and tumor necrosis factor (TNF)-alpha.
“To the best of our knowledge, this is the first study to evaluate the effect of CBT on the serum proinflammatory cytokines of FM patients,” the researchers wrote.
The study enrolled 42 women with fibromyalgia, at a mean age of 46.5 years, with a median disease duration of almost two years. Patients were divided into two groups — the intervention group (16 patients) and the control group (17 patients).
Those in the intervention group underwent traditional face-to-face CBT with a psychotherapist. The sessions, given twice weekly for two hours over 10 weeks, focused on identifying the troublesome situations in a patient’s life and her negative/inaccurate thought patterns. These were followed by sessions to reshape and restructure patients’ thinking and behavior.
Patients underwent a total of 20 CBT sessions. Depression and anxiety were measured in both groups using two adapted versions of the Beck Depression Inventory-II (BDI-II) and Beck Anxiety Inventory-II scales, in which higher scores correlated with more severe depression and anxiety.
For the primary outcome — to assess the impact of CBT sessions on the levels of proinflammatory cytokines — researchers used blood samples taken immediately before the start of the first CBT session and at the end of the last CBT session. In the control group, they took blood samples three months apart. Secondary outcomes included patients’ answers on the Fibromyalgia Impact Questionnaire (FIQ) and the Widespread Pain Index (WPI) during the same period.
Results showed that patients in the intervention group had statistical meaningful improvements in both the self-reported FIQ and WPI measures, compared with the control group.
In addition, CBT significantly reduced the serum levels of IL-6 and IL-8. No changes were seen in the levels of TNF-alpha.
These results uphold previous findings and suggest that the levels of proinflammatory cytokines in the blood are potential useful biomarkers of treatment efficacy in fibromyalgia patients.
“CBT not only improved the self-reported measures including FIQ and WPI, but also resulted in a significant decrease in the serum concentration of IL-6 and IL-8, as the main proinflammatory mediators in [fibromyalgia] pathogenesis,” the researchers wrote, concluding that the results of the study support the use of CBT as “a safe and effective non-pharmacological treatment for FM management.”
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