Completing an eight-week program of mindfulness-based stress reduction (MBSR) helps lessen clinical symptoms of fibromyalgia, including disease severity, depression, perceived stress, and cognitive difficulties, a pilot trial suggests.
The practice also seems to ease patients’ pro-inflammatory condition, helping to normalize blood levels of an anti-inflammatory cytokine called IL-10.
The study, “Immune-inflammatory pathways and clinical changes in fibromyalgia patients treated with Mindfulness-Based Stress Reduction (MBSR): A randomized, controlled clinical trial,” was published in the journal Brain, Behavior and Immunity.
There is some promising evidence that training in mindfulness, including engaging in a mindfulness-based stress reduction program, can relieve chronic pain in many conditions including fibromyalgia (FM).
Besides its potential benefit to overall well-being, there have been reports that mindfulness training helps balance the pro- versus anti-inflammatory state of individuals affected by different conditions such as cancer, depression, or stress.
Little research has been done to investigate if MBSR can help normalize the inflammatory status of FM patients or if their condition makes a difference in the way they respond to MBSR.
Thus, a team led by researchers at Sant Joan de Déu Research Institute in Spain conducted a randomized and controlled trial to address two main issues: the effect of MBSR on the clinical symptoms and inflammatory status of FM patients; and if some immune pathways influence patients’ response to MBSR, and can be used to predict the benefit of this intervention beforehand.
The trial included 70 female FM patients, randomly divided in two groups of 35: a treatment group that received MBSR plus their standard care, and a control group that had standard care alone. The study was part of a larger Phase 3 trial called EUDAIMON (NCT02561416), which included another type of intervention, outside the scope of this report.
First reported in 1982, the standard MBSR is an eight-week program of 2.5-hour sessions, which was developed at the University of Massachusetts Medical School. It provides intensive training in mindfulness meditation, and aims to help patients increase their awareness of their present experience and relate to their physical and psychological conditions in a more accepting and non-judgmental manner.
For this study, the original program was slightly changed to eight weekly sessions of two hours each focused on mindfulness meditation exercises. Each session was led by an accredited MBSR instructor, who remained the same for the entire program. Participants were also encouraged to practice mindfulness at home (45 minutes a day), guided by a book and an audio CD.
To measure the effect of MBSR, the researchers compared the changes in several patient-reported symptom scores and levels of inflammatory markers in the blood, before and after patients had completed the mindfulness program. As a reference, these values were compared with the group on standard care alone.
The results show that MBSR significantly attenuated overall self-reported disease severity (on the FIQR questionnaire), depression (HADS scale), perceived stress (PSS-10 scale), and pain catastrophizing (PCS scale), compared with the standard care control group.
IL-10, an anti-inflammatory cytokine, appeared to be significantly altered by the MBSR program (other inflammatory biomarkers measured included IL-6, CXCL8, and high-sensitive C-reactive protein). IL-10 levels decreased over time in control patients, but in those exercising mindfulness, the molecule was kept at stable levels, which “may be related to a more healthy status,” the report stated.
Although mindfulness was associated with a relief in many FM symptoms, 46% of patients did not respond to treatment, meaning they had less than a 20% reduction in their FIQR scores.
Non-responders had higher levels of CXCL8 — a messenger molecule that promotes inflammation — at the beginning of the study, compared with responders. This finding predicted that patients with lower pre-treatment levels of CXCL8 and CXCL8/IL-10 ratio were more likely to respond better to MBSR.
“Therefore, the idea that a mild chronic inflammatory status can moderate the response to a mind-body treatment might be more than plausible,” the researchers said.
The study “showed that MBSR (in addition) to usual medical care is an efficacious intervention to reduce functional impairment and severity, depression and anxiety symptomatology, and perceived stress in FM patients.”
Also, the fact that MBSR correlates with stable IL-10 levels, “is of special interest because the anti-inflammatory cytokines IL-4 and IL-10 have an analgesic power and happen to be lower in FM patients when compared to healthy controls.”
However, the researchers stress that this trial was exploratory and had important limitations such as a small number of participants. More studies are needed to confirm the benefits of mindfulness-based therapies for FM patients and their immune system response to such therapies.