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Novel therapy improves outcomes in patients with fibromyalgia
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Research published in Pain indicated that the novel emotional awareness and expression therapy improved many outcomes in patients with fibromyalgia, when compared with cognitive behavioral therapy and educational interventions.
“[CBT] is considered the gold standard nonpharmacological fibromyalgia treatment and is strongly recommended in practice guidelines. Yet, the average benefits of CBT and other psychological therapies for fibromyalgia are modest,” Mark A. Lumley, of the department of psychology at Wayne State University, and colleagues wrote. “There is a need to develop and evaluate novel interventions that might have stronger effects or help more patients, perhaps by targeting risk factors that are not directly addressed by current therapies.”
Lumley and colleagues developed emotional awareness and expression therapy by combining techniques used in other emotion- and trauma-focused therapies.
The therapy ascribes pain and other symptoms to emotionally-activated central nervous system mechanisms. Patients then become aware of, experience, and adaptively express their emotions stemming from conflict, adversity or trauma.
The study included 230 patients with fibromyalgia who were randomly assigned to eight 90-minutes sessions of CBT, emotional awareness and expression therapy, or educational intervention. They were evaluated at baseline, completion of treatment, and at 6-month follow-up for pain reduction, extent of pain, life satisfaction, depression, anxiety, concentration and attention problems, and physical impairment.
Researchers found that 34.8% of patients receiving emotional awareness and expression therapy reported being “very much/much” improved vs. 15.4% of those receiving the educational intervention. In addition, a higher percentage of patients receiving the novel therapy achieved 50% pain reduction, had less widespread pain and fewer fibromyalgia symptoms than those receiving CBT.
“This trial has demonstrated that a treatment that provides patients a new conceptual model of fibromyalgia and facilitates their awareness and expression of avoided emotions related to psychosocial adversity or conflict is both feasible and efficacious. Emotional awareness and expression therapy was well accepted by patients and did not lead to treatment rejection or patient deterioration,” Lumley and colleagues wrote.
Researchers added that the novel therapy may not be universally applicable, and encouraged further research that combines CBT and emotional awareness and expression therapy into a new treatment that is even more effective. – by Janel Miller
Disclosures: Lumley reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
Perspective
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Vickie L. Sayles, BSN, CRNI, RN-BC
Health care providers should consider treating patients with fibromyalgia (with therapies that include emotional awareness and expression therapy along with other conventional therapies. In the past, the gold standard treatment for fibromyalgia and other chronic pain disorders has been cognitive behavioral therapy, which addresses coping with the pain associated with fibromyalgia using self-management skills and psychological interventions. Additionally, empowering patients with knowledge about fibromyalgia in educational settings has also shown promise.
Emotional awareness and expression therapy links psychological interventions with patients’ past experiences and has made strides toward relieving fibromyalgia symptoms. This treatment helps patients address negative encounters from their past such as trauma, conflict and other stressors, and assists them in understanding that emotions may be causing their pain.
According to the Institute for Chronic Pain Trauma, such as domestic violence, sexual assault, or abuse in childhood, tends to overwhelm a person's ability to cope with pain, resulting in anxiety symptoms. Anxiety is a state affecting the nervous system, and pain can be a physical manifestation of this fear. Recurring thoughts or memories of injury cause the body to be in a constant state of reactivity, which in turn changes neural pathways in the brain, causing central sensitization. The common link between chronic pain and trauma is the nervous system. With this in mind, emotional awareness and expression therapy assists in addressing past negative experiences and helps patients actively process these experiences. Once a patient is aware that they can change their outlook by facing past trauma, the door to addressing chronic pain opens. This information is essential to primary care providers and other specialists when treating patients with fibromyalgia.
Since fibromyalgia is the most common chronic, widespread pain syndrome diagnosed worldwide, all health care providers should be aware of all new and emerging treatments to treat the symptoms associated with this condition. Emotional awareness and expression therapy is an excellent alternative to pharmacological therapies since it identifies past stressors and assists patients to process and resolve those conflicts actively, resulting in pain relief. Suggesting this treatment protocol to patients may result in long-term pain relief and assist in treating patients with fibromyalgia.
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