Abstract
Objective
Fibromyalgia (FM) is characterized by pervasive pain-related symptomatology and high levels of negative affect. Mind-body treatments such as cognitive-behavioral therapy (CBT) appear to foster improvement in FM via reductions in pain-related catastrophizing, a set of negative, pain-amplifying cognitive and emotional processes. However, the neural underpinnings of CBT’s catastrophizing-reducing effects remain uncertain. This randomized, controlled, mechanistic trial was designed to assess CBT’s effects on pain catastrophizing and its underlying brain circuitry.
Methods
Of 114 enrolled participants, 98 underwent a baseline neuroimaging assessment and were randomized to 8 weeks of individual CBT or a matched fibromyalgia education control condition (EDU).
Results
Compared with EDU, CBT produced larger decreases in pain catastrophizing at post-treatment (P < 0.05), and larger reductions in pain interference and symptom impact. Decreases in pain catastrophizing played a significant role in mediating those functional improvements in the CBT group. At baseline, brain functional connectivity between ventral posterior cingulate cortex (vPCC), a key node of the default mode network, and somatomotor and salience network regions was increased during catastrophizing thoughts. Following CBT, vPCC connectivity to somatomotor and salience network areas was reduced.
Conclusion
Our results suggest clinically important and CBT-specific associations between somatosensory/motor- and salience-processing brain regions and the default mode network in chronic pain. These patterns of connectivity may contribute to individual differences (and treatment-related changes) in somatic self-awareness. CBT appears to provide clinical benefits at least partially by reducing pain-related catastrophizing and producing adaptive alterations in default mode network functional connectivity.