Category Archives: Fibromyalgia

Fibromyalgia: Smartphone Delivered CBT Therapy Reduced Symptoms and Enhanced Well-Being

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PainRelief.com Interview with:
Mike Rosenbluth, PhD
CEO, Swing Therapeutics
UCSF Rosenman Innovators Program
San Francisco, CA

PainRelief.com: What is the background for this study?

Response: Fibromyalgia is a chronic pain condition that affects an estimated 10 million Americans, characterized by widespread pain and other physical and cognitive symptoms that include fatigue, disrupted sleep, reduced physical function, memory problems and difficulty concentrating (“brain fog”). Clinical guidelines recommend multimodal treatment that combines medication management with non-drug approaches including cognitive behavioral therapy (CBT), but only 5% of fibromyalgia patients annually end up receiving some form of CBT due to lack of trained providers or cost. 

There have been dozens of studies on CBT for management of chronic pain or fibromyalgia specifically. The majority of these studies are small, are testing an intervention that cannot scale, and are run at a single site. These studies ultimately conclude that more research should be done. We aimed to develop a product that could deliver behavioral therapy for fibromyalgia at scale and test that product in a rigorous study that was powered to demonstrate definitive clinical benefit of the treatment.

Stanza is a self-guided, smartphone-based digital therapy that delivers acceptance and commitment therapy (ACT), a type of CBT.  In this multi-center, randomized controlled trial, 275 participants were randomized to receive either Stanza treatment or an active control intervention (in this case a digital symptom tracker and access to health education). 

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Fibromyalgia: Imaging Studies Find Cognitive Behavioral Therapy Reduces Pain Catastrophizing

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PainRelief.com Interview with:
Jeungchan Lee, Ph.D.,
Instructor
MGH/HST Athinoula A. Martinos Center for Biomedical ImagingSpaulding Rehabilitation Hospital
Harvard Medical School
Charlestown, MA 024129

Jeungchan Lee, Ph.D., Postdoctoral Research Fellow MGH/HST Athinoula A. Martinos Center for Biomedical ImagingSpaulding Rehabilitation Hospital Harvard Medical School Charlestown, MA 024129

PainRelief.com: What is the background for this study?

Response: Cognitive behavioral therapy (CBT) has shown promise in alleviating fibromyalgia (FM) symptoms by targeting pain-related catastrophizing, which comprises negative cognitive and emotional processes amplifying pain perception.

However, the neurological mechanisms underlying CBT’s impact on pain catastrophizing in FM patients have remained unclear.

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Including a Body Map Can Help Clinicians Manage Chronic Pain

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PainRelief.com Interview with:
Ben Alter, MD, PhD
Assistant Professor
Director, Translational Pain Research
Division of Pain Medicine
Department of Anesthesiology and Perioperative Medicine
University of Pittsburgh Medical Center

Dr. Ben Alter

PainRelief.com:  What is the background for this study?  What are the main findings?

Response: In the clinical environment, I am often asking patients where their pain is.  There is a large amount of research establishing that widespread or “all-over” pain is difficult to manage and impacts nearly every aspect of a patient’s life. In fact, a tally of body areas is involved with the diagnosis of fibromyalgia, although this is not the only diagnostic criteria. What wasn’t clear to us was whether patterns of pain across the body also impacted important facets of the pain experience.  

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Green Light Therapy Can Augment Traditional Pain Relief Methods

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PainRelief.com Interview with:
Mohab Ibrahim, MD., Ph.D
Associate Professor, Departments of Anesthesiology, Neurosurgery, and Pharmacology.
Director, Chronic pain clinic. 
Director, Chronic pain fellowship. 
Medical Director, Comprehensive Pain and Addiction Center
Banner-University Medical Center
University of Arizona

PainRelief.com:  What is the background for this study?  What are the main findings?

Response: This study is the continuation of the green light story we first published in 2017. Our first paper in 2017 investigated the effect of green light on pain behavior in animals. This idea was inspired by my brother who suffers from headaches and finds relief in green spaces. My brother’s experience with green spaces inspired me to look initially into green light therapy for pain in rodents which resulted in our first publication in 2017.  Because green light therapy decreased pain behavior in animals coupled with the safety profile of green light (we use low-intensity green light), we obtained approval from the University of Arizona to conduct human trials. This has resulted in two clinical trial papers that were recently published.

We have shown that green light exposure decreased the severity of pain in patients with fibromyalgia and also decreased the intensity and frequency of migraine headaches in migraine patients. At this point, we wanted to explore the mechanism(s) of action and explain how green light works. We had some preliminary data from our initial publications pointing towards the endogenous opioid system. Therefore, we decided to explore the endogenous opioid system in more detail in the HIV-induced neuropathy model in rodents. Our findings indicate that green light reversed hypersensitivity in a model of HIV-related neuropathy in rodents by stimulating the endogenous opioid system. Green light exposure significantly increased the CSF levels of β-endorphin and proenkephalin, but not dynorphin. The µ- and δ-opioid receptors appeared to be key actors in green light-induced antinociception. 

PainRelief.com: What should readers take away from your report?

Response: Chronic pain is a complicated medical condition with several dimensions. Chronic pain may affect sleep quality, life quality, and may result in depression.

The management of chronic pain requires a deep appreciation of the factors involved and necessitates the evaluation of a pain specialist and the collaboration of several medical specialists.

Non-pharmacological methods can be used to complement current pharmacological and procedural interventions to control pain.

Color and light therapy are still in their infancy and we still need to learn more about them. More research and more funding are needed to better understand the biological

Green light therapy can augment current traditional methods to control pain.

If you live in an area with trees or forests, you can enjoy free green light therapy while walking and exercising. It’s a win-win situation.

PainRelief.com: What recommendations do you have for future research as a result of this work?

Response: We and other labs have shown that different colors of light have biological effects. It’s important that we start looking at new indications for light therapy as well as mechanisms of action. Light therapy is relatively a new field and there may be some or a lot of skepticism in the scientific community about its benefits. It may be time to start thinking about organizing regional/national annual meetings focused on the medical benefits of light therapy. This type of meeting will foster collaborations among physicians and scientists and attract more attention and interest in this field.

Finally, looking at the financial burden secondary to the price and cost of medications and the side effects associated with some of these interventions, light therapy may offer a safer complementary tool that is more affordable and has fewer side effects than a significant number of medications. While light therapy may not replace traditional medications, it may decrease the amount of medications needed.

PainRelief.com: Is there anything else you would like to add?

Response: Even though green light therapy is easy to do and relatively safe, I advise anyone who wishes to try it to consult their physicians first. Some medical conditions may not be suitable for extended visual light exposure. Always check with your doctor before you start any new therapy. Also, please do not stop ANY medication you are on without consulting with your physician first. Some medications should not be stopped abruptly.

Finally, as a disclosure, I have a patent for the green light therapy, and it is currently being commercialized.

Citation:

Laurent F. Martin, Aubin Moutal, Kevin Cheng, Stephanie M. Washington, Hugo Calligaro, Vasudha Goel, Tracy Kranz, Tally M. Largent-Milnes, Rajesh Khanna, Amol Patwardhan, Mohab M. Ibrahim,

Green light antinociceptive and reversal of thermal and mechanical hypersensitivity effects rely on endogenous opioid system stimulation,

The Journal of Pain, 2021,

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Fibromyalgia: MRI Imaging Links Brain Metabolites and Pain

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PainRelief.com Interview with:
Jeungchan Lee, PhD
Department of Radiology
Athinoula A. Martinos Center for Biomedical Imaging
Massachusetts General Hospital
Harvard Medical School
Charlestown, MA

PainRelief.com:  What is the background for this study?

Response: Fibromyalgia is a centralized chronic pain syndrome, characterized by multidimensional symptoms. The underlying mechanism, however, in the brain is not well understood. Plus, the application of neuro-metabolic imaging has been limited to a preselected single brain region, which has a potential bias in single region-preselection, and is time-consuming if data collection is needed from multiple brain regions.

Thus, we tried to understand its mechanism with a better spatial resolution and brain coverage using an advanced neuro-metabolic imaging technique (3D proton magnetic resonance spectroscopy, 1H-MRS) by linking metabolic levels to multidimensional clinical/behavioral variables in fibromyalgia patients.

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Fibromyalgia: Evaluation of Pain Relief Therapies

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PainRelief.com Interview with:
VINÍCIUS CUNHA OLIVEIRA, PhD 
Departamento de Fisioterapia – UFVJM 
Brasil

Dr. Oliveira

PainRelief.com:  What is the background for this study?

Response: Fibromyalgia is a chronic health condition of unknown etiology characterized by generalized body pain, fatigue, sleep disturbance, impaired cognition, and anxiety. It causes disability, lowers quality of life and is responsible for with high direct and indirect costs. Many therapeutic options are available and delivered to these patients and it is important to patients and clinicians to understand the average effects sizes of these interventions in order to make their choices.

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Stimulation of Nerves in Ear May Provide Pain Relief for Fibromyalgia Patients

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PainRelief.com Interview with:
Anna Woodbury, MD, C.Ac
Associate Professor | Anesthesiology
Associate Program Director | Emory Pain Fellowship
Emory University School of Medicine

PainRelief.com:  What is the background for this study?  What are the main findings?

Response: I have long been interested in non-pharmacologic and minimally invasive therapies for my pain patients.  Unfortunately, there are not a lot of non-pharmacologic options available, particularly for those suffering from fibromyalgia, a poorly understood condition that leads to widespread pain among a constellation of disturbing symptoms.  I observed that many fibromyalgia patients are stigmatized and often dismissed without suitable treatments, and I wanted to find a way to better help them.  

Working in the VA, I learned that gulf war syndrome and fibromyalgia seemed to overlap in terms of their clinical manifestations, and I was presented with an interesting option for pain treatment – the “Military Field Stimulator,” a stimulator that goes on the ear to treat pain using percutaneous electrical nerve field stimulation (PENFS).  I tried it on a few of my difficult to treat pain patients with positive results.  However, the stimulator had not yet been rigorously tested in a clinical trial.  We therefore conducted a small trial to examine the clinical effects of the ear stimulator in veterans with fibromyalgia and examined brain changes that may result from use of the stimulator us a special kind of MRI known as resting state functional connectivity MRI.  

All veterans in the study received standard therapy, including medication management, physical therapy, etc., but some were randomized to standard therapy alone, while others received standard therapy in addition to PENFS.  We found that there was pain relief in both groups immediately following a 4 week treatment period, but the PENFS group seemed to have longer term pain relief (12 weeks), and the changes in the brain differed between the groups.  Further, pain interference measures (the level pain interferes with activity, mood, stress, and sleep) were significantly improved in the PENFS group at some of the timepoints.

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Can CBD and Cannabis Provide Pain Relief in Fibromyalgia?

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PainRelief.com Interview with:
Amnon A. Berger, MD, PhD
MD/PhD Program 2006-2017
The Hebrew University Hadassah Medical School
Jerusalem, Israel
Resident Physician (CA-1/PGY-2) and Loring Scholar
Department of Anesthesiology, Critical Care and Pain Medicine
Beth Israel Deaconess Medical Center, Boston, MA

Dr. Berger

PainRelief.com:  What is the background for this study?  What are the main findings?

Response: Fibromyalgia is a common disorder of chronic widespread pain. It has been estimated to affect 2-4% of the general population, though that number is likely an underestimate of the actual incidence. Outside of chronic pain, it also contributes to morbidity and disability because it affects sleep, causes cognitive impairment and psychiatric perturbations. Fibromyalgia is difficult to diagnose and even more difficult to treat.

Because the underlying causes – the etiology and pathophysiology at the base of this condition – are still largely unknown, it is harder to tailor specific treatments. There is evidence to support several modes of treatment, but truly high-level evidence exists only for physical exercise. Effective treatment depends on long term commitment and a multimodal approach by a multidisciplinary team.

Recently, with the rise of use in cannabis and CBD, both for medical and recreational use, evidence has emerged to support its use in fibromyalgia. While most of the evidence is not clear cut and not high enough evidence to support cannabis use, the evidence is overall positive and cannabis derivatives may be an effective choice as part of a multimodal treatment plan.

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