title: The effect of guided imagery and amitriptyline on daily fibromyalgia pain: a prospective, randomized, controlled trial.
abstract: OBJECTIVE
  The effectiveness of an attention distracting and an attention focusing guided imagery as well as the effect of amitriptyline on fibromyalgic pain was studied prospectively.
  
  
  METHODS
  Fifty-five women with previously diagnosed fibromyalgia were monitored for daily pain (VAS) in a randomized, controlled clinical trial. One group received relaxation training and guided instruction in "pleasant imagery" (PI) in order to distract from the pain experience (n=17). Another group received relaxation training and attention imagery upon the "active workings of the internal pain control systems", "attention imagery" (AI) (n=21). The control group (CG) received treatment as usual (n=17). Patients were also randomly assigned to 50-mg amitriptyline/day or placebo. Some psychological and socio-demographic variables were also measured initially. The slopes of diary pain ratings over a 4-week period were used as the outcome measures.
  
  
  RESULTS
  We found significant differences of the pain-slopes between the three psychological conditions (P=0.0001). The pleasant imagery (P<0.005), but not the attention imagery group's slope, declined significantly when compared with the control group (P>0.05). There was neither a difference between the amitriptyline and placebo slopes (main effects, P=0.98) nor a significant amitriptyline x psychological interaction (P=0.76).
  
  
  CONCLUSIONS
  Pleasant imagery (PI) was an effective intervention in reducing fibromyalgic pain during the 28-day study period. Amitriptyline had no significant advantage over placebo during the study period.
authors.affiliation: Department of Psychiatry and Behavioural Medicine, Norwegian University of Science and Technology (NTNU), PO Box 3008 Lade, NO-7441, Trondheim, Norway. eafors@online.no
authors.forename: Egil A
authors.initials: EA
authors.lastname: Fors
authors.forename: Harold
authors.initials: H
authors.lastname: Sexton
authors.forename: K Gunnar
authors.initials: KG
authors.lastname: Götestam
mesh_terms: D000328:Adult; D000639:Amitriptyline / Q000494:pharmacology* / Q000627:therapeutic use; D018712:Analgesics, Non-Narcotic / Q000494:pharmacology* / Q000627:therapeutic use; D005260:Female; D005356:Fibromyalgia / Q000188:drug therapy* / Q000523:psychology*; D006801:Humans; D019018:Imagery, Psychotherapy; D008875:Middle Aged; D010146:Pain / Q000188:drug therapy / Q000209:etiology* / Q000523:psychology; D010919:Placebos; D016896:Treatment Outcome
chemical_list: D018712:Analgesics, Non-Narcotic; D010919:Placebos; D000639:Amitriptyline