title: Cognitive-behavioral therapy attenuates nociceptive responding in patients with fibromyalgia: a pilot study.
abstract: OBJECTIVE
  To explore the possibility that cognitive-behavioral therapy (CBT) influences fibromyalgia symptoms via descending inhibition of nociception, we evaluated the effects of CBT on the nociceptive flexion reflex (NFR) threshold, an objective measure of spinal nociceptive transmission.
  
  
  METHODS
  Female fibromyalgia patients (n = 32) were randomized to 6 weekly sessions of telephone-delivered CBT or usual care (UC). Assessments of the NFR threshold and clinical outcomes were conducted at baseline, week 6 (post-CBT), and week 12.
  
  
  RESULTS
  From baseline to week 6, the NFR threshold increased in the CBT group and decreased in the UC group (mean +/- SD 4.4 +/- 13.7 mA versus -10.2 +/- 9.9 mA; P = 0.005). This difference was also apparent at week 12 (mean +/- SD 7.3 +/- 9.2 mA for CBT versus -5.4 +/- 13.5 mA for UC; P = 0.01). The groups reported similar reductions in NFR pain ratings at week 6 (mean +/- SD -20.2 +/- 23.9 for CBT versus -14.9 +/- 16.4 for UC; P = 0.8) and week 12 (mean +/- SD -8.9 +/- 25.3 for CBT versus -10.8 +/- 24.1 for UC; P = 0.4).
  
  
  CONCLUSIONS
  Compared with UC, CBT reduced nociceptive responding in fibromyalgia patients. Moreover, while the UC group exhibited longitudinal decreases in both the stimulation level and pain associated with the NFR threshold, those receiving CBT required more intense stimulation to elicit the NFR as well as rated that stimulation as less painful than at baseline. These data indicate the need for a larger study to confirm that changes in nociceptive responsivity may underlie the benefits of CBT in fibromyalgia patients.
authors.affiliation: Indiana University, Indianapolis, USA. dang@iupui.edu
authors.forename: Dennis C
authors.initials: DC
authors.lastname: Ang
authors.forename: Rafael
authors.initials: R
authors.lastname: Chakr
authors.forename: Steve
authors.initials: S
authors.lastname: Mazzuca
authors.forename: Christopher R
authors.initials: CR
authors.lastname: France
authors.forename: Jennifer
authors.initials: J
authors.lastname: Steiner
authors.forename: Timothy
authors.initials: T
authors.lastname: Stump
mesh_terms: D000328:Adult; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D005260:Female; D005356:Fibromyalgia / Q000150:complications / Q000523:psychology* / Q000628:therapy; D006801:Humans; D008875:Middle Aged; D010146:Pain / Q000150:complications / Q000523:psychology; D059408:Pain Management; D010147:Pain Measurement; D017288:Pain Threshold / Q000523:psychology*; D010865:Pilot Projects; D018709:Statistics, Nonparametric; D016896:Treatment Outcome