Sustained pain reduction through affective self-awareness in fibromyalgia: a randomized controlled trial.
OBJECTIVE
Affect and how it is regulated plays a role in pain perception, maintenance of pain, and its resolution. This randomized, controlled trial evaluated an innovative affective self-awareness (ASA) intervention, which was designed to reduce pain and improve functioning in individuals with fibromyalgia.


METHODS
Forty-five women with fibromyalgia were randomized to a manualized ASA intervention (n = 24) or wait-list control (n = 21). The intervention began with a one-time physician consultation, followed by 3 weekly, 2-h group sessions based upon a mind-body model of pain. Sessions focused on structured written emotional disclosure and emotional awareness exercises. Outcomes in both conditions were measured by a blinded assessor at baseline, post-intervention, and 6-month follow-up.


METHODS
The primary outcome was pain severity (Brief Pain Inventory); secondary outcomes included tender-point threshold and physical function (SF-36 Physical Component Summary). Intent-to-treat analyses compared groups on outcomes using analysis of covariance and on the proportion of patients achieving ≥ 30% and ≥ 50% pain reduction at 6 months.


RESULTS
Adjusting for baseline scores, the intervention group had significantly lower pain severity (p < 0.001), higher self-reported physical function (p < 0.001), and higher tender-point threshold (p = 0.02) at 6 months compared to the control group. From baseline to 6 months, 45.8% of the ASA intervention group had ≥ 30% reduction in pain severity, compared to none of the controls (p < 0.001).


CONCLUSIONS
The affective self-awareness intervention improved pain, tenderness, and self-reported physical function for at least 6 months in women with fibromyalgia compared to wait-list control. This study suggests the value of interventions targeting emotional processes in fibromyalgia, although further studies should evaluate the efficacy of this intervention relative to active controls.
Hsu
Michael C
MC
Department of Physical Medicine & Rehabilitation, Kaiser-Permanente Northwest, Portland, OR, USA.
Schubiner
Howard
H
Lumley
Mark A
MA
Stracks
John S
JS
Clauw
Daniel J
DJ
Williams
David A
DA
D000328:Adult; D000339:Affect; D000368:Aged; D000698:Analgesia / Q000379:methods / Q000523:psychology; D005260:Female; D005356:Fibromyalgia / Q000150:complications / Q000523:psychology* / Q000628:therapy*; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D026441:Mind-Body Therapies / Q000379:methods / Q000523:psychology*; D010146:Pain / Q000209:etiology / Q000523:psychology*; D059408:Pain Management; D012649:Self Concept; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome