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.
Department of Physical Medicine & Rehabilitation, Kaiser-Permanente Northwest, Portland, OR, USA.
Michael C
MC
Hsu
Howard
H
Schubiner
Mark A
MA
Lumley
John S
JS
Stracks
Daniel J
DJ
Clauw
David A
DA
Williams
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