title: Virtual reality exposure therapy as treatment for pain catastrophizing in fibromyalgia patients: proof-of-concept study (Study Protocol).
abstract: BACKGROUND
  Albeit exercise is currently advocated as one of the most effective management strategies for fibromyalgia syndrome (FMS); the implementation of exercise as a FMS treatment in reality is significantly hampered by patients' poor compliance. The inference that pain catastrophizing is a key predictor of poor compliance in FMS patients, justifies considering the alteration of pain catastrophizing in improving compliance towards exercises in FMS patients. The aim of this study is to provide proof-of-concept for the development and testing of a novel virtual reality exposure therapy (VRET) program as treatment for exercise-related pain catastrophizing in FMS patients.
  
  
  METHODS
  Two interlinked experimental studies will be conducted. Study 1 aims to objectively ascertain if neurophysiological changes occur in the functional brain areas associated with pain catastrophizing, when catastrophizing FMS subjects are exposed to visuals of exercise activities. Study 2 aims to ascertain the preliminary efficacy and feasibility of exposure to visuals of exercise activities as a treatment for exercise-related pain catastrophizing in FMS subjects. Twenty subjects will be selected from a group of FMS patients attending the Tygerberg Hospital in Cape Town, South Africa and randomly allocated to either the VRET (intervention) group or waiting list (control) group. Baseline neurophysiological activity for subjects will be collected in study 1 using functional magnetic resonance imaging (fMRI). In study 2, clinical improvement in pain catastrophizing will be measured using fMRI (objective) and the pain catastrophizing scale (subjective).
  
  
  CONCLUSIONS
  The premise is if exposing FMS patients to visuals of various exercise activities trigger the functional brain areas associated with pain catastrophizing; then as a treatment, repeated exposure to visuals of the exercise activities using a VRET program could possibly decrease exercise-related pain catastrophizing in FMS patients. Proof-of-concept will either be established or negated. The results of this project are envisaged to revolutionize FMS and pain catastrophizing research and in the future, assist health professionals and FMS patients in reducing despondency regarding FMS management.
  
  
  BACKGROUND
  PACTR201011000264179.
authors.affiliation: Division of Physiotherapy, Faculty of Health Sciences, Stellenbosch University, Tygerberg, 7505, South Africa. ldmorris@sun.ac.za
authors.forename: Linzette D
authors.initials: LD
authors.lastname: Morris
authors.forename: Karen A
authors.initials: KA
authors.lastname: Grimmer-Somers
authors.forename: Bruce
authors.initials: B
authors.lastname: Spottiswoode
authors.forename: Quinette A
authors.initials: QA
authors.lastname: Louw
mesh_terms: D001921:Brain / Q000503:physiopathology*; D058443:Catastrophization / Q000209:etiology / Q000503:physiopathology / Q000523:psychology / Q000628:therapy*; D005081:Exercise Therapy / Q000523:psychology*; D005356:Fibromyalgia / Q000150:complications / Q000503:physiopathology / Q000523:psychology / Q000628:therapy*; D006801:Humans; D007171:Implosive Therapy; D008279:Magnetic Resonance Imaging; D009483:Neuropsychological Tests; D010146:Pain / Q000209:etiology / Q000503:physiopathology / Q000523:psychology; D059408:Pain Management; D010147:Pain Measurement; D010349:Patient Compliance; D010775:Photic Stimulation; D012107:Research Design; D013019:South Africa; D016896:Treatment Outcome; D014584:User-Computer Interface