MedicalResearch.com Interview with:
Mark A. Lumley, Ph.D.
Distinguished Professor and Director of Clinical Psychology Training
Department of Psychology
Wayne State University
Detroit, Michigan 48202 and
Howard Schubiner, M.D
Founder and Director Mind-Body Medicine Center
Providence-Providence Park Hospitak
Warren, MI 48092
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Fibromyalgia is a condition that afflicts many people with chronic pain and other symptoms, which are often severe. There is no clear evidence of tissue damage or other peripheral causes of the symptoms, and experts agree that the pain is real, and its primary source is the brain. Medications for fibromyalgia have limited effectiveness, so psychological and behavioral therapies are core to treatment.
Research documents a strong relationship between emotions and pain, and many patients with FM struggle with negative emotions related to difficult life circumstances, such as trauma, abuse, or relationship conflicts. Ironically, most psychological therapies for FM do not address these problems, but rather teach people how to manage their symptoms. Emerging research, however, demonstrates that therapies that help patients engage rather than avoid their difficult emotional experiences improve both psychological and physical symptoms, including pain. Therefore, we developed an emotion-focused therapy, which we call Emotional Awareness and Expression Therapy (EAET), and compared it to both an active education-based control condition and to the leading psychological intervention for fibromyalgia, cognitive-behavior therapy (CBT).
The EAET condition was substantially better on multiple outcomes that the control condition 6 months after treatment. Importantly, although EAET did not differ from CBT on many outcomes, EAET was superior than CBT on reducing widespread and in the percentage of individuals achieving substantial pain reduction (that is, at least 50% pain reduction from baseline).
MedicalResearch.com: What should readers take away from your report?
Response: This is the first large-scale study to show that directly addressing the emotionally difficult issues in patients’ lives improves their fibromyalgia symptoms beyond providing an active control condition. Moreover, this is the first study to show superiority of one psychological intervention for fibromyalgia pain over another legitimate psychological intervention, in this case, the leading intervention in the field. Difficulty life experiences drive emotional struggles, and experiencing and expressing such emotions can be effective.
MedicalResearch.com: What recommendations do you have for future research as a result of this study?
Response: We hope to study other pain conditions, such as chronic back pain and headaches, to see if they will also respond to this emotion-focused approach. In addition, we have started a study using fMRI of the brain to see if a similar treatment approach actually changes the brain pathways involved in pain.
MedicalResearch.com: Is there anything else you would like to add?
Response: There are many other painful disorders, like fibromyalgia, for which there is no evidence of tissue damage. These include tension and migraine headaches, irritable bowel and pelvic syndromes, and various neck and back pain conditions. Neuroscience research is now demonstrating that much chronic pain is constructed by the brain as a warning and protective mechanism. Emotional experiences have been found to activate the same brain mechanisms as do physical injury, thus suggesting a mechanism by which emotional experiences can cause physical pain. Individuals who have early life adversity are more likely to have chronic pain as adults, which suggests that the brain’s alarm mechanism is sensitized in childhood and then can be triggered later in life by stressful life events. Many people with fibromyalgia and these other painful conditions have experienced adverse childhood events and other emotional difficulties, and we have an approach to address these problems.
MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.
Pain. 2017 Aug 8. doi: 10.1097/j.pain.0000000000001036. [Epub ahead of print]
Lumley MA1, Schubiner H, Lockhart NA, Kidwell KM, Harte SE, Clauw DJ, Williams DA.
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