Fibromyalgia affects 10 million or more Americans ages 18 and older and an estimated 3-6 percent of the world population. A complex, long-term pain condition, fibromyalgia takes a powerful toll on health, well-being and quality of life, affecting sleep, social activities, thinking and memory. Of those who face the challenges of fibromyalgia, 75-90 percent are women.
Although recent research suggests a possible genetic component, fibromyalgia has no known cause or cure. The condition often occurs following a physical trauma, such as an acute illness or injury, which may act as a "trigger" in the development of the disorder. Without a cure, treatment focuses on addressing and managing symptoms with prescription medications and alternative therapies.
Cognitive behavioral therapy (CBT), initially used in the treatment of mood disorders, has subsequently been expanded to include various other medical conditions, including chronic pain states. Over the past 18 years, several chronic pain treatment programs have used CBT techniques in the management of fibromyalgia.
But a new treatment called emotional awareness and expression therapy (EAET) may provide more relief than CBT, according to a new study.
An alternative to opioids for the treatment of chronic pain, CBT helps patients change the way they think about and manage their pain by helping them to understand that pain is a stressor to which they can adapt and cope. Studies suggest that CBT has a "top-down" effect on pain control and perception of painful stimuli. CBT can also normalize reductions in the brain's gray matter volume, which are thought to result from the effects of chronic stress.
A novel psychological therapy, called emotional awareness and expression therapy (EAET) encourages patients to view their pain and other symptoms as stemming from changeable neural pathways in the brain that are strongly influenced by emotions. This therapy empowers people be more honest and direct in relationships that have been conflicted or problematic by expressing important feelings such as anger, sadness, gratitude, compassion and forgiveness
Mark A. Lumley, Ph.D., professor of psychology at the College of Liberal Arts and Sciences at Wayne State University, in collaboration with a team from the University of Michigan Medical Center, conducted a randomized clinical trial to assess the new therapy compared with education and the gold-standard treatment CBT.
In the study, 230 adults with fibromyalgia formed 40 treatment groups, which were randomized to EAET, CBT or education and given eight 90-minute sessions. Patient-reported outcomes were assessed at baseline, post treatment and six-month follow-up (primary endpoint). Retention of patients to follow up was excellent (90 percent).
Intent-to-treat analyses indicated that although EAET did not differ from education on pain severity (primary outcome), EAET had significantly better outcomes than education on overall symptoms, widespread pain, physical functioning, cognitive dysfunction, anxiety, depression, positive affect and life satisfaction. The percentage of patients reporting being "very much/much" improved was 35 percent with EAET vs. 15 percent with education.
Emotional awareness and expression therapy did not differ from CBT on the primary or most secondary outcomes, but EAET led to significantly lower fibromyalgia symptoms and widespread pain and a higher percentage of patients achieving 50 percent pain reduction compared to CBT (22 percent vs. 8 percent).
This is an important study, according to Lumley, because many people with fibromyalgia have experienced adversity, family problems and internal conflicts that are often suppressed or avoided — emotions that can contribute to pain and other physical symptoms. In this study, not all those with fibromyalgia had relief with EAET, but many found it helpful by helping them reduce their symptoms rather than just manage them.
