Secondary Topic: Clinical skills-building
Tertiary Topic: Mind-body (including meditation and yoga)
Efficacy of Systolic Extinction Training (SET) in Reducing Pain and Interference in Female Fibromyalgia Patients that Respond to Stress with Elevated Blood Pressure
Kati Thieme, PhD, Umiversity of Marburg, Marburg, Germany
Late Breaker: No
An intrinsic pain regulatory system is both modulated by cardiovascular dynamics that influence baroreflex sensitivity (BRS) and diminished in Fibromyalgia (FM). Baroreceptors relay cardiovascular output to the dorsal medial nucleus tractus solitarius reflex arcs that regulate pain, sleep, anxiety, and blood pressure. This study evaluated the effects of systolic extinction training (SET) that combines operant treatment (OT) with baroreflex training (BRT). BRT delivers peripheral electrical stimulation immediately after systolic or diastolic peak of the cardiac cycle. This treatment is compared to 1) OT-TENS, transcutaneous electrical stimulation independent of cardiac cycle, and 2) aerobic training (AT)-BRT in FM patients with elevated blood pressure stress responses.
Seventy-two female FM patients were randomized to receive either SET (n=21), OT-TENS (n=20) and AT + BRT (n=21). Outcome assessments occurred before (T1), immediately after 5 weeks of treatment (T2), and 6-12-month follow-up (T3).
In contrast to OT-TENS and AT-BRT, patients receiving SET reported a significant greater reduction in pain and interference (all Ps<0.01) that were maintained at 6-12-month follow-up. Significant clinically pain reduction at T3 was reached in 82% of SET, 39% of OT-TENS and 14% of AT-BRT treated patients. After SET, compared to OT-TENS and AT-BRT, BRS increased 57% (Ps<0.01).
SET resulted in significant and long-lasting pain remission and interference compared to the OT-TENS and AT-BRT groups suggesting that BRS modification was the treatment outcome mechanism. Additional research with larger samples and other chronic pain conditions appears to be warranted to confirm and extend the results.