Fibromyalgia Pain: New Insights, New Hope
Which type of physical activity best relieves symptoms? What underlies the hypersensitivity of fibromyalgia? Recent studies offer answers.
References1. Wang C, Schmid CH, Fielding RA, et al. Effect of tai chi versus aerobic exercise for fibromyalgia: comparative effectiveness randomized controlled trial. BMJ. 2018;360:k851. doi: 10.1136/bmj.k851.2. Lee U, Kim M, Lee K, et al. Functional brain network mechanism of hypersensitivity in chronic pain. Sci Rep. 2018;8:243. doi:10.1038/s41598-017-18657-4.3. Scioli-Salter ER, Smith BN, McSheffrey S, et al. Self-efficacy for adoption and maintenance of exercise among fibromyalgia patients: a pilot study. Am J Lifestyle Med. Published online December 12, 2017. doi.org/10.1177/1559827617745264.
Fibromyalgia causes widespread pain that may also lead to extreme fatigue, muscle stiffness, difficulty in sleeping, and depression. New research shows the potential for improved treatments of fibromyalgia pain. Studies compared tai chi versus aerobic exercise for symptom management; examined the role of hyper-reactive brain networks in the hypersensitivity of fibromyalgia; and identified a strong relationship between self-efficacy and exercise.1-3
Scroll through the slides for details of the studies and take-home messages.
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A prospective, randomized, 52-week, single-blind comparative effectiveness trial included 226 adults with fibromyalgia (average age, 52 years) with an average duration of body pain of 9 years.1 Participants were randomly assigned to either supervised aerobic exercise (24 weeks, twice weekly) or one of four classic Yang style supervised tai chi interventions (12 or 24 weeks, once or twice weekly).
The combined tai chi groups improved statistically significantly more than the aerobic exercise group in revised fibromyalgia impact questionnaire scores at 24 weeks, compared with baseline.
Tai chi also showed greater benefit when compared with aerobic exercise of the same intensity and duration (twice weekly for 24 weeks). Those who practiced tai chi for 24 weeks showed greater improvements than those who practiced for 12 weeks; there was no significant increase in benefit for twice-weekly tai chi compared with once-weekly.
“Tai chi mind-body treatment results in similar or greater improvement in symptoms than aerobic exercise, the current most commonly prescribed non-drug treatment, for a variety of outcomes for patients with fibromyalgia. This mind-body approach may be considered a therapeutic option in the multidisciplinary management of fibromyalgia,” stated the researchers, led by Chenchen Wang, professor of medicine at Tufts University School of Medicine in Boston.
Data from electroencephalograms (EEGs) of recorded electrical activity in the brains of 10 female patients with fibromyalgia showed hypersensitive, unstable brain networks.2 There was a strong correlation between the degree of explosive synchronization conditions and self-reported intensity of chronic pain reported by the patients at the time of EEG testing.
A computer model of brain activity compared stimulus responses of patients with fibromyalgia to the normal condition. The brains of those with chronic pain again showed signs of unstable electrical activity.
“For the first time, this research shows that the hypersensitivity experienced by chronic pain patients may result from hypersensitive brain networks. The subjects had conditions similar to other networks that undergo explosive synchronization,” said co-senior author Richard Harris, PhD, associate professor of anesthesiology at Michigan Medicine with the Chronic Pain and Fatigue Research Center.
Computer modeling could help guide future treatments for fibromyalgia, transforming a hypersensitive network into a more stable one, the researchers stated.
A group of 19 women veterans with fibromyalgia completed an anonymous Internet survey that measured fibromyalgia impact, adoption of exercise behavior, and self-efficacy for exercise.3 Women who exercised regularly reported higher fibromyalgia symptoms, but strong effects sizes were found for higher self-efficacy for exercise as well, which suggests that women with more symptoms may have stronger motivation to exercise regularly.
“Exercise programs must be tailored to the individual and progressively advanced as the patient becomes better conditioned to mitigate the potential exacerbation of fibromyalgia symptoms,” said lead author Erica R. Scioli-Salter, PhD, clinical research psychologist at the VA Boston Healthcare System and assistant professor of psychiatry at Boston University School of Medicine. “We may be able to provide an effective, non-pharmacological approach to fibromyalgia patients that can better manage their illness and improve their overall quality of life and functioning.”
