Abstract
Fibromyalgia (FM) is a disabling syndrome characterized by chronic pain associated with fatigue. Its pathogenesis is unknown, but alterations in central sensitization, involving an imbalance of brain-derived neurotrophic factor (BDNF) and inflammatory biomarkers, appear to be implicated. The aim of this study was to evaluate the impact of attachment-based compassion therapy (ABCT) on levels of BDNF, the inflammatory markers TNF-α, IL-6, IL-10, and the C-reactive protein (CRP), analysing whether biomarkers play a mediating/moderating role in improvements in FM functional status. Thirty-four female patients with FM participated in a RCT and were assigned to ABCT or relaxation therapy. Blood extractions were conducted at baseline and post-intervention, with self-report assessments of functional status (FIQ) at baseline, post-intervention and 3-month follow-up. A pro-inflammatory composite was obtained by summing up IL-6, TNF-α and CRP normalized values. Non-parametric tests, analysis of variance and regression models were used to evaluate treatment and mediation/moderation. Compared to relaxation therapy, ABCT showed significant improvements in FIQ and decreases in BDNF, CRP, and pro-inflammatory composite. Changes in BDNF had a mediating role in FIQ. ABCT seems to reduce BDNF and appears to have anti-inflammatory effects in FM patients. Reductions in BDNF could be a mechanism of FM functional status improvement.Clinical Trial Registration:http://ClinicalTrials.gov, identifier NCT02454244. Date: May 27th, 2015.
Highlights
Fibromyalgia (FM) is a debilitating rheumatic chronic pain syndrome of unknown and complex aetiology, which includes symptoms such as widespread pain, fatigue, disturbed sleep, cognitive difficulties, psychological distress and associated affective disorders[1,2,3]
Montero-Marin et al.[26] recently found that a new third-wave psychological treatment, attachment-based compassion therapy (ABCT) ‒ which is composed of a regimen of 8 sessions of 2 hours of mindfulness and compassion practices ‒ administered as coadjutant treatment along with standard of care, improved in a significant and clinically relevant way the general health status of patients with FM compared to a suitable active control group of relaxation therapy
The main aim of the present exploratory study was to extend previous clinical findings reported by Montero-Marin et al.[26] by analysing the possible influence of ABCT on the levels of brain-derived neurotrophic factor (BDNF) and C-reactive protein (CRP) and on the levels of IL-6, TNF-α and IL-10 cytokines in patients suffering from FM
Summary
Fibromyalgia (FM) is a debilitating rheumatic chronic pain syndrome of unknown and complex aetiology, which includes symptoms such as widespread pain, fatigue, disturbed sleep, cognitive difficulties, psychological distress and associated affective disorders[1,2,3]. In www.nature.com/scientificreports this sense, FM has been related to a variety of physical and/or psychological stressors, which may contribute to a chronic pro-inflammatory state (both in the CNS and in peripheral tissues), which in turn could exert effects in central processing of pain[8]. These possible altered pain pathways might involve low-grade baseline chronic neuro-inflammation processes, with stress peptides triggering the release of neurosensitizing mediators[9]. Our general exploratory hypotheses where that: a) ABCT would result in significantly greater decreases in the BDNF and pro-inflammatory markers as well as significantly greater increases in the anti-inflammatory markers compared with the relaxation condition; and b) BDNF and (pro- and anti-) inflammatory biomarkers would play a significant mediating and moderating role on clinical improvements in the FM functional status
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