Poor Mental Health in Patients with Fibromyalgia is Associated with Brain Systems
By John M. de Castro, Ph.D.
“practicing mindfulness techniques may be a low-cost, side effect free option for people wishing to reduce the severity of their fibromyalgia.” – Kim Jones
Fibromyalgia is a mysterious disorder whose causes are unknown. It is very common affecting over 5 million people in the U.S., about 2% of the population with about 7 times more women affected than men. It is characterized by widespread pain, abnormal pain processing, sleep disturbance, and fatigue that lead to psychological distress. Fibromyalgia may also have morning stiffness, tingling or numbness in hands and feet, headaches, including migraines, irritable bowel syndrome, sleep disturbances, thinking and memory problems, and painful menstrual periods. The symptoms are so severe and debilitating that about half the patients are unable to perform routine daily functions and about a third have to stop work. Although it is not itself fatal, suicide rates are higher in fibromyalgia sufferers. Clearly, fibromyalgia greatly reduces the quality of life of its’ sufferers.
There are no completely effective treatments for fibromyalgia. Symptoms are generally treated with pain relievers, antidepressant drugs and exercise. But these only reduce the severity of the symptoms and do not treat the disease directly. Mindfulness practices have also been shown to be effective in reducing pain from fibromyalgia. Some of the effects of mindfulness practices are to alter thought processes, changing what is thought about. In terms of pain, mindfulness training, by focusing attention on the present moment has been shown to reduce worry and catastrophizing. Pain is increased by worry about the pain and the expectation of greater pain in the future. Brain systems are involved in pain processing. It is not known, however, what brain systems may be involved in the psychological effects of fibromyalgia.
In today’s Research News article “The Bed Nucleus of the Stria Terminalis as a Brain Correlate of Psychological Inflexibility in Fibromyalgia.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7074535/ ) Feliu-Soler and colleagues recruited adult women who were diagnosed with fibromyalgia and assigned them to either treatment as usual or to receive and 8-week program of Mindfulness-Based Stress Reduction (MBSR). They were measured before and after the program for psychological inflexibility in pain, functional impairment, anxiety, depression, perceived stress, pain catastrophizing, mindfulness, and self-compassion. They also underwent measurements of the gray matter volume in the brain with Magnetic Resonance Imaging (MRI).
They found that the higher the levels of psychological inflexibility in pain, the higher the gray matter volume of the bed nucleus of the stria terminalis (BNST). Further they found that the higher the gray matter volume of the BNST the higher the levels of functional impairment, anxiety, depression, perceived stress, and pain catastrophizing and the lower the levels of mindfulness and self-compassion. The Mindfulness-Based Stress Reduction (MBSR) program did not significantly alter the BNST volume or psychological inflexibility in pain.
These results are correlative and as such caution must be exercised in causal inferences. It was disappointing that mindfulness training did not produce a change in either psychological inflexibility or BNST volume. But the results are clear that the gray matter volume of the bed nucleus of the stria terminalis (BNST) is associated with poor mental health in patients with fibromyalgia. This brain structure is associated with physiological and psychological responses to stress. Since, the constant pain associated with fibromyalgia is very stressful it is not surprising that enlargement of the BNST would be associated with poor mental health in these patients.
So, poor mental health in patients with fibromyalgia is associated with brain systems.
“being overly observant of symptoms or trying to avoid pain can actually contribute towards the development of fibromyalgia and worsen the existing symptoms. Mindfulness practice can actually change the way you relate to your pain, . . the mindfulness group showed less avoidant and hypervigilance behaviour, supporting the idea that mindfulness encourages a non-judgemental and accepting relationship with pain, rather than trying to push it away.” – Vidyamala Burch
CMCS – Center for Mindfulness and Contemplative Studies
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Study Summary
Feliu-Soler, A., Martínez-Zalacaín, I., Pérez-Aranda, A., Borràs, X., Andrés-Rodríguez, L., Sanabria-Mazo, J. P., Fayed, N., Stephan-Otto, C., Núñez, C., Soriano-Mas, C., & Luciano, J. V. (2020). The Bed Nucleus of the Stria Terminalis as a Brain Correlate of Psychological Inflexibility in Fibromyalgia. Journal of clinical medicine, 9(2), 374. https://doi.org/10.3390/jcm9020374
Abstract
This study explored the brain structural correlates of psychological flexibility (PF) as measured with the Psychological Inflexibility in Pain Scale (PIPS) in patients with fibromyalgia (FM). Structural magnetic resonance imaging data from 47 FM patients were used to identify Gray Matter Volume (GMV) alterations related to PIPS scores. Brain GMV clusters related to PIPS were then correlated with clinical and cognitive variables to further explore how emerged brain clusters were intertwined with FM symptomatology. Longitudinal changes in PIPS-related brain clusters values were assessed by studying pre–post data from 30 patients (15 allocated to a mindfulness-based stress reduction (MBSR) program and 15 to treatment-as-usual). Changes in PIPS-related brain clusters were also explored in participants showing greater/lower longitudinal changes in PIPS scores. PIPS scores were positively associated with GMV in a bilateral cluster in the ventral part of the bed nucleus of the stria terminalis (BNST). Significant associations between BNST cluster with functional impairment, depressive symptomatology, perceived stress and the nonjudging mindfulness facet were observed. Participants reporting greater pre–post increases in PIPS scores showed greater increases in BNST cluster values. These findings contribute to the understanding on the neurobiological bases of PF in FM and encourage further explorations of the role of the BNST in chronic pain.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7074535/