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Morris L.1, Louw Q.1, Grimmer K.2, Meinjies E.3
1Stellenbosch University, Physiotherapy, Cape Town, South Africa, 2University of Adelaide, Adelaide, Australia, 3University of Cape Town, Cape Town, South Africa
Background: Pain catastrophizing is a key predictor of poor compliance in patients with fibromyalgia syndrome (FMS). The alteration of pain catastrophizing to improve compliance towards exercises in patients with FMS is therefore warranted.
Purpose: This study aimed to provide proof-of-concept for the further development and testing of a novel virtual reality exposure therapy (VRET) program as treatment for exercise-related pain catastrophizing in patients with FMS.
Methods: An exploratory, case-controlled study was conducted. Two study groups were included: a FMS subject group and a matched-control group. Functional magnetic resonance imaging (fMRI) was used to acquire neural correlates from both study groups. The fMRI task consisted of two stimuli: active (exercise activity visuals)/passive (relaxing visuals). Structural images and blood-oxygenation-level-dependent (BOLD) contrasts were acquired for the conditions and compared within-subjects/groups and between-groups. The condition of interest was the active>passive condition. Brain volumes collected during on conditions were compared with the off conditions using Students t-test. Statistic images were thresholded using clusters determined by Z>2.3 and a (corrected) cluster significance threshold of p=0.05.
Results: Thirteen FMS subjects and nine healthy matched controls were included in this study. The right (R) inferior-frontal gyrus, R middle-frontal gyrus, R posterior-cerebellum, left (L) thalamus and L supramarginal gyrus were significantly activated for the FMS subjects (p 0.000), and not the healthy control group, during the active>passive condition.
Conclusion(s): The findings of this research significantly add to the current body of knowledge regarding the possibility of objectively identifying cognitive behavioural strategies like pain catastrophization often observed among chronic pain patients. The results of this study suggests that exposing patients with FMS visuals of healthy exercise activities elicits neurophysiological changes in functional brain areas associated with pain catastrophization. Further research is however warranted to support the use of an intervention like VRET for pain catastrophization in patients with FMS.
Implications: The development of such a program may finally provide physiotherapists with a tool to address issues such as poor patient compliance in clinical practice, which often hinders the successful management of FMS and other chronic conditions. Physiotherapists will not only be involved in prescribing exercise therapy in the management of FMS, but could also become more involved in changing existing negative thoughts (i.e. catastrophizing thoughts) that the patient may have towards exercises, possibly increasing compliance towards exercise programs among FMS sufferers.
Funding acknowledgements: Funders: National Research Foundation, the Medical Research Council, the Harry Crossley Foundation, and the Stellenbosch University.
Topic: Pain & pain management
Ethics approval: Ethics obtained: Health Research Ethics Committee of the Stellenbosch University, South Africa during July 2010.
All authors, affiliations and abstracts have been published as submitted.
