Efficacy of Systolic Extinction Training in Fibromyalgia Patients With Elevated Blood Pressure Response to Stress: A Tailored Randomized Controlled Trial

Thieme, Kati; Meller, Tina; Evermann, Ulrika; Malinowski, Robert; Mathys, Marc G.; Graceley, Richard H.; Maixner, William; Turk, Dennis C.

doi:10.1002/acr.23615

Cited by 7 publications

(5 citation statements)

References 43 publications

(64 reference statements)

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“…Painful and non-painful stimuli during the systolic and diastolic phases of the cardiac cycle decreases clinical pain and pain sensitivity. A preliminary study has demonstrated that the experimental protocol used as a baroreflex training, in combination with operant behavioral therapy, can activate inhibition in various components of the pain network [ 70 ]. Restoring BRS, known to be depreciated in FM, and sympatico-vagal balance seem to be linked by classical and operant conditioning.…”

Section: Discussionmentioning

confidence: 99%

Cardiac-Gated Neuromodulation Increased Baroreflex Sensitivity and Reduced Pain Sensitivity in Female Fibromyalgia Patients

Thieme

Jung²,

Mathys³

et al. 2022

JCM

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The study presents a novel approach of programing pain inhibition in chronic pain patients based on the hypothesis that pain perception is modulated by dysfunctional dorsal medial nucleus tractus solitarii (dmNTS) reflex arcs that produce diminished baroreflex sensitivity (BRS) resulting from a conditioned response. This study tested whether administration of noxious and non-noxious electrical stimuli synchronized with the cardiac cycle resets BRS, reestablishing pain inhibition. A total of 30 pain-free normotensives controls (NC) and 32 normotensives fibromyalgia (FM) patients received two, ≈8 min-epochs of cardiac-gated, peripheral electrical stimuli. Non-painful and painful electrical stimuli were synchronized to the cardiac cycle as the neuromodulation experimental protocol (EP) with two control conditions (CC1, CC2). BRS, heart-rate-variability (HRV), pain threshold and tolerance, and clinical pain intensity were assessed. Reduced BRS in FM at baseline increased by 41% during two, ≈8 min-epochs of stimulation. Thresholds in FM increased significantly during the experimental protocol (all Ps < 0.001) as did HRV. FM levels of clinical pain significantly decreased by 35.52% during the experimental protocol but not during control stimulations (p < 0.001). Baroreceptor training may reduce FM pain by BRS-mediated effects on intrinsic pain regulatory systems and autonomic responses.

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Section: Discussionmentioning

confidence: 99%

Cardiac-Gated Neuromodulation Increased Baroreflex Sensitivity and Reduced Pain Sensitivity in Female Fibromyalgia Patients

Thieme

Jung²,

Mathys³

et al. 2022

JCM

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“…A behavioural pain treatment with neuromodulator called "Systolic Extinction Training" (SET) that combines operant behavioural pain therapy (OBT) and cardiac-gated electrical baroreceptor training could reactivate baroreflex sensitivity and reprogram the brainstem in female patients with fibromyalgia. Long-term effects of 12 months after a 20hours SET showed pain freedom in 82% of the patients [12]. We hypothesize that a patient with an inflammatory rheumatic disease such as rheumatoid arthritis can also reactivate their baroreflex sensitivity and influence pain perception by the behavioural neuromodulator methods such as the SET.…”

Section: Introductionmentioning

confidence: 91%

Effects of Systolic Extinction Therapy in a Female Patient with Seropositive Rheumatoid Arthritis. A Case Report

2023

Ann Case Report

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Important components of intrinsic pain regulatory systems are modulated by cardiovascular dynamics that influence bar reflex sensitivity (BRS). Various studies have shown BRS is diminished in chronic pain patients compared to healthy controls. Our own study has shown a 62% increase in BRS after systolic extinction training (SET), a cardiac gated electrical baroreceptor training combined with operant-behaviour therapy. A case report evaluated the effects of SET in a 66-year old patient with rheumatoid arthritis (RA) comorbid with osteoarthritis (OA), fibromyalgia (FM) and hypertension. Clinical pain, BRS, blood pressure, sleep, Disease Activity Score (DAS28), and autoantibodies were assessed before, after and 12 months after the 28-hour-treatment with SET combined with 15mg MTX and 20mg cortisone. The clinical pain was reduced from 70 to 0 (VAS= 0-100) and maintained for 26 weeks. At 12-month follow-up, pain intensity on VAS = 15 for RA, 0 for OA and FM. Blood pressure was normotensive, sleep rhythm normalized, BRS increased to 70.34%, DAS28 changed from 5.26 to 3.11 (≤ 3.2). IgM, IgG Rheumatoid Factors and anti-CCP-antibody had returned to normal values. The results suggest that SET, by restoring BRS activation, is synergistic with pharmacotherapy in reducing inflammation and/or pain in RA, OA and FM.

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“…Bezüglich verschiedener psychologischer Verfahren liegen inzwischen systematische Übersichtsarbeiten von randomisierten kontrollierten Studien zu achtsamkeitsbasierter Stressreduktion [42], Biofeedback [43], Hypnotherapie [44] und kognitiven Verhaltenstherapien (live, internetbasiert) [45,46] vor. Die systematischen Übersichtsarbeiten belegen eine Wirksamkeit der Verfahren auf mehrere Kernsymptome des FMS (Schmerz.…”

Section: Stellenwert Psychotherapeutischer Verfahrenunclassified

“…Aufgrund der eingeschränkten Verfügbarkeit von ärztlichen und psychologischen Psychotherapeuten zur Behandlung chronischer Schmerzen, ist der Wirksamkeitsnachweis von internetbasierten psychologische Verfahren von Interesse [46]. Diese Behandlungen stehen in Deutschland noch nicht in der Routineversorgung zur Verfügung.…”

Section: Stellenwert Psychotherapeutischer Verfahrenunclassified

Update Fibromyalgiesyndrom

Haüser

2020

Aktuelle Rheumatologie

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ZusammenfassungIn der neuen Klassifikation der Krankheiten (ICD-11) der Weltgesundheitsorganisation wurde das FMS – ohne Absprache mit rheumatologischen Fachgesellschaften – aus dem Kapitel „Erkrankungen des muskuloskelettalen System und des Bindegewebes“ entfernt und in ein neu geschaffenes Kapitel „Chronischer Schmerz“ aufgenommen. Pathologische Befunde an den kleinen Nervenfasern bei einer Untergruppe von Patienten belegen nicht, dass das FMS eine Neuropathie der kleinen Nervenfasern ist. Die Überprüfung der sogenannten Tender Points zur Diagnose des FMS ist nicht mehr erforderlich. Es wurden mehrere neue diagnostische Kriterien entwickelt, welche zur symptombasierten Diagnose neben chronischen Schmerzen in mehreren Körperregionen nicht-erholsamen Schlaf und Müdigkeit (körperlich und / oder geistig) erfordern. Die nach klinischen Kriterien durchführbare Schweregradeinteilung (leicht, mittel, schwer) des FMS ist wichtig für eine abgestufte Versorgung. In Abhängigkeit von psychologischen Befunden stehen verschiedene evidenzbasierte psychotherapeutische Verfahren zur Verfügung, welche bei schweren Formen des FMS eingesetzt werden sollen. Ein komorbides (sekundäres) FMS ist bei entzündlich-rheumatischen Erkrankungen häufig und führen zu falsch hohen Aktvitätsscores. Cannabisbasierte Arzneimittel sind eine Therapieoption für eine Untergruppe von FMS-Patienten.

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Efficacy of Systolic Extinction Training in Fibromyalgia Patients With Elevated Blood Pressure Response to Stress: A Tailored Randomized Controlled Trial

Cited by 7 publications

References 43 publications

Cardiac-Gated Neuromodulation Increased Baroreflex Sensitivity and Reduced Pain Sensitivity in Female Fibromyalgia Patients

Cardiac-Gated Neuromodulation Increased Baroreflex Sensitivity and Reduced Pain Sensitivity in Female Fibromyalgia Patients

Effects of Systolic Extinction Therapy in a Female Patient with Seropositive Rheumatoid Arthritis. A Case Report

Update Fibromyalgiesyndrom

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