Mindfulness-Based Program Plus Amygdala and Insula Retraining (MAIR) for the Treatment of Women with Fibromyalgia: A Pilot Randomized Controlled Trial

Abstract

The lack of highly effective treatments for fibromyalgia (FM) represents a great challenge for public health. The objective of this parallel, pilot randomized controlled trial (RCT) was two-fold: (1) to analyze the clinical effects of mindfulness plus amygdala and insula retraining (MAIR) compared to a structurally equivalent active control group of relaxation therapy (RT) in the treatment of FM; and (2) to evaluate its impact on immune-inflammatory markers and brain-derived neurotrophic factor (BDNF) in serum. A total of 41 FM patients were randomized into two study arms: MAIR (intervention group) and RT (active control group), both as add-ons of treatment as usual. MAIR demonstrated significantly greater reductions in functional impairment, anxiety, and depression, as well as higher improvements in mindfulness, and self-compassion at post-treatment and follow-up, with moderate to large effect sizes. Significant decreases in pain catastrophizing and psychological inflexibility and improvements in clinical severity and health-related quality of life were found at follow-up, but not at post-treatment, showing large effect sizes. The number needed to treat was three based on the criteria of ≥50% Fibromyalgia Impact Questionnaire (FIQ) reduction post-treatment. Compared to RT, the MAIR showed significant decreases in BDNF. No effect of MAIR was observed in immune-inflammatory biomarkers (i.e., TNF-α, IL-6, IL-10, and hs-CRP). In conclusion, these results suggest that MAIR, as an adjuvant of treatment-as-usual (TAU), appears to be effective for the management of FM symptoms and for reducing BDNF levels in serum.

Research in Mindfulness Interventions for Patients With Fibromyalgia: A Critical Review

“…The investigation of the mechanisms of fibromyalgia is expected to provide important results in the next years. In fact, as to the neurobiological mechanisms referred in the Introduction, namely the immune-inflammatory connection, recent studies indicated that MBSR has regulatory effects of the immune response since it partially corrected the imbalance in the ration of pro- and anti-inflammatory cytokines, along with Brain-Derived Neurotrophic Factor (BDNF) ( Andres-Rodriguez et al, 2019 ; Sanabria-Mazo et al, 2020 ). As to the “brain hypothesis,” and considering that impaired endogenous pain modulation was detected by imaging studies in fibromyalgia patients ( Staud, 2011 ), an interesting study showed that the regional cerebral blood flow is altered in patients with fibromyalgia subjected to mindfulness interventions ( Medina et al, 2022 ).…”

Tratamientos coadyuvantes y su impacto en la flexibilidad cognitiva de adultos con psicopatología diversa: una revisión sistemática exploratoria

“…Los participantes tuvieron cambios significativos y positivos en los resultados del Cuestionario de Aceptación y Acción II, el cual emplearon para medir la FC (p ≤ 0.001). 27 Asimismo, Greenberg y su equipo de trabajo ofrecieron 14 sesiones de atención plena a 32 adultos (aproximadamente tres horas semanales). Aquellos que llevaron a cabo la intervención tuvieron un mejor desempeño en la prueba de la jarra de agua de Einstellung (p ≤ 0.02).…”

Review of Fibromyalgia (FM) Syndrome Treatments

“…Although the pathogenesis of FM is unknown, imaging has shown that alterations in central sensitization, involving an imbalance of brain-derived neurotrophic factor (BDNF) and inflammatory biomarkers, appear to be implicated [36,37]. Montero-Marin et al [36] sought to assess the impact of attachment-based compassion therapy (ABCT) on BDNF levels and the levels of inflammatory markers, namely, TNF-α, IL-6, IL-10, and the Creactive protein (CRP).…”